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Benign positional vertigo- The brief attacks of vertigo are harmless.


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Vertigo is the feeling that everything around you is spinning or swaying. This can happen while standing, walking or lying down. Depending on the cause, a dizzy spell can last for different lengths of time and be associated with lightheadedness, nausea, or other symptoms.

If a disorder of the vestibular organ is the cause, it is most commonly benign positional vertigo. In this case, certain movements trigger dizziness for a short time. Benign positional vertigo is unpleasant but harmless. It can be easily detected and treated.

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Benign positional vertigo gives the impression that everything is spinning ("carousel sensation"). As a rule, rapid movements of the head make one dizzy – for example, when one is

– turn, tilt, or neck your head, – lie down, – turn around while lying down, – sit up from lying down, or – bend down.

Typically, the dizziness lasts only a short time – for a few seconds to five minutes at most.

In addition, nausea may occur during and after the dizzy spell, rarely also vomiting.

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Benign positional vertigo is likely caused by loose deposits in the so-called arcuate ducts of the inner ear. This fluid-filled duct system is part of the vestibular organ . Sensory cells in the three arcuate ducts sense whether the head is spinning and in what direction.

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Structure of the ear and vestibular organ

In most cases, the deposits have accumulated in the posterior arcuate as tiny stones – why usually remains unclear. When the head moves, the pebbles "trickle" through the arcade, irritating the sensory cells. You pass on misinformation that does not match the other sensory perceptions – for example, of the eyes. The conflicting information triggers a feeling of vertigo.

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Structure of the organ of equilibrium

Less commonly, positional vertigo occurs as a result of skull injury, ear infections , circulatory problems, or bedriddenness.

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About 2 out of 100 people get benign positional vertigo at some point in their lives. It occurs about twice as often in women as in men. People between the ages of 40 and 70 are most likely to experience it.

In benign positional vertigo, short attacks of vertigo may occur repeatedly. Over time, however, the stones can become lodged in the arcade and be broken down by the body. This is why benign positional vertigo often disappears on its own: about half of those affected are symptom-free again within three months.

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In general, benign positional vertigo is easy to recognize and distinguish from other forms of vertigo based on symptoms and past history. The doctor therefore asks, for example, whether the dizziness is permanent, occurs in fits and starts, or is triggered by certain events. The suspicion can be confirmed with the help of the so-called Hallpike test: In this test, head. Trunk moved rapidly in a fixed sequence with medical assistance. If this causes vertigo, it is benign positional vertigo.

The doctor also observes the eyes during this test, because typical jerky eye movements (nystagmus) occur during the vertigo attack. It may be necessary to wear special glasses (Frenzel glasses) during the test. The triggered eye movements are then easier to recognize.

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Because benign positional vertigo can disappear on its own, it is often enough to simply wait and see. However, there are also ways to treat vertigo. So-called positioning maneuvers are common. In this case, a certain sequence of movements of the head and body should move the loose stones in such a way that they become lodged and no longer trigger new attacks.

The doctor helps with the positioning maneuvers. But there are also variants that can be done at home alone.

Other treatments such as anti-nausea medications are rarely necessary.

More knowledge

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Dizziness attacks can be frightening – especially when it is not yet clear that it is a harmless positional vertigo.

Uncertainty during a vertigo attack increases the risk of falling, especially in elderly people. Some people move very little for fear of vertigo attacks. Are therefore restricted in everyday life.

Bhattacharyya N, Gubbels SP, Schwartz SR, Edlow JA, El-Kashlan H, Fife T et al. Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update) . Otolaryngol Head Neck Surg 2017; 156(3_suppl): S1-S47. German Society for General Medicine. Family medicine (DEGAM). Acute vertigo in general practice (S3 guideline) . AWMF registry no.: 053-018. 12.07.2019. (DEGAM guidelines; volume 17).

Mattle H, Mumenthaler M. Neurology. Stuttgart: Thieme; 2013.

Von Brevern M, Radtke A, Lezius F, Feldmann M, Ziese T, Lempert T et al. Epidemiology of benign paroxysmal positional vertigo: a population based study . J Neurol Neurosurg Psychiatry 2007; 78(7): 710-715.

Zhang X, Qian X, Lu L, Chen J, Liu J, Lin C et al. Effects of Semont maneuver on benign paroxysmal positional vertigo: a meta-analysis . Acta Otolaryngol 2017; 137(1): 63-70.

Updated on 11. March 2020 Next planned update: 2023

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