PPPD – Persistent Postural Perceptual Dizziness
What is PPPD?
PPPD is a functional disorder, meaning that there is no physically damaged tissue causing the symptoms. It is characterised by persistent symptoms of dizziness, unsteadiness and hypersensitivity to motion (“visual vertigo”) and is often associated with underlying anxiety. This condition is very common and occurs in many patients after a precipitating event as explained below. There are three main types of PPPD:
Otogenic PPPD
• This is ongoing perceptual dizziness that persists after a specific inner ear condition has occurred and resolved. Inner ear conditions that may precede this type of PPPD include BPPV, vestibular neuritis/labyrinthitis and post-concussion syndrome.
• After the inner ear condition has resolved, there are changes to the brain’s perception of movement which leads to persistent symptoms.
Psychogenic PPPD (also sometimes called anxiety related dizziness)
• Persistent dizziness that begins without any precipitating medical event.
• This is likely a manifestation of a patient’s anxiety disorder and can be triggered by an event that acts as a psychological or social trigger, such as a period of high stress or anxiety.
Interactive PPPD
• This is a combination of the above two conditions, where a patient has a specific condition that affects the inner ear but also has a pre-existing anxiety disorder. The anxiety disorder affects the way the brain recalibrates during the recovery period after the vestibular condition, leading to persistent symptoms of perceptual dizziness after the original condition is resolved.
What are the symptoms of PPPD?
Typically, a patient will experience symptoms of dizziness, unsteadiness and/or rocking sensations without any spinning of their surroundings (vertigo). These dizziness symptoms typically worsen with movement or movement within the patient’s visual field (visual vertigo). Common activities that can provoke a person’s symptoms include shopping in a busy supermarket with people moving around them or looking at a computer, phone or television where there is movement of images or text on a screen.
How is PPPD diagnosed?
There is no one test that confirms a patient has PPPD. The diagnosis is made based on the characteristics of the patient’s symptoms, together with ruling out other conditions such as BPPV, vestibular neuritis/labyrinthitis and vestibular migraine. A vestibular physiotherapist can diagnose PPPD after a thorough assessment within the clinic. If further testing is also required, they are able to refer for these.
How is PPPD treated?
BPPV is usually treated through a combination of vestibular rehabilitation exercises, as well as cognitive behavioral therapy (CBT). This involves a series of physiotherapy sessions and home exercises that aim to recalibrate the body’s balance systems and de-sensitise the body’s response to challenging situations. If the patient is troubled by anxiety, the vestibular physiotherapist will also work closely with the patient’s GP and psychologist to ensure this is managed effectively.
Our vestibular physiotherapist Justin has undergone extensive further training for the rehabilitation of dizziness and balance conditions including PPPD.
If you would like to ask Justin a question about PPPD or anything else, visit our Contact Us page to get in touch.
If you are ready to make an appointment, visit our make a booking page and let us help you with your recovery.
Get Active!
For more, visit our Frequently Asked Questions page.
If you would like to ask a question about our services or anything else, visit our Contact Us page to get in touch.
If you are ready to make an appointment, visit our make a booking page and let us help you with your fitness or recovery.