Benign Paroxysmal Positional Vertigo (BPPV) is the most common inner ear problem and cause of vertigo (a false sense of spinning). Each word in the name ‘BPPV’ is important in describing the condition:
- Benign means it is not life-threatening, even though the symptoms can be intense and disabling.
- Paroxysmal means that the symptoms come in sudden, short spells.
- Positional means that certain head positions or movements trigger symptoms.
- Vertigo is the term used to describe the feeling that you are spinning or the world around you is spinning.
What causes BPPV?
There are crystals of calcium carbonate (otoconia) that exist as a normal part of our inner ear and help us with our balance and body motion. BPPV is caused by the crystals becoming ‘dislodged’ from their normal place and floating around in the wrong part of the inner ear. As the crystals move, they stimulate hair cells and nerves endings which then send inaccurate messages to your brain and body telling you that you are violently spinning when all you may have done is moved your head (eg as in lying down or rolling over in bed).
What are the most common symptoms?
Everyone can experience BPPV slightly differently but there are some very common symptoms. The most common symptoms are that of distinct, short-lived spells of vertigo or spinning lasting for seconds to minutes which are usually brought on by a change in head or body position (like moving from lying down to sitting up, rolling over in bed, looking upward or bending over). You may also experience nausea (and sometimes vomiting) and a sense of disorientation in space. You can have lasting feelings of imbalance and instability at a lesser level once the intense vertigo episode has passed.
How is BPPV diagnosed?
Medical imaging or medical laboratory testing cannot confirm BPPV. A vestibular physiotherapist can complete simple bedside testing to help confirm your diagnosis. The bedside testing requires the therapist to move your head into a position that allows the crystals to move and will subsequently make you feel dizzy. The testing may include hanging your head a little off the edge of the bed or rolling your head left and right while lying in bed. The therapist will be watching you for a certain eye movement to confirm your diagnosis. The most common tests are called the Hallpike-Dix test or the supine Roll test.
Can BPPV be treated?
Yes. Most BPPV cases can be corrected by your vestibular physiotherapist with bedside repositioning manoeuvres that usually only take a few minutes to complete. They have high success rates although sometimes the treatment needs to be repeated a few times. These manoeuvres are designed to guide the crystals back to their original location in your inner ear. They can be done immediately after the bedside testing for diagnosis has been performed. The Physio Clinic has several physiotherapists who are highly skilled at diagnosing and treating this condition.
For more information or to book an initial appointment, please call The Physio Clinic on 8342 1233.
Written by Kate Seeliger | Neurological and Accredited Vestibular Physiotherapist / Rehabilitation Team Leader at Prospect and Blackwood
Reference
Bhattacharyya N, Gubbels SP, Schwartz SR, et al; Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update). Otolaryngol Head Neck Surg. 2017; 156(3_suppl):s1-s47
