Benign Paroxysmal Positional Vertigo (BPPV) – Strategies for Prevention-by Harold Gunatillake
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Over the past week, I received calls from three colleagues who were dealing with BPPV. They visited their doctors and went home with prescriptions to help them recover.
They weren’t happy with the pills and were seeking my advice on how I could help them trust me.
Benign Paroxysmal Positional Vertigo (BPPV) is a frequently diagnosed condition among patients presenting with vertigo or dizziness in Sri Lanka, often identified as the leading cause of such symptoms in clinical settings.
Key findings from studies on BPPV in the Sri Lankan population include:
The prevalence of BPPV among patients presenting with dizziness was examined in a cross-sectional descriptive study conducted between 2016 and 2017 at the ENT clinic of the Teaching Hospital, Anuradhapura. The study revealed that BPPV was the most prevalent cause of vertigo, accounting for 36.5% (229 cases) of the 627 patients reviewed.
The most common symptoms you could get, mainly as soon as you get up from sleep, are: Sudden, intense vertigo, Dizziness or spinning sensation, Loss of balance, Nausea and vomiting (sometimes)
Symptoms often triggered by specific head movements e.g., rolling over, looking up, or suddenly getting out of bed.
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As the diagram indicates, there is a small sac known as the saccule situated between the utricle and the cochlear canal. This saccule contains calcium particles that help maintain balance during everyday activities.
As individuals age, BPPV occurs when minute calcium carbonate crystals, known as otoconia or “ear stones,” are dislodged from their typical location in the utricle or saccule of the inner ear.
There are various methods for repositioning these particles; let us explore them further.
Upon awakening in the morning, sudden head movements may induce an episode of BPPV. So, gradually rise with your eyes closed, then sit on the edge of the bed for a few seconds before standing upright. This procedure may prove beneficial in many situations.
If this fails, you need to buy an electric reclining chair, which costs you less than AUS $2,000.
The benefit of the reclining chair is that, upon waking in the morning, one needs only press the button to sit upright vertically without any neck movement.
This approach is efficacious and may obviate the need for medication that could cause adverse effects.
The author has recommended this method to over 50 Sri Lankan patients, and it has been effective for all without the use of medication.
Medications prescribed by physicians for Benign Paroxysmal Positional Vertigo (BPPV) are predominantly employed to address immediate symptoms such as nausea and dizziness (vestibular suppressants), rather than to eradicate the underlying condition, as prolonged use may impede recovery.
The preferred medications for the treatment of BPPV include benzodiazepines, antihistamines, and anticholinergic agents, particularly when the patient’s history and physical examination findings are indicative of BPPV.
Common short-term prescriptions include antihistamines (Meclizine), benzodiazepines (Diazepam), and antiemetics (Prochlorperazine).
Occasionally, symptoms may manifest during the day with abrupt head movements, such as those involved in household chores or occupational activities requiring neck movement. Therefore, it is advisable to avoid sudden head movements.
If you have an attack during working hours, take a Stemetil tablet, then sit down and rest for about 15 minutes.
Staying hydrated is important, as dehydration can worsen symptoms.
One method to reposition these particles is the Epley manoeuvre. This procedure is conducted in clinical settings by physicians and trained nurses to realign these displaced particles. Its effectiveness may vary from person to person.
So, stick to the reclining chair for long-lasting cures.
If you’d like to know more, feel free to reach out to me on WhatsApp at +94 768253159. I’m here to help!
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