Causes of positional vertigo

The Balance organ in the Inner ear controls the perception of body position in space and ensures that we are in a stable, upright posture.
Basis of benign positional vertigo is the detachment and sliding of the smallest salt crystals (splinters of otholites, calcium carbonate crystals) into the semicircular canals (in 80% -90% of those affected in the posterior semicircular canal) of the inner ear.
Why these salt crystals peel off has not yet been fully proven.

It is certain that this process is part of the normal aging process, but in rare cases this process can also be demonstrated in children.

Other possible factors causing positional vertigo are:

• Accidents
  or
• Inflammation
  and
• Operations

in the Inner ear.
With appropriate head movements, these detached, small particles slide back and forth in the semicircular canal. Through these movements, the smallest feelers (receptors) in the semicircular canal are stimulated brain report conflicting information.
The brain on the one hand receives notification of a movement from the Balance organwhich, on the other hand, do not match the current perception of positioning (Sense of balance) and the See (visual impression) matches.
The result is a so-called vestibular mismatch ("mess" in the balance problem), which triggers the dizziness. In the same way as the salt crystals via the rapid movement of the head into the Semicircular canals wander and thus trigger the vertigo attack, they can also be transported out again. This fact is used in testing and treatment.

Positional vertigo due to stress

Stress can also be a cause of positional vertigo.
It can occur in stressful situations, such as before an important exam or an important performance, when the workload is too great, or when you are in large crowds.

The death of a loved one can also become a stressful situation and can be accompanied by dizziness and a feeling of powerlessness. The dizziness often helps those affected unconsciously to withdraw from the stressful situation caused by the dizziness for a moment.
Affected develop alongside Attacks of dizziness and fainting, and often also Migraine attacks and depression. In order to avoid the dizziness becoming chronic, relaxing methods such as yoga, meditation, Progressive Muscle Relaxation or Autogenic training.
The person concerned learns to better interpret the signals of his body and to deal with them better. Psychotherapy can also help resolve underlying conflicts.

psychogenic causes of dizziness

Lots Types of vertigo can be caused by mental stress or in the context of mental illness, such as depression, Anxiety disorders or Psychosis occur and are reinforced by them.
Psychogenic vertigo is usually described as diffuse, is associated with unsteadiness and unsteadiness as well as with a tendency to fall. Most often this is one phobic postural vertigowho often at Anxiety disorders or depressions occurs.

This occurs in stressful situations (For example, a high workload, conflicts between partners or being in large crowds) to a strong vacillation and drowsiness.
Often the psychogenic dizziness can be accompanied by circulatory reactions, such as with Racing heart, shortness of breath and Fainting. Nausea and vomiting are rare. In women, the psychogenic dizziness occurs mainly between the 30 and 40 years of age on, in men rather between the 40-50 age.

Most of the time the psychogenic vertigo has no organic cause. But the patient's fear of the next attack of vertigo leads to withdrawal and an intensification of their mental illness.
Often the patients then no longer dare to leave the house and avoid any triggers Dizzy spells and increase pathologically into their fear. The main therapeutic help here is behavioral therapy, in which the cause of the dizziness is addressed together with the therapist and behavioral measures are discussed in order to counter the next vertigo attack.

Forms of positional vertigo

Benign positional vertigo

At the Positional vertigo A distinction is made between benign positional vertigo and malignant positional vertigo. The benign positional vertigo is very uncomfortable for the person affected, but in itself harmless.
The cause is usually a replacement of the Otholites (small ear stones) of the Equilibrium organs. If the stones get into the semicircular canals, they irritate there Balance organ and it comes to a sudden dizziness.

The dizziness usually occurs in attacks and when the head changes position, for example when turning around, bending over or getting out of bed. Positioning exercises can help therapeutically, which can lead to an improvement or healing of the disease.
The positional vertigo should definitely be clarified by an ENT doctor and neurologically.

Malignant positional vertigo

In malignant positional vertigo, the cause of the vertigo is not in the inner ear, as in benign positional vertigo, but in the central nervous system.
Causes can be diseases of the Brain stem or des Cerebellum be like for example multiple sclerosis, Bleeding into the brain area, a stroke or a tumor.
Here too, as with benign positional vertigo, it occurs Dizziness and nauseawhen you assume certain head positions. More precise causes should be investigated by a neurologist.

Diagnosis of positional vertigo

Anamnese:
When collecting the medical history, the physiotherapist or doctor asks about the symptoms typical of benign positional vertigo.

For the assessment of the clinical picture and the treatment, information from:

• daily activities
• Tendency to fall
  and
• the impairment of everyday life and work

As the dizziness-inducing process in the inner ear occurs more frequently as a result of the aging process, it is predominantly older people (rarely before the age of 35) who are affected by the problem. Attacks of dizziness are to a great extent fear-inducing and lead to reduced everyday activities and falls, especially in older patients with serious complications that can lead to further impairment of the quality of life. Depending on the age structure concerned, various concomitant diseases occur more frequently, which either indicate another cause of the vertigo, or one Contraindication for therapy, including:

• uncompensated heart disease (heart failure)
• Vascular occlusive diseases
  and
• severe movement restrictions in the Cervical spine, caused by rheumatism or Degeneration processes (age wear).

The information gathered in the initial survey (especially the causes) about the symptoms and the impairments in everyday life serve as a measure of the success of the therapy in the final findings.

Dix-Hallpike test = provocation maneuver

The Dix-Hallpike test is a meaningful test to check for benign positional vertigo if the symptoms are present The cause is in the posterior semicircular canal lies.
Before performing the test (provocation of dizziness), the patient should be informed in detail about the procedure and the effects of the test. This is the only way to achieve trustful cooperation. By quickly turning the head by 45 ° and quickly lying down on a bench in the supine position with the head overhang, the typical symptoms of dizziness, eye movements and possible nausea are triggered.
The symptoms begin about 10 seconds. after turning the head and are dependent on the speed of the induced movement. The patient must describe the symptoms in their various intensities (onset, increase, decrease in dizziness and nausea), the therapist assesses the eye movements after turning the head and lying down.
After the symptoms have subsided, the patient is slowly put back on. If the storage sample is repeated several times, the symptoms are exhausted.