MySecondEar Kundin mit Lagerungsschwindel

What is positional vertigo?

Have you ever heard of the so-called positional vertigo? There is a lot you should know about it. It is a very special feeling of vertigo. This occurs when there is a change in position. The so-called ear stones are the cause, because they detach. Thus, your vestibular organ is directly affected. The dizziness occurs when these ear stones get into the archway.

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Benigner Paroxysmaler Lagerungsschwindel

The so-called "Benign paroxysmal positional vertigo" translates virtually as "seizure-like". Often there is also talk about peripheral paroxysmal positional vertigo. This means that the cause is in the outer zone of the body. In principle, such vertigo is relatively harmless for you. Nevertheless, it can be very unpleasant.

Who is affected by positional vertigo?

The posterior, lateral, and superior semicircular canals together form the semicircular canal apparatus. The sacculus (not shown in this drawing) is connected to the underside of the utriculus. Source: msdmanuals

About two out of every 100 people are affected by benign positional vertigo. Mostly this occurs in the elevated age. The disease is thus often from the 50th year of life. Women are affected more often than men. The vertigo recurs in 30-50% of those affected. If you are also affected by it, your ear, nose and throat doctor can show you special exercises, which you can do at home to treat yourself.

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Why are older people predominantly affected?

In advanced age, positional vertigo occurs more frequently because the ear stones detach more often due to the aging process and shift into the arcade. Accidents may also occur more frequently after a certain age, which is another factor in the development of positional vertigo. Injuries to the head are typical examples of this.

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What are the symptoms of positional vertigo?

Typical symptoms include:

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  • Fast, uncontrolled trembling of the eyelids (nystagmus)
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  • Nausea, vomiting
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  • Sweating
  • Balance problems that can lead to falls
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Very often there is also a spinning dizziness. This occurs when the head is quickly changed in position. The vertigo is perceived and referred to virtually like a merry-go-round in your head. The rotary vertigo often occurs in the following situations:

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  • Turning to the affected side
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  • Bending over
  • quickly.
  • Quickly straightening up from a lying position
  • Quickly turning over in bed

You can usually rule out circulatory forms of vertigo if you notice positional vertigo in the above situations. Other forms of vertigo may be caused by a diseased brain, or diseased eyes, or a diseased brain.

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The diagnosis of positional vertigo

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After a detailed patient interview, your ear, nose and throat (ENT) doctor will perform the examination. If he or she suspects you have benign positional vertigo, he or she will apply the CIX Hallpike positional test. This sample is used for provocation, so that the vertigo is specifically induced.

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In this test, you sit upright on a surface. Then you lie down with your head to the side. This usually results in nystagmus and an accompanying feeling of dizziness. If a balance disorder or other dizziness is present, it may have to do with the cardiovascular system.

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Definition: nystagmus

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A nystagmus is an uncontrolled and rhythmic movement from an organ. Most often, this refers to the eyes. If your eyes tremble it is a typical indicator that positional vertigo is present. It comes to a false coordination between sense of balance and sense of sight.

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Which archway is irritated?

The doctor can tell which arcuate duct is irritated by the direction your eyes are moving. For example, the lateral arcuate is irritated if the nystagmus is horizontal. Most often, however, the ear stones are in the posterior arcuate. In this case, the nystagmus is vertical. The anterior arcade is very rarely affected.

What are the therapeutic options for positional vertigo?

You cannot treat positional vertigo with medication. It is much better if you practice special positioning exercises. This will allow the detached parts to move in the right direction. By the way, there are various types and forms of positional vertigo. Most of them are more anterior, or are located more posterior. We are talking about the anterior or posterior arcuate. Vertigo can usually be eliminated with the responsive exercises. For this, the Epley or Sémont maneuver is used.

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Storage dizziness exercises

Sémont maneuver

In this exercise, your head is rotated 45° and you sit uprightin front of your doctor. Then you will be quickly turned onto your side and shifted onto your side. Meanwhile, your head will always remain in the same position. Now you are on the couch facing upwards. You will remain in this situation for between two and three minutes. After that, you will be repositioned 180° to the other side of your body. You keep your head in the same position, now you look down at the surface. At the end, you are returned to your original position and remain sitting like this for three minutes.

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Epley Maneuver

Procedure of the Epley maneuver for deposits in the left ear. Source: health information

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This maneuver is due to the inventor and has the same name. You sit with your legs extended in front of your doctor. You turn your head 45° to the affected side. That is, your doctor has a clear view of the healthy ear. Now you are quickly transferred to the supine position. The head must protrude over the edge of the couch. This is called the head hanging position. In this position you will now remain until the dizziness has subsided.

It usually takes about 1 minute. Once the symptoms have subsided, turn your head 90° to the healthy side. Hold this position for about 1 minute. Now turn to the healthy side and remain in the original position for 1 minute. First, sit upright again in the original position. During this exercise, you may experience nausea due to dizzy spells. It is best to close your eyes to avoid the nausea.

