BPPV (Benign Paroxysmal Positional Vertigo)
Benign Paroxysmal Positional Vertigo (BPPV) is an inner ear condition and the most common cause of vertigo. Vertigo is a symptom of BPPV where it feels as though the environment around you is spinning.
BPPV arises when one of the many tiny calcium crystals (otoconia) in our inner ear gets displaced and ends up in the fluid-filled semi-circular canals or an adjacent structure called the cupula. If the crystals are within the canals this type of BPPV is called ‘Canalithiasis; if it is stuck to the cupula it is called ‘Cupulolithiasis’.
The semi-circular canals and cupula help provide important information to your brain about the movement of your head in relation to gravity. Movement of the head can often cause an otoconia, which is present within the canals or cupula, to further disrupt these sensitive structures and lead to inconsistent signals being relayed to the brain. Ultimately this leads to BPPV symptoms.
BPPV is a result of wandering crystals within our inner ear’s semi-circular canals. The reasons for dislodgement of these crystals can vary however BPPV is largely considered to be an idiopathic condition, meaning there is no known cause. Some known causes for BPPV are trauma to the head, lying on your back for prolonged times or trauma to the inner ear via surgery.
Other risk factors for BPPV include:
Being >50 years old due to possible degenerative changes to the inner ear
Inner ear diseases such as labyrinthitis and Meniere’s disease
High blood pressure or cholesterol
The most common symptoms of BPPV are vertigo, dizziness, loss of balance/unsteadiness and nausea/vomiting. The severity of symptoms varies from person to person however their onset is commonly due to a certain change in head position. The aggravating head movement also tends to vary between people.
BPPV symptoms are not usually permanent and tend to last less than one minute. The symptoms an individual displays in terms of type, severity, onset, and settling time can help a practitioner to classify the type of BPPV an individual is experiencing.
Physiotherapists can readily diagnose BPPV in-clinic without the need of imaging. This is done by taking a full detailed history of your condition, which also helps to rule out other inner ear or hearing/balance disorders. Afterwards, a physical examination and diagnostic manoeuvres which aim to provoke symptoms will be done to confirm a BPPV diagnosis.
These diagnostic manoeuvres are made to provoke your symptoms so they can be quite uncomfortable but that is normal. Once a BPPV diagnosis is confirmed, a treatment manoeuvre can be done usually right away.
BPPV can be treated by physiotherapists in-clinic as soon as a diagnosis is confirmed. Treatment includes a physical manoeuvre (called the Epley’s and Semont manoeuvres) which aims to reposition the patient in a way that will clear the wandering crystals out from the cupula or semi-circular canals. Studies have shown that these manoeuvres can resolve most a patient’s vertigo symptoms after one session. However, on average it takes 2-3 sessions for symptoms to completely resolve.
Other important aspects of treatment include:
Activity modification and temporary positional restriction to prevent further aggravation and recurrence of your symptoms.
Exercises to help your body to become accustomed to aggravating head movements.
Balance training exercises.
Surgical intervention is also possible however conservative management such as physiotherapy should be the first line of treatment as the majority of BPPV cases are successfully treated through these repositioning manoeuvres.
It is common for BPPV to reoccur down the line, if you feel you are experiencing familiar BPPV symptoms then it is better to get physiotherapy treatment earlier than later.
For more information, please call to book in for advice and management from your physiotherapist.
Prim-Espada, M. P., De Diego-Sastre, J. I., & Pérez-Fernández, E. (2010). Estudio metaanalítico de la eficacia de la maniobra de Epley en el vértigo posicional paroxístico benigno [Meta-analysis on the efficacy of Epley's manoeuvre in benign paroxysmal positional vertigo]. Neurologia (Barcelona, Spain), 25(5), 295–299.
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