What is BPPV?
BPPV stands for Benign Paroxysmal Positional Vertigo and is usually characterised by an intense, brief episode of dizziness associated with head movement, often when rolling over in bed or getting up in the morning.
Benign – not life threatening or sinister
Paroxysmal – it comes on suddenly, but usually short lasting
Positional – triggered by certain head positions or movements
Vertigo – a false sense of spinning or dizziness
In our vestibular system, located in our ear, we have 3 canals in which fluid passes through stimulating tiny receptors that send messages to alert the brain of any head rotation or movements. The brain receives the messages and we can then adjust our eyes and posture accordingly. The normal fluid travelling within the canals do not react to gravity.
When BPPV occurs, a tiny crystal is formed and enters the vestibular system through one of the canals. As the crystal is heavier than the fluid moving through these canals, it reacts with gravity when our head is turned, causing the brain to receive a false message that the head is spinning at a much faster rate than what is happening. Therefore, there is a mismatch in messages between what the ears are sensing and what the eyes are seeing or how our body is reacting, resulting in a spinning experience or dizzy sensation.
What Are The Symptoms of BPPV?
The main and most common symptoms are a sensation that the room is spinning, dizziness, light-headedness, imbalance or nausea. These symptoms usually occur with change in body position. An external person will observe your eyes rapidly moving, this is known as nystagmus.
BPPV symptoms usually last a few seconds, this is until the crystal comes to rest in the canal due to gravity. It is important to know that BPPV will not give you constant dizziness that is unaffected by movement or a change in position. It will not affect your hearing or elicit neurological symptoms such as numbness, pins and needles, trouble speaking, weakness or difficulty co-ordinating your movements.
Why Do People Get BPPV?
The exact cause or reason for BPPV still is unknown; however, research has linked the following causes to cases of BPPV;
- Head injury
- Degeneration of the vestibular system in the inner ear due to ageing
- Damage caused by an inner ear disorder
- Illness such as the flu or viral symptoms
How is it Diagnosed?
Normal medical imaging (e.g. MRI) is not effective in diagnosing BPPV; however, a trained physiotherapist or doctor is able to assess a patient and diagnose the condition through a series of tests and head movements. A positive BPPV test returns when a patient displays nystagmus (rapid eye movements) and/or their dizziness symptoms. The most common manoeuvre to assess is called a Dix-Hallpike.
The aim of assessing and diagnosing is to reproduce your symptoms; therefore, it is advised that a patient be accompanied and driven to their appointment or that they are to wait in the waiting room after their treatment until they are safe to drive home.
How is it Treated?
Many patients are given medication for BPPV from their doctor; however, these medications usually just mask the symptoms.
Majority of cases can be corrected manually by your Enhance Physiotherapist. Once the affected canal is identified and the type of BPPV is determined, you will undergo the appropriate manoeuvre which makes use of gravity to guide the crystals back to the appropriate chamber where they are supposed to be. The most common manoeuvre is called the Epley Manoeuvre.
What Happens After Treatment?
Many studies have shown that the above technique has a high success rate after the first treatment. In some instances, the crystals may be more stubborn and require multiple treatments. There can also be more than one canal involved; however, only one canal can be treated at a time.
Even once the crystal has been successfully returned to the correct chamber, some people can be left with residual dizziness or fatigued feeling. Your Enhance Physiotherapist can give home-based exercises to address this.
Will it Come Back?
Unfortunately, BPPV is a condition that can re-occur periodically, especially those related to trauma. There are other conditions that can mimic BPPV symptoms, so it is always advisable to have a thorough assessment performed by an Enhance Physiotherapist and a diagnosis given before commencing treatment.
Peng You, R. I. (2019, February). National Center for Biotechnology Information. Retrieved from Benign Paroxysmal Positional Vertigo: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6383320/pdf/LIO2-4-116.pdf