Benign Paroxysmal Positional Vertigo (BPPV)
Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause of vertigo in adults. Despite the high incidence, it is rarely tested for in primary care settings. BPPV, however, can be successfully treated and resolved by physiotherapists that have had advanced training in vestibular rehabilitation therapy (VRT).
Mechanism of Dysfunction:
BPPV occurs when the small calcium carbonate crystals, called otoconia, break loose from the gel-like floor of the utricle. These crystals can then fall into one of the three semicircular canals where they will either float within the canal or get stuck at the end of the canal, on a region known as the cupula. When the otoconia move, they cause the cupula to move which, in turn, stimulates the vestibular nerve. A message is then relayed to the brain, telling you that you are moving, even though you are not.
Image courtesy of VeDA and T.C. Hain, with permission.
Symptoms:
Symptoms of BPPV include intermittent episodes of vertigo (a sense of you or the world spinning), dizziness, nausea and abnormal eye movements, known as nystagmus. These symptoms are often triggered by specific movements, such as turning over in bed or looking upwards. The episodes usually last less than one minute, once the head is still.
Etiology:
BPPV can be caused by rapid head movements, such as a whiplash injury after a car accident, a concussion, or a slip and fall. It can also occur spontaneously due to changes in the vestibular organs with age or after a recent viral infection that spreads to the inner ear.
Assessment and Treatment:
The assessment for BPPV involves determining into which semicircular canal the crystals have fallen. This is accomplished by carefully watching/recording (with the use of infra-red goggles) abnormal eye movements that occur during a series of head positions. If BPPV is diagnosed, treatment can begin within the same session. Using a series of movements called canalith repositioning maneuvers (CRP), the crystals can be moved around the canal and back onto the utricle. One of the most widely known maneuvers is the Epley maneuver, which treats one form of posterior canal BPPV. There are, however, actually numerous variants of BPPV, which is why a careful assessment by a qualified physiotherapist is needed to determine the best maneuver for your specific condition.
For more information on BPPV, please visit the Vestibular Disorders Association at vestibular.org