Benign Paroxysmal Positional Vertigo and Physiotherapy

Jul5th 2018

Does rolling over in bed make the room spin? Does looking up to change a light bulb or down to tie your shoes send you spinning? It might be something called Benign Paroxysmal Positional Vertigo – or BPPV – and the good news is physiotherapy can help!

So, what does the BPPV mean anyways? Let’s break it down word-for-word.

Benign – not harmful in effect

Paroxysmal – a sudden recurrence of intensification of symptoms

Positional – related to or determined by posture

Vertigo – a sensation of spinning or whirling

The prevalence of BPPV in the general population is thought to be 2.4% but increases with age. It is seven times more common in persons over the age of 60 compared to persons from 18 to 39 years. In people over the age of 65, the incidence may be as high as 35% to 40%. BPPV is also more common in women than men of all ages.

What is the vestibular system?

The vestibular system is made up of 5 sensory organs in your inner ear that provides your brain with information about head position and movements. The 5 organs include 3 semicircular canals and 2 otoliths (the saccule and utricle). We have one of these systems in each ear and they are connected to the cochlea which is part of the hearing mechanism. The vestibular system is constantly providing information to your brain about head movements and static position.

What is BPPV?

In the otoliths, there are calcium carbonate crystals or otoconia that occur naturally. These ‘ear rocks’ are fixed to a membrane within the saccule and utricle. If they dislodge, the can move into one of the semicircular canals where they don’t belong. If this happens, the problem is called BPPV.

With BPPV, the dislodged otoconia can move when the individual moves their head in certain directions. This movement of the crystals can trigger incorrect information to be sent from the vestibular system to the brain, creating vertigo (spinning), uncontrollable eye movements (nystagmus), and often nausea.

The vertigo is usually short in duration (less than 60 seconds) and goes away if the person stays in the provoking position. Common movements done every day that can provoke vertigo associated with BPPV include turning over in bed, looking up to wash your hair, or tilting your head back in a dentist’s chair.

What causes BPPV?

The majority of BPPV cases (35%) have no known cause. Prior head trauma, which can be minor, is present in about 15% of cases. BPPV occurs in relationship with a variety of vestibular dysfunctions such as Meniere’s disease, vestibular neuritis, and ear surgeries. There is also a higher incidence of BPPV in people who experience migraines.

How is BPPV assessed?

Typically, two tests are performed in a clinic to look for otoconia in one or more of the semicircular canals. These tests are called the Dix-Hallpike and Head Roll tests. A test is considered positive if the patient experiences vertigo and involuntary eye movement while in the test position.

How is BPPV treated?

The first step in treating BPPV is assessing which semicircular canal the crystals have moved to. The Dix-Hallpike and Head Roll tests give us a very good idea which canal is affected. The basis of all of the treatment techniques is to move or ‘float’ the loose otoconia around the semicircular canal in order to reposition them in the saccule where they belong. The treatment usually takes about 10 minutes and when the correct treatment manoeuvre is used, the patient should see a complete resolution of their symptoms immediately.

How successful is the treatment?

Luckily, the various treatment techniques for BPPV are usually very successful. Many studies have demonstrated success rates of over 80% with one treatment. Some people require multiple treatments and rarely the BPPV can be difficult to resolve.

Can BPPV recur?

Yes – BPPV does recur in many persons. The recurrence rate has been reported as varying from 18% to 37%. It can recur at any time although, during the first year after treatment, the recurrence rate is highest. The good news is that BPPV is very treatable by the properly trained physiotherapist so there is no reason to suffer when the issue arises.

If you have symptoms of BPPV such as intermittent vertigo or dizziness, contact Peach Physiotherapy office in Chatham-Kent, Ontario at 519-358-7342 to schedule a 60 minute 1-on-1 assessment with one of our physiotherapists to help resolve your symptoms.