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De what is it?
The human ear has two functions: hearing and balance.
Hearing is provided by the outer ear (the pinna and the auditory canal), the middle ear (the eardrum and the ossicles) and the inner ear (the cochlea and the auditory nerve).
Balance is regulated by a balance organ (the posterior labyrinth or vestibule) located in the inner ear. The labyrinth consists of 3 semicircular canals and two pocket-shaped bulges containing the otoliths. The canals are filled with a viscous liquid (endolymph) which registers the rotational movements. The pocket-shaped bulges register acceleration and deceleration.
Benign paroxysmal positional vertigo (BPPV) is the most common cause of dizzy spells (dizziness). It is a benign condition. Dizziness is caused by small bits of otoliths breaking off and moving to the semicircular canals, causing dizziness with rotating movements of the head. In the majority of cases, it is the posterior semicircular canal that is involved.
The prognosis is good: symptoms usually go away on their own after 4 weeks.
In whom and how often does it occur?
Each year, about 5 in 100 people experience dizziness. About 1 in 4 times, this vertigo is benign paroxysmal positional vertigo (BPPV). It mainly occurs in middle-aged people and the elderly, but also in young people, usually after a head injury.
How to recognize it?
You suddenly feel like you’re dizzy or the room is spinning around you. Usually, vertigo starts when you turn your head or change your posture. Dizziness is often accompanied by nausea and vomiting.
How is the diagnosis made?
The doctor makes the diagnosis on the basis of the characteristic symptoms, and confirms it using the Dix-Hallpike test. In this test, it turns your head slightly and helps you move quickly from sitting to lying down. After a few seconds, if your eyes are making characteristic, jerky movements (nystagmus), and you feel dizzy, you are having benign paroxysmal positional vertigo (BPPV). Sometimes additional tests are needed to rule out other causes of vertigo.
What can you do ?
Continue your usual activities as much as possible. Usually the condition goes away on its own within 4 weeks.
Be careful if you work in hazardous conditions, such as working at heights on a ladder or on a roof. Turning your head while driving can also be risky behavior.
There are exercises that make dizziness go away faster that you can do at home (Brandt-Daroff exercises). Sit on the edge of the bed (center), and lie on your side. Once in bed, turn your head to look at the ceiling. Get up when the dizziness has passed. Lie on the other side and turn your head to look at the ceiling. Repeat this until the vertigo subsides. Do these exercises 3-5 times a day. These exercises cause dizziness, which makes it difficult at first to continue until the end.
What can your doctor do?
The doctor will first wait to see if the vertigo goes away on its own. Medications often do more harm than good.
There are various maneuvers (repositioning interventions) to move the tips of otoliths detached from the semicircular canal to the pocket-shaped bulges. However, these maneuvers take some time and are only carried out by a doctor or physiotherapist with sufficient experience in the matter.
If there is no improvement, surgery may be necessary. During the operation, the vestibular nerve on the affected side is cut.
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