Benign Paroxysmal Positional Vertigo, also known as BPPV, is one of the most frequent causes of vertigo. Vertigo is the sudden sensation of you spinning in space or objects around you spinning. BPPV is actually very treatable with physiotherapy treatment in specially trained physiotherapists who have taken additional courses on vestibular conditions.
What is BPPV?
BPPV is a disorder that impacts the inner ear, specifically the vestibular system, which controls balance and orientation. The symptoms of BPPV typically include:
- Sudden, brief episodes of dizziness
- A spinning sensation triggered by changes in head position (e.g., turning over in bed or looking up)
- Nausea, sometimes vomiting
- A feeling of light-headedness or unsteadiness
These symptoms can be quite distressing and when severe they can impact quality of life.
What Causes BPPV?
In our inner ear, we have small structures called otoconia, which are tiny calcium carbonate crystals. Otoconia help us detect gravity and motion. Normally, these crystals sit in a part of the inner ear called the utricle. In BPPV, some of these crystals become dislodged and move into the semicircular canals, where they don’t belong. Therefore, when you change the position of your head, the crystals shift and send false signals to the brain about your body’s position. The brain receives conflicting messages from the inner ear and the eyes, leading to vertigo.
Who Gets BPPV?
BPPV can affect people of any age, but it is more common in older adults, especially those over 50. Other risk factors include:
- Head injury
- Prolonged bed rest
- Ear infections
- Migraines
- Osteoporosis
How is BPPV Diagnosed?
Diagnosis of BPPV is primarily clinical, based on a patient’s symptoms and a physical examination. The most commonly used diagnostic test is the Dix-Hallpike maneuver. During this test, the physiotherapist helps you lie back quickly with your head turned to one side and slightly extended. If you have BPPV, this movement will trigger vertigo and nystagmus (a characteristic eye movement), confirming the diagnosis.
How Is BPPV Treated?
Vestibular physiotherapy for BPPV is non-invasive and focuses on simple, hands-on maneuvers designed to reposition the dislodged crystals back to their original location in the utricle. These treatments are usually highly effective, often resolving symptoms after just one or two sessions. There are two maneuvers commonly used in treatment. One is the Epley Maneuver that is the most widely used and more passive in nature. If this maneuver isn’t tolerated or does not work then the Semont Maneuver is commonly used, which involves moving a patient more rapidly from one side to the other. In addition to maneuvers performed, there are specific exercises prescribed to help maintain the progress achieved during the maneuvers.
Physiotherapy treatment for BPPV is safe and often very effective. It will involve a thorough assessment and history taking; balance and coordination testing; head and eye movement tests; the appropriate repositioning maneuver and education on symptoms, triggers, and prevention strategies. Relief is often immediate or within a few days. Some patients may feel slightly off-balance for a short period afterward, but this usually resolves.
In conclusion, BPPV is often very curable with proper diagnoses. It can recur, however the treatments only take a few sessions and usually provide relief for some time. If you or someone you know is struggling with dizziness, this could be the answer!