This is one of the most common causes of vertigo. It occurs predominantly in women and usually presents as attacks in patients between 50 and 70 years old, less commonly in younger people after head trauma1. It is a good example of paroxysmal dysfunction of the inner ear (alternating between quiescent phases and severe attacks = paroxysm).
BPPV is sudden in onset and recurrent attacks usually continue for 3 weeks to a month, after which the attack frequency decreases, leaving the patient with an impression of discomfort, and apprehensive about readopting the position which triggered the problem. The patients often suffer sensations of instability or feeling inebriated which considerably impacts their quality of life..
The causes (trauma, viral infections or degenerative) and pathophysiology of BPPV (detachment of otoconia, calcium carbonate crystals present in the inner ear which then lodge in the labyrinth) are nowadays better understood.
The treatment of BPPV involves physiotherapy, particularly if the patient consults during attacks. Symptomatic treatments are used for resistance or recurrence but are relatively non-specific, only modest in efficacy and are a source of side effects.
Management of BPPV is essential as it causes major functional neurosensory and social handicap. The anxiety and fear of recurrent attacks may, in addition, cause reactive depression in some patients. The related handicap and comorbidities are further evidence of the need for care workers and patients to have access to targeted therapies which are easy to administer and provide effective and very rapid remission from the attack of vertigo.