Information on the following diseases can be found in the Related Disorders section of this report:

• Meniere Disease
• Vestibular Neuronitis of Dix and Hallpike

Benign Paroxysmal Positional Nystagmus (BPPN) is characterized by episodes of sudden, extreme dizziness triggered by certain positions of the head, and often accompanied by nausea, vomiting and impaired muscle coordination (ataxia). Involuntary rhythmic movements of the eyes (nystagmus) in horizontal, vertical or circular directions usually also occur. An attack may last for 30 seconds or less, but the symptoms may linger over a few weeks or months. Symptoms may disappear as spontaneously as they appeared. Frequently, there are recurring episodes.

The fundamental cause of BPPN is not known. The problem resides in the fluid-filled chamber (vestibular chamber) of the inner ear that controls balance. One of several different mechanisms affecting the semicircular canals of the inner ear may be present. These may include spontaneous degeneration of the membranes in the labyrinth of the ear, head injuries, serious middle ear infection, ear surgery, and closing off of the anterior vestibular artery to the inner ear.

Some clinicians attribute attacks of BPPN to stone-like calcium deposits found within the posterior semicircular canals of the inner ear.

BPPN primarily affects females during middle or late adulthood.

Meniere Disease is a disorder characterized by recurrent prostrating attacks of dizziness (vertigo), possible hearing loss and ringing sounds (tinnitus). (For more information on this disorder, choose "meniere" as your search term in the Rare Disease Database.)

Vestibular Neuronitis of Dix and Hallpike is a disorder of unknown cause, with abrupt onset during young adulthood and continuing through the fifth decade of life. It is characterized by dizziness, nausea and vomiting. Head movements may make the symptoms more severe. Hearing is usually not impaired. This disorder is often associated with upper respiratory tract infections and fever.

Patients with BPPN are often advised to avoid head movements and positions that could bring on the attacks. Medications may decrease dizziness and control nausea or vomiting. If the dizziness is caused by bacterial infection in the ear, antibiotics may help.

Some clinicians recommend a five-step maneuver known as the canalith repositioning procedure to relieve positional vertigo. This treatment involves, in five distinct steps, moving from a sitting to a reclining position on a flat surface and rolling over while the head is extended downward at a 45 degree angle.

A surgical treatment used in some cases of acoustic nerve compression is known as the Jannetta procedure, which may be of some help in some cases of BPPN. Dr. Margareta Moller, who was one of the foremost proponents of this neurosurgical procedure while at the University of Pittsburgh, no longer practices surgery. However, she has indicated that she would be pleased to correspond with persons interested in the Janetta procedure to make referrals to neurosurgeons experienced in this procedure.

Her address in Dallas, where she now lives, is:

Margareta Moller, MD, DMS
6934 Desco Place
Dallas, TX 75225

TEXTBOOKS
Thoene JG., ed. Physicians' Guide to Rare Diseases. Montvale, NJ: Dowden Publishing Company Inc; 1995:281

Larson DE. ed. Mayo Clinic Family Health Book. New York, NY: William Morrow and Company, Inc; 1996:584-85.

Berkow R., ed. The Merck Manual-Home Edition. Whitehouse Station, NJ: Merck Research Laboratories; 1997:300.

Beers MH, Berkow R., eds. The Merck Manual, 17th ed. Whitehouse Station, NJ: Merck Research Laboratories; 1999:679.

REVIEW ARTICLES
Dieterich M, et al., Vestibulo-ocular reflex. Curr Opin Neurol. 1995;8:83-88.

Brandt T, et al., Current view of the mechanism of benign paroxysmal positional vertigo: cupulolithiasis or canalolithiasis? J Vestib Res. 1993;3:373-82.

JOURNAL ARTICLES
Baloh RW, et al., Horizontal semicircular canal variant of benign positional vertigo. Neurology. 1993;43:2542-49.

Ushio K, et al., Three-component analysis of benign paroxysmal positional nystagmus. Acta Otolaryngol Suppl. 1995;519:107-09.

Yagi T, et al., Nystagmus in benign paroxysmal positional vertigo: a three component analysis. Acta Otolaryngol Suppl. 1995;520 Pt 2:238-40.

Baloh RW, et al., Persistent direction-changing positional nystagmus: another variant of benign positional nystagmus? Neurology. 1995;45:1297-301.

Nuti D, et al., Benign paroxysmal positional vertigo of the horizontal canal: a form of canalolithiasis with variable clinical features. J Vestib Res. 1996;6:173-84.

Steddin S, et al., Horizontal canal benign paroxysmal positional vertigo (h-BPPV): transition of canalolithiasis to cupulolithiasis. Ann Neurol. 1996;40:918-22.

Vannucchi P, et al., Treatment of horizontal semicircular canal benign paroxysmal positional vertigo. J Vestib Res. 1997;7:1-6.

Lida M, et al., Evaluation of the vertical semicircular canal function by the pendular rotation test: a study on patients with benign paroxysmal positional vertigo. ORL J Otorhinolaryngol Relat Spec. 1997;59:269-71.

Nuti D, et al., The management of horizontal-canal paroxysmal positional vertigo. Acta Otolaryngol. 1998;118:455-60.