Vertigo… CAUGHT IN A SPIN CYCLE?

Do you experience a dizzy sensation in certain head positions? For instance, rolling over in bed or tilting your head down as if to tie your shoe? If so, you may have benign paroxysmal positional vertigo (BPPV).

Benign Paroxysmal Positional Vertigo (BPPV)

BPPV is a mechanical problem within the inner ear, characterised by a false sense of spinning and often triggered by rapid changes in head position with respect to gravity. It is explained by migration of degenerated calcium carbonate crystals (otoconia) into one or more of the three fluid-filled semicircular canals within the ear itself. BPPV is the single most common cause of dizziness in older adults and is more common amongst women. Provoking activities typically include lying down in bed, getting out of bed, rolling over in bed, bending over and looking up. Symptoms can last for weeks and can recur after remission.

Vertigo Risk Factors

A number of factors have been demonstrated to have strong correlation with the development BPPV:

• Head trauma – (e.g., concussion or whiplash)
• Recent Viral infection
• Advanced age

Clinical Features: Signs & Symptoms

The following are common signs and symptoms that typically occur while experiencing BPPV:

• Vertigo (spinning sensation)
• Light-headedness (sensation of giddiness)
• Nausea
• Motion sensitivity
• Imbalanced/Unsteadiness
• Nystagmus (abnormal rhythmic eye movements)

If you experience vertigo along with the following neurological symptoms, you must call the ambulance and undertake further medical assessment.

• Diplopia (double vision)
• Dysarthria (trouble speaking)
• Dysphagia (trouble swallowing)
• Dysmetria (incoordination)
• Dysesthesia (facial numbness)

How can Physio help with vertigo?

Assessment

BPPV can be diagnosed by your physiotherapist based on a comprehensive subjective history and physical examination, along with specific tests. Some of these tests are aimed at provoking and replicating your dizziness by placing your head in certain positions. Your physiotherapist will combine information about the position that provoked your dizziness and the direction of eye movements to establish which semicircular canal is the culprit.

 Treatment

Most people (about 90%) respond well with repositioning manoeuvres such as the ‘Epley Manoeuvre’ or ‘Semont Manoeuvre’ which are aimed at relocating the crystals out of the semi-circular canals using gravity. Research has demonstrated that repositioning manoeuvres are 80-90% effective on first visit. However, 1-3 treatments may be required to fully resolve symptoms particularly in cases where multiple canals are affected or if both ears are affected. It is normal to feel nauseous or feel your balance is “off” for a short period of time following treatment.

Post Treatment Recommendations

1. Wait at least 10 minutes after the manoeuvre before going home to allow your inner ear system to settle down. If possible, have someone drive you home.
2. Sleep semi-recumbent for the next two nights. This is most easily done by sleeping with two pillows appropriately stacked 45 degrees.
3. Avoid sleeping on your affected side.
4. Rise slowly from bed in the morning.
5. Avoid looking up such as at a high cupboard shelf or bending over to pick something from the floor.
6. Gradual exposure to motion and movement will help to speed your healing so it is important to move your head as normally as possible once your symptoms have settled.

Referral

There are very rare instances where BPPV does not respond to repositioning manoeuvres. If symptoms of continuous vertigo, severe ongoing headaches and progressive hearing loss develop, your physiotherapist may refer you to an Ear, Nose and Throat (ENT) specialist for further examination.

Can BPPV come back?

BPPV has a 15-20% recurrence rate. About 1/3 of people have a recurrence in the first year after treatment, and by five years, about 50% of people have a recurrence (Kim et al.,2021; Sakaida et al.,2003). A recent meta-analysis found that female gender, hypertension, diabetes mellitus, hyperlipidemia, osteoporosis, and vitamin D deficiency are risk factors for recurrences of BPPV (Chen et al.,2020). Should your vertigo return, it’s best to contact your physiotherapist as the crystals may have dislodged into a different canal, and consequently the repositioning technique performed may be different than before. You should NEVER attempt to reposition yourself unless cleared by your physiotherapist.

If you or someone you know is suffering from vertigo, please get in contact to see how our physiotherapists may be able to help you 🙂

References

1. Chen, J., Zhang, S., Cui, K., & Liu, C. (2020). Risk factors for benign paroxysmal positional vertigo recurrence: a systematic review and meta-analysis. Journal of Neurology, 1-11.
2. Kim, H. J., Park, J., & Kim, J. S. (2021). Update on benign paroxysmal positional vertigo. Journal of Neurology, 268(5), 1995-2000.
3. Sakaida, M., Takeuchi, K., Ishinaga, H., Adachi, M., & Majima, Y. (2003). Long-term outcome of benign paroxysmal positional vertigo. Neurology, 60(9), 1532-1534.
4. Shaughnessy, A. F. (2014). Epley Maneuver Effective in the Long Term for Positional Vertigo. American Family Physician, 90(9), 660.