What Is Benign Paroxysmal Positional Vertigo (BPPV)?
Benign Paroxysmal Positional Vertigo or BPPV is a common disorder of the inner ear which causes episodes of dizziness or vertigo. Within our inner ear is our vestibular or balance system. The vestibular system detects gravity, movement and motion and aids us to maintain correct balance. The two parts of the vestibular system responsible for sensing linear acceleration and gravity are the utricle and saccule. These parts contain tiny hair follicles and calcium-carbonate crystals called otoconia, which send signals to the brain to maintain bodily balance during movement.
BPPV occurs due to the displacement of otoconia within the fluid-filled semi-circular canals (SCC) of the inner ear. The SCCs are filled with fluid which move and help inform the body of the head’s location in space.
The SCC are part of the vestibular system of the inner ear and are referred according to their orientation: anterior, horizontal and posterior. Otoconia will occasionally drift into one of the SCCs, usually the posterior SCC given its orientation relative to gravity at the lowest part of the inner ear. When the head moves the displaced otoconia shift within the fluid, and the subsequent stimulus is unbalanced with respect to the opposite ear, inappropriately causing symptoms of dizziness, spinning, and/or swaying. Hence, symptoms of BPPV are profound with movement.
Approximately 50% to 70% of BPPV cases occur with no known cause and are referred to as primary or idiopathic BPPV. The remaining cases are called secondary BPPV and are often associated with an underlying pathology, such as head trauma, vestibular neuronitis, labyrinthitis, Ménière disease, migraine, ischemia, and iatrogenic causes. The most common cause of secondary BPPV is a head injury, accounting for 7% to 17% of BPPV cases.
Risk Factors for Benign Paroxysmal Positional Vertigo (BPPV)
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- Female
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- Age – degeneration
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- Hypertension
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- COPD
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- Infection
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- Migraine
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- Menopause
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- Falls
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- Hyperlipidaemia
Symptoms
Benign Paroxysmal Positional Vertigo (BPPV) symptoms include:
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- Vertigo – triggered by any action which stimulates the posterior semi-circular canals such as tilting the head, rolling over in bed, looking up or down, sudden head movements
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- Loss of balance
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- Nausea and vomiting
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- Visual disturbance – due to nystagmus
Treatment
Even though Benign Paroxysmal Positional Vertigo (BPPV) may resolve spontaneously, research has found a series of specific head movements or canalith repositioning procedures (CRP) to be the gold standard for the treatment of BPPV. CRPs may result in resolution of symptoms in 80% with a single application, and in up to 92% with a repetition.
The most effective CRP is the Epley Maneuver, which focuses on moving the otoconia out of the SCCs. The Epley Maneuver may be attempted by the patients themselves at home. Adding self-treatments at home after the CRPs performed at the office/clinic is more effective than the office/clinic-based CRPs alone. Ask us in your next appointment at Logan Physio. Book an appointment today.
