Benign Paroxysmal Positional Vertigo (BPPV)
Benign Paroxysmal Positional Vertigo (BPPV) is a disorder of the vestibular system (Fig 1), that effects an individual’s sense of balance and is very common, particularly present in the elderly population or in individuals who have suffered head trauma. It can account for approximately 50% of people over the age of 65, who complain of dizziness.
The inner ear (Fig 2) withholds a sophisticated system, which consists of three (3) semicircular canals, each filled with fluid, which detect the movements of your head. The information generated from these canals create messages which are sent to the brain. The brain registers and synthesises this information and results in compensatory eye movements to restore your sense of balance during head movements or head positional changes. These canals also play a major role in influencing an individual’s overall balance.
What are the symptoms?
As part of the vestibular system, there are little calcium carbonate crystals (known as otoconia), which are normally attached within a thick jelly-like substance. In cases of BPPV, these crystals can detach from the jelly-like substance (either through traumatic contact to the head or without no known cause, spontaneously) and migrate to any of the three canals. Whilst in the semi-circular canal (s) (Fig 3), the crystals can influence the movement of fluid within the canal which may lead to false information being transmitted to the brain about the movement and positioning of the head with respect to its surroundings. This can cause symptoms of dizziness, vertigo and/or nausea when your head moves in certain positions.
Individuals presenting with BPPV will commonly report that their symptoms are provoked by rolling over in bed, lying down from an upright position, standing up, and/or bending over forward and then looking up. The symptoms most commonly last less than one minute (<1 min). It is often associated with imbalance or unsteadiness during walking, once other visual symptoms are present.
This condition is diagnosed following a combination of reported findings described by the patient (as per above described symptoms) in addition to a positive finding during a Dix-Halpike test (Fig 4). This clinical test involves positioning the individual from a sitting position with his/her head turned towards one side, followed by the patient lying quickly backwards (supine) with the clinician supporting the patient’s head throughout the entire maneuver and allowing slight extension of the patient’s head over the end of the bed.
How do you treat this condition?
Your Physiotherapist or Doctor can treat this condition by moving your head through a number of different head and body positions.
The aim is to re-position or relocate the crystals back out of the semi-circular canals, where they will be re-absorbed by your body. The most common treatment option is called an ‘Epley Maneuver’ (Fig 5) or canalith repositioning maneuver. In some cases, an alternative maneuver may be required depending on which canal the crystals may have ended up. It is normal to feel your dizziness symptoms during or residually lasting short-term following the treatment technique.
It is important to follow directions provided by your treating physiotherapist or practitioner. It is recommended that you should not put your head down or position yourself lying down until you are ready to go to bed that night. It is not uncommon, for people to experience an exacerbation of their dizziness on the same day that they have received treatment.
Overall, the treatment has been found to be very effective in most cases. Many individuals have complete resolution of their symptoms within one to three treatments. As positive and promising as that may seem, it has been shown that a recurrence rate of up to 30% may occur in people. To minimise the risk of BPPV recurring, a home exercise program is usually provided to guide self-management and reduce the chances of dizziness or vestibular symptoms associated with BPPV from returning at any time in the future. Additionally, you may require to include or be provided with balance exercises to treat/restore any remaining balance problems once the BPPV issues have resolved.
Please contact your physiotherapist or contact Ferry Rd Physio clinic at the details provided, if you have any concerns at all.
NOTE: Avoid self-diagnosing and refer yourself to a qualified clinician to assess and deliver appropriate and safe treatment strategies, before directing independent management and potentially causing further aggravation of symptoms or increasing health risks.
Note: Please avoid self-diagnosis of this condition, if you feel that these symptoms are provoked in this fashion, as there are various medical conditions that may present with similar symptoms. Always consult a health professional if you have any concerns regarding dizziness or balance issues.
APA Sports and Exercise Physiotherapist
APA Musculoskeletal Physiotherapist