Benign paroxysmal positional vertigo
| Classification according to ICD-10 | |
|---|---|
| H81.1 | Benign paroxysmal vertigo |
| ICD-10 online (WHO version 2019) | |
Benign paroxysmal positional vertigo (BPLS) or benign paroxysmal positional vertigo - not to be confused with positional vertigo - is a harmless, if extremely unpleasant, very common form of vertigo and at the same time the most common disease of the balance organ .
Synonymous terms are Cupulolithiasis , canalolithiasis and Benign paroxysmal positional vertigo (BPPV) , Benign peripheral paroxysmal positional vertigo (BPPV) or Peripheral paroxysmal positional vertigo (PPLS) .
frequency
Reliable and systematic studies on the frequency of benign positional vertigo are hardly available. One reason for this lies in the high rate of spontaneous remissions , which make the dizziness disappear before the doctor's consultation. In addition, frequent misdiagnoses make systematic surveys more difficult. A prevalence of 2.4% in the general population is assumed.
Epidemiological figures assume an incidence of 64 new cases per 100,000 population annually (about 160,000 in the USA ). Figures from Germany suggest that BPLS is responsible for around 1/3 of the forms of vertigo that can be traced back to a disorder of the inner ear .
causes
The cause of benign positional vertigo is assumed to be the detachment of intact or degenerate otoconia (consisting of calcium carbonate crystals ) from the utriculus of the organ of equilibrium located in the inner ear . But organic material is also suspected to be the cause. Intact otoconia may resolve as a result of trauma. "Degenerate" otoconia are probably the cause of positional vertigo in older people. If one follows the widely accepted theory of the so-called canalolithiasis , these otoconia enter the semicircular canals of the inner ear and move here with corresponding head movements back and forth. This movement triggers a suction that stimulates the semicircular canal receptors. Such irritation usually only occurs when the head is moved in the corresponding plane of the semicircular canal. The result is that the brain receives a message about a movement that is not reported by other sensory systems. The result is contradicting information in the brain (vestibular mismatch) that leads to dizziness.
Why the otoconia peel off is only partially understood. Studies suggest that this is part of the normal aging process . Detached otoconia can be detected in many people, and even in children, without them suffering from dizziness. The detachment of otoconia seems to increase with age, which also increases the likelihood of developing benign positional vertigo with age. In addition, there are other factors that detach large amounts of otoconia and thus increase the risk of benign positional vertigo : cranial brain trauma , inner ear surgery and inflammation in the area of the inner ear. Even the Meniere's disease and migraine are risk factors for BPPV.
Symptoms
When lying down, turning their head, looking up or down, patients complain of brief attacks of vertigo that rarely last longer than 30 seconds. Quite a few patients complain of nausea , some even of vomiting . Some also complain of a feeling of walking on cotton wool after the vertigo attacks. Some patients quickly develop avoidance behavior in order not to have to experience dizziness, which is perceived as very uncomfortable.
diagnosis
The diagnosis is made after targeted questioning and implementation of a special provocation maneuver, the Dix-Hallpike positioning test. To do this, the patient is placed on an examination couch and quickly laid down with his head turned to one side to induce dizziness. The doctor observes the eyes to identify nystagmus . It is typical that the eye movements only occur with a latency of approx. 1 to 2 seconds after the provocation.
therapy
Since the benign positional vertigo is caused by otoliths in the semicircular canal, the treatment consists of a sequence of body positioning and head positioning exercises, with which these are carried out of the semicircular canals of the organ of equilibrium and brought into a harmless resting position. The provocation of the typical symptoms during the treatment is consciously accepted. One of these treatment measures is the so-called Epley maneuver . In addition to treatment by the doctor, there is also the option of self-treatment. However, this should only be done after a confirmed diagnosis by a doctor. Only he can reliably differentiate between benign positional vertigo and other possible causes of vertigo. It should be made clear to the patient that the mere avoidance of the symptoms leads to an increase in the duration of the illness, but the targeted triggering of the symptoms leads to a certain amount of habituation, possibly through cerebral adaptation processes.
Course and prognosis
The benign positional vertigo is a harmless but extremely unpleasant disease. Although it usually disappears after a few days and weeks even without treatment, some patients have longer courses, sometimes over months or even years. Therefore, and because of the considerable psychological stress , therapy is justified in any case and should not be delayed by referring to spontaneous remission.
Benign positional vertigo recurs in 30–50% of patients within two years, with or without treatment. Using special positioning methods, the patient can treat such relapses independently at home.
Individual evidence
- ↑ Current information on the therapy of dizziness and balance disorders , p. Stuckrad-Barre, S. Heitmann, WH Jost in the Hessisches Ärzteblatt from January 2007, p. 15ff, accessed in May 2016
- ↑ Guidelines for Diagnostics and Therapy in Neurology. ( Memento of January 24, 2014 in the Internet Archive ) 4th revised edition Georg Thieme Verlag Stuttgart 2008, pp. 654 ff, ISBN 978-3-13-132414-6 . (PDF; 1.4 MB)
- ↑ Information ( memento of June 8, 2016 in the Internet Archive ) on peripheral paroxysmal positional vertigo (PPLS), Clinic for Clinical Neurophysiology of the University Medical Center Göttingen, accessed in May 2016
- ^ TD Fife: Benign positional vertigo. In: Semin. Neurol. , Volume 29, 2009, pp. 500-508.
- ↑ Leif Erik Walther et al .: Detection of human utricular otoconia degeneration in vital specimen and implications for benign paroxysmal positional vertigo. In: Eur. Arch. Otorhinolaryngol 2013.
