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How to Determine which Ear BPPV is in?

Benign Paroxysmal Positional Vertigo or BPPV as it is commonly known, is the most commonly diagnosed type of Peripheral Vertigo in patients. Vertigo is the sensation of spinning or your head feeling out of balance. Patients often feel like their surroundings are spinning even when they are perfectly still, & thus feel disoriented, off balance, & dizzy.

There are multiple causes of vertigo: Some of which include:

1. BPPV Vertigo:

BPPV Vertigo occurs when tiny calcium carbonate crystals that are normally found in the inner ears mistakenly get lodged in the semicircular canals. These crystals then create problems with the vestibular system, causing it to send out false signals to the brain regarding the patient’s position in space & external stimuli.  There could be many reasons for BPPV Vertigo. It could occur with age, some viral infections of the inner ear, Meniere’s disease, or any other unknown cause. At times, BPPV doesn’t have a cause, & occurs without any specific reason.

2. Meniere’s Disease:

It is an inner ear disease that is caused by a buildup of fluid in the inner ear & a pressure change in the ears. It leads to a ringing, buzzing, or hissing sound in one ear or both, also known as Tinnitus. Meniere’s Disease can also lead to temporary or permanent hearing loss.

3. Vestibular Neuritis or Labyrinthitis:

Vestibular Neuritis is an inner ear problem that is usually caused by an inner ear infection. This infection leads to inflammation in & around the inner ear nerves which are responsible for maintaining the body’s balance, leading to BPPV Vertigo.

BPPV Vertigo can also be caused by the following different factors:

  • Any head or neck injury
  • Problems of the brain such as a stroke or tumor
  • Certain medications that can cause ear damage as a side effect
  • Migraine headaches

4. BPPV Signs & Symptoms

Benign Paroxysmal Positional Vertigo episodes are usually triggered by a change in the position of the head. BPPV signs & symptoms typically include:

  • Tilting
  • Spinning
  • Swaying
  • Feeling unbalanced
  • Centered to one direction

Aside from these general symptoms, BPPV signs & symptoms also include:

  • Feeling of nausea
  • Vomiting
  • Jerking, abnormal eye movements, also called nystagmus
  • Headaches of migraine intensity
  • Sweating
  • Ringing sound in the ears, also called Tinnitus, & hearing loss

These BPPV signs & symptoms may come & go, or last a few days according to the condition & the exact diagnosis of the patient. A typical BPPV Vertigo episode lasts anywhere between a few minutes to a few hours.

5. BPPV Test

There are various tests that can determine whether you’re indeed suffering from BPPV Vertigo. These usually include your doctor moving your head in certain ways to check the eye movements & whether they align with the head or not, & certain tests that ascertain whether you experience dizziness due to certain movements. BPPV also generally affects one of the ears. BPPV Vertigo Treatment & BPPV exercises depend largely on which ear the BPPV Vertigo comes from does.

There are simple BPPV tests that help you find out which of the two ears suffers from BPPV Vertigo.

  • Sit on the bed in such a way that when you lie down, your head hangs over the edge of the bed slightly.
  • Turn your head in the right direction & lie back quickly.
  • Wait for about a minute.
  • If you feel dizzy, then the right ear is the one affected by BPPV Vertigo.
  • If you don’t experience dizziness, then sit up.
  • Wait for about 1 minute.
  • Turn your head to the left & lie back quickly.
  • Wait for about 1 minute.
  • If you feel dizzy, then the left ear is the one affected by BPPV Vertigo.

Once you identify which ear the BPPV Vertigo is occurring in, it becomes easier to begin with BPPV Vertigo treatment & Vertigo medicines.

BPPV Exercises for Vertigo treatment

Exercises for Vertigo target the dislodged crystals in the semicircular canal & try to place them back in their original position in the inner ear. There are multiple BPPV exercises for Vertigo treatment. Some of these include:

1. Brandt-Daroff Exercises

Brandt-Daroff exercises utilize gravity to help dislodge crystals from the semicircular canal so that they no longer pose a problem in maintaining the body’s balance.

This exercise can be performed at home in a few simple steps as given below:

  • Sit in the bed with your feet on the floor, then turn your head 45 degrees in the right direction.
  • Without changing the direction of your head, lie down on the left side on the bed. Remain in this position for about 30 seconds.
  • Slowly return to the original position, & take a 30-second pause.
  • Next, turn your head 45 degrees to the left side, & repeat the previous steps in the right direction.
  • Return to the original position & pause for 30 seconds.
  • Repeat this entire set of procedures for about five times in a single sitting.

This exercise, not unlike other exercises for Vertigo, can bring about dizziness. Hence it’s important to wait for some time to let the dizziness pass before getting up to stand after performing the Brandt-Daroff exercise.

2. The Semont Maneuver

The Semont Maneuver is also known as the liberatory manoeuvre, & is another exercise for Vertigo recommended for BPPV Vertigo treatment. It takes less time to perform than the Brandt-Daroff exercise; however, these should be done in the presence of a healthcare provider.

For the below set of exercises, it’s assumed that you have left-ear BPPV.

  • Sit on the edge of your bed in an upright position & turn your head 45 degrees to the right.
  • Quickly drop to your left until your head is on the bed, & hold this position for 30 seconds.
  • Next, quickly move your body to the right side in a single movement without changing the position of your head.
  • Hold this position for 30 seconds, then slowly return to the original position.

If you are suffering from right ear BPPV, then turn your head to the right side first, & lay down on your left side on the bed.

3. Epley Maneuver

The Epley Maneuver is another widely recommended exercise for Vertigo. Most patients with BPPV Vertigo get relief from their symptoms with the Epley Maneuver. Below is the procedure for performing the Epley Maneuver at home if you have left-ear BPPV. In the case of right ear BPPV, just perform these steps in the opposite direction.

  • Sit on the bed in an upright position, & place your legs straight ahead in front of you with a pillow behind you.
  • Next, turn your head 45 degrees to the left.
  • Lie on your back quickly until your shoulders are on the bed. Hold this position for 30 seconds.
  • Next, turn your head 90 degrees to the left without lifting it. Hold this position for 30 seconds.
  • Now, turn your body & head another 90 degrees to the right & hold for 30 seconds.
  • Next, sit upright on the right edge of the bed.

Perform the Epley Maneuver thrice a week, 3 times a day for long term relief.

Besides these BPPV exercises, there are also certain Vertigo medicines that have shown to be successful in BPPV Vertigo treatment.

These include:

  • Benzodiazepines
  • Betahistines
  • Cinnarizine
  • Dimenhydrinate
  • Meclizine
  • Metoclopramide
  • Prochlorperazine
  • Promethazine
  • Ondansterone
  • Piracetam
  • Scopolamine, which can be administered as a skin-patch SSRI, like amitriptyline