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Difference between posterior and anterior

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The anterior form occurs relatively rarely, usually occurring during a freeing maneuver. In this case, the ear stones get into the anterior arch canal. The posterior form occurs much more frequently. The vertigo is felt when sitting up or lying down. So the speech is always the corresponding affected arcade.

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Prognosis and course in positional vertigo

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If you suffer from positional vertigo, the situation is unpleasant, but usually harmless. After the appropriate therapy, the symptom disappears again. Of course, there are exceptions. In a few cases there is a prolonged course. The dizziness occurs between a few days and several weeks. Only very rarely does it persist for several years. Therefore, a timely visit to your ear, nose and throat doctor is recommended. Even then, if this type of dizziness often disappears by itself again, you should not take any risks.

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Mostly, positional vertigo occurs in attacks and is benign. Sometimes complications make your daily life more difficult. It is important to cure the vertigo attacks. You will learn how to cope and live with the symptoms. The problem can degenerate into a burden for you, if you can not sleep because of it, for example.

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The disease is usually accompanied by balance disorders. In this situation, you then have a risk of falling. Your condition and behavior may be negatively affected if the spinning vertigo lasts longer. If you notice the symptoms, you should therefore immediately go to the ear, nose and throat doctor or see a specialist in ear, nose and throat medicine. Only in this way can the ear stones, or otoliths back into the inner ear position.

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Does positional vertigo lead to permanent damage?

Generally, you can assume that positional vertigo is harmless. Nevertheless, it can be distressing. This can have psychological consequences. The vertigo attacks occur like a seizure and you are at risk of falling. Therefore, you should avoid dangerous situations at all costs during such a vertigo attack.

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Vicious positional vertigo symptoms

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In principle, there is no such thing as malignant positional vertigo. There is only the term benign positional vertigo, because in this case then no immediate damage is triggered. The damage is caused rather by falls or the nervous stresses that can be a consequence.

Causes of positional vertigo

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Construction of the ear and organ of balanceSource: Health Information

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Once ear stones become detached, positional vertigo can occur. These stones then get into the arch canals. The deepest part changes. There is fluid in the semicircular canals. This gets into motion. The gelatinous cone in the posterior arcuate is deflected and the affected arcuate is excited.

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Why do ear stones detach?

  • Advanced age
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  • Skull trauma or injury to the head
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  • Traffic accident
  • Sports accident
  • Equilibrium organ in the inner ear is inflamed

When the organ of balance fails or is disturbed, the information for the room can be incorrectly transmitted to the brain. As a result, the typical spinning vertigo occurs. Why the ear stones detach, could not be clarified until today.

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Definition: ear stones

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"Statoliths, otoliths ("ear stones"), otoconia or statoconia are microscopic grains to several centimeters in size stones made of solid material (for example, lime or starch), which are found in unicellular organisms as well as in the position and balance organs of many other living things."

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Source: wikipedia.org

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Good type of positional vertigo duration

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As a rule, benign positional vertigo regresses in most cases within a few days to weeks, rarely it persists for months bzw. years. Timely treatment usually shortens the duration of discomfort.

Definition: archway

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The arcuate duct is a part from the organ of balance located in your inner ear. It is a circular tube. This tube is filled with fluid. Inside are tiny little hairs that are connected to nerve cells. Any movement of your body causes the fluid to move into the archway and also the hairs. The nerve cells pass this on to the brain as a stimulus.

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What other forms of vertigo are there besides positional vertigo?

There are other forms of vertigo that can occur in addition to positional vertigo. However, these are due to different causes. One example is Meniérè's disease. This is caused by pressure in the hearing organ and the organ of equilibrium. Usually, this vertigo is accompanied by vomiting, sweating and nausea. This always affects only one ear. Mostly, a hearing loss or tinnitusis recorded before. Psychological stress can also be the reason for such a fluctuating vertigo. If the brain is damaged can also develop a central vertigo.

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Diagnosis of positional vertigo in a young child

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In infants or children, positional vertigo is very rare. Sometimes there are balance problems in infancy. This is not uncommon. In rare cases there are also migraines or other ailments. The ear stones can also detach in children, but this does not necessarily lead to vertigo. Why the ear stones detach in the first place, medicine can not answer until now. However, the risk increases with age. A benign positional vertigo is therefore expected approximately from the age of 35.

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The cupulolithiasis theory

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According to this theory, the crystals and stones are deposited in the posterior arch. There the stones form an overweight and lead to changed gravitational forces. Thus the rotary vertigo develops, or so it comes to the symptoms.

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The canalolithiasis hypothesis

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According to this hypothesis, the vertigo is rather caused and triggered by a degenerative effect or trauma. Small pieces of the stones detach and form a blockage in the posterior arch of the tube, leading to a complete blockage in the interior of the hollow organs. If the position of the head is changed quickly, the blockage can be moved out. Exactly then it comes to the typical symptoms.

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