Vertigo is one of the most common complaints among patients of any age. Moreover, it can be a manifestation of various pathological conditions, from harmless and short-term to life-threatening. Naturally, each of these pathologies requires its own diagnostic and therapeutic approach. That is why it is so important to know the possible causes of vertigo and establish what kind of vertigo arose in a particular patient in a timely manner.

Positional vertigo is characterized by short episodes of vertigo that occur when the head is positioned in a specific way. Patients complain of nausea; nystagmus is characteristic. Diagnosis is clinical. Treatment involves a change in the position of the otoliths in the semicircular tubules. Medicinal and surgical treatment is used less often, only when indicated.

Positional vertigo is the cause of the development of recurrent otogenic vertigo. Elderly people are more susceptible to this disease, and it can severely disrupt the sense of balance in this age group, leading to potentially traumatic falls.

Types of vertigo

The sensations often referred to as dizziness can range from a feeling of lightness in the head to the sensation of a spinning environment. Depending on what worries the patient, systemic and non-systemic dizziness are distinguished for these two types of completely different causes.

Systemic dizziness is a sensation of imaginary rotation or linear displacement of the surrounding space relative to one’s own body or one’s body in space. It is characteristic of the lesion of the vestibular analyzer, and in most cases, of its peripheral part, in particular, the inner ear.

Non-systemic dizziness combines symptoms:

  • Indistinctness in the head.
  • Difficulty concentrating.
  • Imbalance when walking.
  • Feeling of impending loss of consciousness, etc.

These sensations are often no symptoms of vestibular pathology but of cardiovascular, endocrine, psychogenic, and some others. But, of course, there are exceptions to the rules that only a specialist can understand.

Positional vertigo diagnostics

Positional vertigo diagnostics

It is believed that the movement of otolith crystals causes positional vertigo. This condition occurs due to the movement of otoliths, irritating the hair cells mainly in the posterior semicircular canal and thereby creating the illusion of movement. Etiological factors:

  • Spontaneous degeneration of the membrane of the membranous sac of the labyrinth in which the otoliths are located.
  • Otitis media.
  • Ear surgery.
  • Recently transferred viral infection (for example, viral neuronitis).
  • Head injury.
  • Prolonged anesthesia or bed rest.
  • History of vestibular disorders (eg, Meniere’s disease).
  • Occlusion of the anterior vestibular artery.

Positional vertigo occurs when the head moves in a certain direction (when bending forward, changing the body’s position in bed). Acute outbreaks of vertigo last from a few seconds to several minutes. Symptoms appear with maximum intensity in the morning, with gradual fading during the day. Nausea and vomiting may occur, but tinnitus and hearing loss are not common.

Diagnosis of positional vertigo requires special diagnostic positional maneuvers, the most famous of which is the Dix-Hallpike maneuver. During the maneuver, the doctor changes the patient’s position to give the studied semicircular canal the desired position and determine whether there is a movement of the otoliths in it. When the semicircular canal is irritated by otoliths during a maneuver, a characteristic nystagmus reaction occurs, then the maneuver is considered positive.

Nystagmus is an involuntary rhythmic movement of both eyes that a person usually does not feel. Each semicircular canal is characterized by its nystagmus, which helps the doctor determine which channel the pathological process has developed. Diagnostic maneuvers are performed on a conventional couch. The combination of the maneuver, the nystagmus reaction that occurs, and the patient’s sensations confirm the vertigo diagnosis. Moreover, in most cases, there is no need for an MRI of the brain or CT of the temporal bones.

Vertigo diagnosis is based on characteristic symptoms. 

Positional nystagmus caused by positional vertigo is different from positional nystagmus caused by CNS damage.

  • Latency, fatigue, and severe subjective sensations are not noted.
  • It can continue as long as the pose is held.
  • It can be vertical or reversing.
  • Rotatory nystagmus often has an unexpected direction.
  • Patients with nystagmus, indicative of CNS damage, undergo gadolinium-enhanced MRI.

Positional vertigo treatment

Positional vertigo treatment
  • Provocative tests are used to deplete symptoms.
  • Otolith repositioning maneuvers.
  • Medication is usually not recommended.

Positional vertigo usually disappears spontaneously over several weeks or months, but it can last for years. Since the disease can be long-term, drug treatment is not recommended. A common side effect of drugs is imbalance.

Due to the fatigue-causing positional vertigo symptoms, it is recommended that the Epley maneuver be performed in a comfortable and safe place in the morning. In this case, during the day, dizziness almost does not appear.

  • Provocative maneuvers to reposition otoliths (most commonly the Epley maneuver or the Semont maneuver, or the Brandt-Daroff exercises) are a series of head movements in a specific position to move the wandering otoliths back into the membranous sac of the ear labyrinth. After performing the Epley or Semont maneuvers, the patient should avoid bending or extending the neck for 1–2 days. These maneuvers can be repeated if necessary. In contrast, Brandt-Daroff exercises are performed by the patient at home five times in a row, three times a day for about two weeks, or until dizziness disappears during exercise.
  • In the Simont maneuver, the patient sits with a straight back in the middle of the couch. The patient turns his head towards the healthy ear. Then the patient lies sideways on the couch on the side of the sore ear with his head thrown upwards. After 3 minutes, the patient is quickly returned to its original position and placed on the opposite side, but with the head down. After 3 minutes, the patient is returned to its original position, and the head is straightened.
  • The patient can be trained to do the Brandt-Daroff exercises. The patient sits upright, then lies on one side while turning the head up so that the nose is at an angle of 45 degrees. The patient remains in this position for about 30 seconds or until the dizziness subsides and then moves back to a sitting position. The same movements are repeated on the opposite side. This cycle is repeated 5 times in a row, 3 times a day, for about 2 weeks, or until dizziness is felt during exercise.

Positional vertigo can be a serious problem if the condition is not treated in time. Qualified doctors, neurologists will be able to determine the causes by symptoms and prescribe the correct treatment. Ignoring the problem does not solve it.