Dizziness Benign Paroxysmal Positional Vertigo (BPPV)

The inner ear is like a shell with canals inside

All of a sudden you have vertigo, the room is spinning, it’s happened before and now it’s happening again. You know it won’t last long because it never does, but it’s horrible none-the-less. Benign Paroxysmal Positional Vertigo (or BPPV for those of us who never remember what the acronym means) is defined by episodes of vertigo lasting seconds to minutes, that usually come on with specific head movements like bending over, rolling over in bed and quick movements of the head. These episodes can be debilitating and can cause nausea and vomiting in some cases.

What is BPPV?

The most common type of vertigo, Benign Paroxysmal Positional Vertigo, is a condition of the inner ear which is part of the Vestibular system. A complex system, the easiest way to think of it is to consider your inner ear as a shell, made up of a labyrinth of canals that have crystals inside. Your inner ear provides information to your nervous system about where your head sits in space so you don’t fall over. A dislodgement of these crystals and their movement into the canals causes vertigo. This occurs for a variety of reasons including trauma, after a car accident, direct trauma for example concussion related or after an ear infection, but it is generally spontaneous and idiopathic with no cause, seen most commonly in people aged 50-70 yrs of age.

How is it diagnosed?

Once other potential causes for vertigo have been excluded, such as (this is not an exhaustive list) the effects of certain medications, neck troubles, orthostatic hypotension, Vetebral Artery Insufficiency or a central nervous system disorder, a detailed history is taken by your therapist and a diagnostic test called The Dix-Hallpike Maneuver is performed which will confirm your condition. Some cases require more investigation to identify which of the canals in your ear has been affected. With this test we look for nystagmus (involuntary rhythmic side-to-side, up and down or circular motion of the eyes) and reproduction of your dizziness. Which is why I always have a bucket handy in case of accidents.

Is BPPV dangerous?

Apart from being exceedingly uncomfortable and distressing especially if you don’t understand why it’s happening, BPPV is not life threatening. But it can significantly affect quality of life such as being able to drive, confidence with mobilising within the community and increase a persons falls risk.

How is it treated?

The Epley Maneuver

After your diagnosis the Epley manoeuvre is performed by the therapist. You will experience discomfort and dizziness initially with the treatment and may feel unwell for a period of time afterwards. Always tell your therapist if you experience side effects from treatment, and usually a few sessions are required to resolve the condition. In some cases there is recurrence, anywhere from 6 weeks to 6mnths is most common and as such touching base with the provider again is a good idea as generally prognosis is good with the right treatment. Things to avoid while you are receiving treatment include:

• lying flat; best to prop yourself upright for a nap or resting

• moving your head too quickly

• bending forwards, for example while gardening, best leave the weeds to grow for the week!

• avoiding the affected side in bed, so lie on the side that doesn’t cause dizziness

All in all the outlook is good for BPPV suffers and if you have any questions relating to our post whether it be for yourself or a friend please reach out to us via our social media platforms or book a consultation online with us via our homepage.