By Zachary Cronk. Physiotherapist
Vertigo can be debilitating and concerning when it comes on suddenly. Although there are many conditions that can cause vertigo, one such is benign paroxysmal positional vertigo (BPPV). It is called benign as there’s no great harm in having the condition/it isn’t life-threatening, paroxysmal as it is episodic and comes on time to time, positional as it is related to head position and vertigo as it causes a feeling of movement without physical movement.
BPPV is a condition arising from dysfunction in the inner ear which causes vertigo when moving the head. Episodes are typically brief and will last for several minutes but symptoms may linger for several days. To understand BPPV, the first place is to understand the vestibular system and how this works.
For more information look at Peripheral Vestibular Apparatus.
BPPV occurs as a result of displaced otoconia, which are small crystals of calcium carbonate inside the inner ear. The otoconia usually are situated in the Utricle and saccule however can become displaced and fall into the semicircular canals. These free-floating crystals impede the flow of fluid through the canals and give a false sense of movement leading to a feeling of vertigo. You may also feel the room spinning, which usually relates to the involuntary movement of the eyes (nystagmus).
The crystals can become dislodged through a number of mechanisms:
- Vestibular neuronitis
- Meniere’s disease
- Head trauma
- Ear surgery or ear infection
- Degeneration of the inner ear structures.
However, almost half of the people who suffer from BPPV the cause is idiopathic, meaning we don’t know the cause.
BPPV can be diagnosed by a trained and experienced physiotherapist. Your diagnosis will include a thorough medical history exam, special tests like a Hallpike-Dix test, and an oculomotor assessment.
Once Diagnosed, your BPPV can be treated using some simple exercises and otoconia repositioning tests such as an Eppley maneuver or Gufoni’s maneuver. These tests aim to reposition the otoconia crystals out of the semicircular canals and back into the utricle, where they can be reabsorbed thereby reducing the feeling of vertigo. While BPPV often will resolve by itself, it is important to be assessed and treated to help prevent falls and rule out any other causes for your vertigo.
If you are suffering from these symptoms, do not hesitate to book a session with one of our friendly physiotherapists. If you have any further questions, please contact us.
Argaet, E. C., Bradshaw, A. P., & Welgampola, M. S. (2019). Benign positional vertigo, its diagnosis, treatment and mimics. Clinical Neurophysiology Practice, 4, 97-111.
Khan, S., & Chang, R. (2013). Anatomy of the vestibular system: a review. NeuroRehabilitation, 32(3), 437-443. S. M. Highstein, R. R. Fay, A. N. Popper, editors (2004). The vestibular system. Berlin: Springer.
Kingma, H., & Van de Berg, R. (2016). Anatomy, physiology, and physics of the peripheral vestibular system. In Handbook of clinical neurology (Vol. 137, pp. 1-16). Elsevier.