Benign paroxysmal positional vertigo (BPPV) is an inner ear disorder that causes repeated bouts of vertigo in the individual. It is the most common cause of vertigo in individuals. Vertigo “is a sensation of spinning or movement in which the world is revolving” (Tortura, 1997, p. 283). Vertigo is distinct from dizziness. The semi-circular canals of the inner ear are filled with fluid that allows the person to determine position. They are approximately one-twentieth of an inch long (Gray, 1977, p. 860). BPPV results when calcium crystals along the inner ear canals break lose and float inside the fluid; this creates pathological fluid displacement within the inner ear (Munsell, 2004, pp. 734-735).
We examined the incidence and prevalence of BPPV among individuals who visited a medical clinic. Patients completed a questionnaire regarding signs and symptoms related to BPPV. They then received a modified epleys maneuver for treatment. Follow-up was conducted approximately three to four weeks later. Overall, the treatment proved successful for the cohort. We examined 103 patients (n=103). Of the sample, 38 were males (37%) and 65 (63%) were females. This corresponds with the published information on BPPV. Studies indicate that 64% of cases occur in females. Only three cases occurred beneath the age of 40. All three were aged 35 years. This also is consistent with the national data. BPPV rarely occurs in individuals less than 35 years unless there is a history of head trauma (Li, 2012). Overall, the lifetime prevalence of BPPV is 2.4% (von Breven et al, 2007, p. 710).
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The frequency of cases encountered is consistent with the prevalence of BPPV nationwide. Healthcare professionals frequently encounter individuals complaining of vertigo. Nationwide, vertigo results in 5.6 million visits to health clinics and EDs annually; of these cases, 17-42% of the individuals are eventually diagnosed with BPPV. Furthermore, the research indicates that of geriatric patients with balance complaints, nine percent are undiagnosed sufferers of BPPV. The prevalence of BPPV increases with age (Bhattacharyya et al, 2008, p. S48).
In our data, episodes of BPPV occurred due to rapid positional changes in a large segment of our cohort. Depending upon the movement, between 79-92% indicated that they suffered vertigo due to changes in head position. This is also consistent with published data. However, the studies do indicate that 2% of individuals suffer from recurrent attacks of vertigo and still do not meet the diagnostic criteria for BPPV. In these individuals, the episodes last generally less than one minute (von Breven et al, 2007, pp. 710-711).
The majority of the patients complained of a feeling of the room spinning around them. Eighty-seven percent of the patients experienced this feeling (n=90). However, of interesting note in the data, more patients did agree with the statement that they felt the need to hang onto something during an episode of vertigo (n=92). While the difference is not statistically significant, it may indicate that patients have difficulty expressing or understanding the sensations they experience during vertigo. This would be consistent with the extensive data that suggests individuals with vertigo describe dizziness as the sensation. This may lead to cases of missed diagnoses and underdiagnoses of the condition. This would suggest that the actual reported lifetime prevalence is lower than the actual prevalence in the population. A large percentage of the patients stated that they have experienced an episode of nausea and/or vomiting associated with their vertigo episodes. Statistics indicate that this is a common symptom for sufferers of BPPV (Vestibular Disorders Association, 2013).
None of the patients in our data group responded that they had recently had brain or ear surgery. While this may be a cause of BPPV, in the majority of cases, the onset is sudden and acute without history of surgery. In individuals under 35, head trauma may cause it; in these individuals, the vertigo is bilateral. It is also interesting to note that many patients believe the episodes last several minutes; this likely is not accurate and is due to the disorientation the disease creates (Santoro, 2012, p. 17).
BPPV creates a significant healthcare burden for the population. Eighty-eight of the 103 patients reported that BPPV has significantly disrupted their social and leisure activities. Furthermore, 65 out of the 103 patients indicated that their condition makes it difficult for them to focus at work, creating employment difficulties. This level of morbidity is commonly seen throughout cohorts who suffer from BPPV. Studies indicate that BPPV often interferes with normal daily activities. We did not assess the incidence of falls or trauma secondary to BPPV. However, this may be considered for future follow-ups. This is especially true for the older patients. Older patients suffer falls from BPPV at a higher incidence; this increases both hospital and nursing home admissions. It also places a greater strain on the caregiver. The true prevalence of BPPV in elderly patients is most likely higher than previous data indicates (Oghalai et al, 2000, p. 630). The studies also show that older patients are more prone to depression and social withdrawal due to the BPPV. This would further suggest additional avenues for data collection and eventually, interventions to improve the outcomes for the patient.
Due to the significant morbidity and societal costs associated with this relatively common condition, more research needs to be conducted to further elucidate the true health care burden of it. The prevalence reported is most likely incorrect due to misdiagnoses. This may indicate that additional follow-up is required with all patients complaining of dizziness or vertigo.
