Benign Paroxysmal Positional Vertigo (BPPV)
What is BPPV?
BPPV is the most common cause of vertigo and refers to a condition of the vestibular system where small calcium carbonate crystals, called “otoconia”, dislodge from within the inner ear and collect in one or more of the semicircular canals (posterior, anterior or horizontal canal). The semicircular canals are sensory organs filled with fluid that register movements of the head such as tilting and turning. As the otoconia move around within the semicircular canal due to gravity, they create turbulence of the fluid which results in a false sense of movement for the patient. This is commonly associated with vertigo, which is a rotary or spinning sensation that usually lasts a few seconds to a couple of minutes.
B – Benign: This means the condition is non-progressive and cannot directly develop into a more life-threatening disease.
P – Paroxysmal: This refers to the fact that the symptoms are intermittent and sudden in onset.
P – Positional: Vertigo episodes are brought on by changes in head position, such as rolling over in bed, going from sitting to lying or bending forward to pick something off the floor.
V – Vertigo: The main symptom of BPPV is vertigo, which is a false sensation of spinning or rotation.
What causes BPPV?
We still don’t fully understand what causes BPPV to occur in most cases. We know that some cases are associated with head trauma, such as car accidents or sports concussions, which result in the otoconia dislodging from their attachments due to direct force. In most cases however, there has been no direct trauma to the head and the actual cause is unknown and may just be due to weakening of the otoconia’s attachments over time. BPPV is very common and does have a higher incidence in older age groups.
What are the symptoms of BPPV?
As the name suggests, the predominant symptom of BPPV is intermittent episodes of vertigo (spinning sensation), that occurs with changes in head position. These episodes usually last between 30 seconds and 2 minutes and settle when the head is kept stationary. Often, people with BPPV also report vague symptoms of dizziness and/or unsteadiness throughout the day between these attacks.
How is BPPV diagnosed?
BPPV is diagnosed by a vestibular physiotherapist who takes the patient’s head through a range of different positions while assessing for any abnormal movements of the eyes. During these “positional tests” the patient wears a pair of specially designed goggles called “frenzel goggles”, which have an infra-red camera to track the eye. The reason why the vestibular physiotherapist assesses eye movement is that the vestibular system has a direct connection to the muscles that control the position of the eye, which normally functions to keep vision stable. Any abnormal signals from the vestibular system can therefore be tracked by looking at the movements of the eye.
How is BPPV treated?
BPPV is usually treated easily through a series of gentle repositioning manoeuvres (such as the Epley manoeuvre), where the vestibular physiotherapist carefully places the head into several sequential positions to encourage the otoconia to exit the semicircular canal. The otoconia then either return to their usual position within the inner ear or are reabsorbed by the body. Most cases of BPPV can be resolved within the first consultation, with one follow-up appointment required to ensure the condition is resolved. Some cases require several treatments, particularly those associated with a history of head trauma or where otoconia are in multiple canals.
Our vestibular physiotherapist Justin has undergone extensive training in the rehabilitation of dizziness and balance conditions including BPPV.
If you would like to ask Justin a question about BPPV or anything else, visit our Contact Us page to get in touch.
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