Benign Paroxysmal Positional Vertigo
Benign paroxysmal positional vertigo (BPPV) is a condition characterised by episodes of sudden and severe vertigo (dizziness) when your head is moved around. Common triggers of your vertigo or dizziness include rolling over in bed, getting out of bed, and lifting your head to look up.
BPPV tends to come and go for no apparent reason. An affected person may have attacks of vertigo for a few weeks, then a period of time with no dizziness symptoms at all.
BPPV is caused by particles within the balance organ of your inner ear. Usually, BPPV affects only one ear.
Other names for BPPV include benign postural vertigo, positional vertigo and top shelf vertigo (because you get dizzy looking up).
Vertigo or Dizziness?
Vertigo or dizziness, are symptoms rather than a disease. Vertigo refers to the sensation of spinning or whirling that occurs as a result of a disturbance in your balance (vestibular) system.
Vertigo may be used to describe feelings of dizziness, lightheadedness, faintness, and unsteadiness. The sensation of movement is called subjective vertigo and the perception of movement in surrounding objects is called objective vertigo.
Vertigo usually occurs as a result of a disorder in the vestibular system (structures of the inner ear, the vestibular nerve, brainstem, and cerebellum).
Your vestibular system is responsible for integrating sensory stimuli and movement and for keeping objects in visual focus as the body moves.
When your head moves, signals are transmitted to the labyrinth, which is an apparatus in the inner ear that is made up of three semicircular canals surrounded by fluid. The labyrinth then transmits movement information to the vestibular nerve and the vestibular nerve carries the information to the brainstem and cerebellum (areas of the brain that control balance, posture, and motor coordination).
The most common cause of dizziness is BPPV. Others include: Inflammation in the inner ear, Meniere's disease, neck joint dysfunction, vestibular migraine and acoustic neuroma. Rarely, vertigo can be a symptom of a more serious neurological problem such as a stroke or brain haemorrhage.
What are the Symptoms of BPPV?
The symptoms of BPPV can include:
- Sudden episodes of violent vertigo.
- Dizziness and/or nausea.
- Movements of your head trigger the vertigo.
- Your vertigo may last half a minute or more.
- Your eyes may drift and flick uncontrollably (nystagmus).
What Causes BPPV?
Inside your inner ear there is a series of canals filled with fluid. These vestibular canals are at different angles. When your head is moved, the rolling of the fluid inside these vestibular canals tells the brain exactly how far, how fast and in what direction your head is moving.
BPPV is caused by little ‘ear rocks’ or otoconia (calcium carbonate crystals) within the vestibular canals.
Usually, these crystals are held in special reservoirs within other structures of the inner ear (saccule and utricle). It is thought that injury or degeneration of the utricle may allow the ‘ear rocks’ to dislodge and escape into the balance organ and interfere with your vestibular system.
What Causes Your ‘Ear Rocks’ to Dislodge?
Factors that may cause or allow ‘ear rocks’ to migrate into your vestibular canals include:
- Head or ear injury.
- Ear surgery or ear infection, such as otitis media.
- Degeneration of the inner ear structures.
- Vestibular neuritis (viral infection of the inner ear).
- Meniere’s disease (disorder of the inner ear).
- Some types of minor strokes.
In around half of BPPV cases, the cause of your BPPV can’t be found. This is known as idiopathic BPPV.
How is BPPV Diagnosed?
Dizziness and vertigo are common to a wide range of medical conditions, so careful differential diagnosis is important. Your physiotherapist or doctor may use several tests to diagnose BPPV.
What is the Treatment for BPPV?
‘Ear Rock’ Relocation Techniques
After assessing, you and confirming BPPV, your BPPV trained physiotherapist will apply specific techniques to relocate the "ear rocks" to an area in the inner ear that doesn't stimulate your feelings of dizziness or vertigo.
How Successful is BPPV Treatment?
When BPPV techniques are performed correctly, reduction of your vertigo, dizziness and other symptoms of BPPV is immediate in 80% or more of cases. Quality BPPV practitioners have a 90%+ success rate within three applications of the techniques.
Other BPPV Treatment Options?
Due to BPPV being caused by the physical presence of ear rocks within your vestibular canal, only relocation of these ear rocks will clear your symptoms. You may find some drugs can help you mask your BPPV symptoms by diminishing your sensitivity your vestibular symptoms. They work in a similar fashion to sea sickness medications. Please discuss this medicated option with your doctor.
BPPV Surgery
Occasionally conservative BPPV treatments fails. If the symptoms continue for more than 12 months, an operation may be needed. Generally, the nerve that services part of the balance organ (posterior semicircular canal) is cut. The risks of this type of operation include hearing loss. Your ENT (Ear Nose Throat) surgeon is the best person to discuss this option.
Who Performs BPPV Treatment?
Some vestibular physiotherapists and doctors are trained in the assessment and treatment of BPPV. BPPV-trained physiotherapists undertake specific training to diagnose and successfully treat BPPV. PhysioWorks has several BPPV trained physiotherapists. Please call them to book your appointment with a BPPV physiotherapist.