Benign Paroxysmal Positional Vertigo

Benign paroxysmal positional vertigo is a brief period of incapacitating vertigo that happens when the position of the patient’s head is changed with respect to gravity, usually by placing the head back with the affected ear turned down. Benign paroxysmal positional vertigo has brief episodes of mild to severe dizziness. This is commonly triggered by specific changes in the position of the head, feeling to be out of balance when standing or walking are also common.

Clinical Manifestations

The signs and symptoms of benign paroxysmal positional vertigo (BPPV) may include:

  • Vertigo
  • Dizziness
  • Loss of balance
  • Unsteadiness
  • Blurry vision
  • Light- headedness
  • Vomiting
  • Nausea

Causes

The following may be the causes of having benign paroxysmal positional vertigo

  • Disruption of debris within the semicircular canal.
  • Mild to severe blow to the head
  • Ear surgery
  • Prolonged positioning on the back
  • Head trauma
  • Infection
  • Head movement

Risk factors

The following are probably the risk factors that an individual may have to develop benign paroxysmal positional vertigo:

  • Mostly occurring in people aging 60 and above
  • Previous head injury
  • Previous ear injury

Assessment and Diagnosis

The following tests and diagnostic procedures are used to verify the presence of benign paroxysmal positional vertigo or may rule out the presence of such.

  • Assessment of the patients episodes of dizziness, involuntary movements of the eyes and head movement
  • Electronystagmography (ENG)-  this test is to detect abnormal eye movement
  • Videonystagmography (VNG)- this test can determine if dizziness is due to inner ear disease
  • Magnetic resonance imaging (MRI)- may identify lesions that may cause vertigo

Management

Management of benign paroxysmal positional vertigo focuses on the safety of the patients. Falls and injuries are avoided and accidents are eliminated.

  • Bed rest
  • Canalith repositioning procedures- provide resolution to vertigo
  • Epley Procedure- is a method that involves repositioning procedures
  • Medications
    • Meclizine
    • Prochloperazine
  • Vestibular rehabilitation
  • Stress management
  • Biofeedback
  • Vocational rehabilitation
  • Physical therapy

Nursing management and Support

  • Tell the patient that the following signs and symptoms may indicate medical interventions, and should be intervened immediately:
    • Sudden episode of headache
    • Fever
    • Double vision
    • Episodes of falls
    • Weakness on the leg
    • Loss of vision
    • Hearing loss
    • Trouble speaking
    • Weakness on the arm
    • Loss of consciousness
    • Numbness
    • Tingling
    • Difficulty walking
  • There is a big possibility that patients may fall and may lose balance, nurses or care givers should be keen in assisting and monitoring the patient’s day to day activities.
  • Instruct the patient to sit down instantly when dizziness s felt.
  • Make sure to provide good and adequate lighting to facilitate better vision of the room and the furniture.
  • If walking is yet not stable, make sure to provide walking devices or assistive tools to maintain balance and safety.

Byron Webb Romero, RN, MSN

Finished BSN at Lyceum of the Philippines University, and Master of Science in Nursing Major in Adult Health Nursing at the University of the East Ramon Magsaysay Memorial Medical Center. Currently working at Manila Doctors College of Nursing as a Team Leader for Level I and II, Lecturer for Professional Nursing Subjects, and also a Clinical Instructor.

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