What is BPPV?

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Our balance is controlled by the vestibular system in the inner ear. There are 3 semi circular canals in the inner ear, each lined with sensory hair cells and filled with fluid called endolymph. Normally as we move our head, the endolymph moves through the 3 semi circular canals, all positioned at different angles to detect different movements, which then stimulates the sensory nerve cells, sending the message to our brain exactly how far and how fast our head has moved.

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In BPPV there is a disturbance to this process. It is thought that tiny particles or crystals called otoconia (which are usually held elsewhere in the inner ear) become disturbed within the canals. This can then interfere with the flow of fluid and the stimulation of the sensory nerve fibres, transmitting misleading information that doesn’t match up with the movement of the head and other sensory information (eg the eyes detecting movement). These contradictory signals lead to the spinning sensation experienced in vertigo.

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Causes​

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The exact cause of BPPV is often unknown, although it is theorized that many cases are triggered by a viral infection shortly before the onset of symptoms or by head trauma.

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Diagnosis

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BPPV is usually easy to diagnose based on the symptoms and your recent medical history, and is easily differentiated from other types of vertigo. It is easily confirmed by provocation tests such as the Dix Hallpike manoeuvre that will be carried out in your assessment session. Note that these tests may temporarily set off your symptoms so in severe cases it can be best to have somebody bring you in to your appointment.

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Treatment

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Once the diagnosis has been confirmed as BPPV, it is actually a relatively easy problem to treat.

The most effective treatments for BPPV are the repositioning manoeuvres. These involve your trained physiotherapist taking you through a specific sequence of movements designed to help move the tiny crystals out of the semi-circular canal and into areas of the vestibular system where they can no longer disturb the sensory hair cells.

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These repositioning manoeuvres have been shown in studies to settle upwards of 95% of true BPPV cases within 2-3 treatment sessions.

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While medication will give some relief from the symptoms of BPPV it does not fix the underlying cause of the problem. Many of our clients come to us after suffering from the symptoms for weeks even months and are amazed at how quick they can be resolved within such a short space of time with such an easy, inexpensive treatment.

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Your physiotherapist may teach you have to perform these manoeuvres at home and may also give you some other balance and vestibular rehab exercises to complete at home to minimise the chances of a recurrence although this is rare.

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Things to Remember

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• BPPV is a condition characterised by episodes of sudden vertigo when the head is moved.

• Common triggers include rolling over in bed, getting out of bed, and lifting the head to look up.

• BPPV can settle with time, but it is important to seek early treatment for swift resolution & to prevent falls or injury

• There are many other causes of vertigo including Meniere’s disease, vestibular neuronitis, labyrinthitis, acoustic neuroma or central disorders.

 

Some of these other causes will also benefit from a physiotherapy led, vestibular rehab program. However, some will require further investigation. If this is the case, or if your symptoms don’t respond to treatment you may be referred to a vestibular or ENT specialist who we liaise with closely.

 

For any vertigo issues, call or book your physiotherapy assessment online today.