Benign Paroxysmal Positional Vertigo
Benign Paroxysmal Positional Vertigo (BPPV) is a specific type of vertigo triggered by changes in the position of the head relative to gravity. This disorder is caused by issues in the inner ear. Individuals with BPPV experience repeated episodes of positional vertigo, characterised by a spinning sensation that occurs with head movement.
BPPV is the most common cause of vertigo, a key symptom of this condition. While the exact cause of BPPV is not fully understood, it is believed to occur when otoconia—small crystals of calcium carbonate—become dislodged from the maculae in the inner ear and enter the fluid-filled semicircular canals. These canals are sensitive to gravity, and changes in head position can trigger episodes of BPPV.
The posterior canal is the area most commonly affected, although the superior and horizontal canals can also be involved. It's important to note that the superior canal is sometimes referred to as the anterior canal, while the horizontal canal may also be called the lateral canal.
The most frequent cause of BPPV is idiopathic, which means the specific reason is unknown. However, degenerative changes in the vestibular system of the inner ear can occur with ageing, potentially contributing to BPPV development. For individuals under the age of 50, head injuries are a common cause. Other contributing factors can include vestibular viruses and Meniere’s disease. Additionally, BPPV may result from surgical procedures that involve prolonged periods of lying down or trauma to the inner ear.
The signs and symptoms of BPPV are usually brief, often lasting less than one minute. Episodes may resolve within a few weeks or months but can recur later. Patients commonly experience dizziness, a sensation of being off balance, and nausea. Symptoms are typically triggered by head movements, such as rotation, looking up, or getting up from a lying position.
BPPV can be easily diagnosed and treated through simple procedures in a clinical setting. Currently, the primary method of diagnosis involves thorough subjective screening, followed by physical examinations and specific diagnostic maneuvers to confirm the presence of BPPV. Early diagnosis is crucial, as it can significantly improve a patient's quality of life and reduce the risk of more serious injuries.
The Dix-Hallpike test is the most commonly used assessment to determine if the posterior semicircular canal is involved, as this is the canal most frequently affected. The test should be performed quickly to ensure proper displacement of the endolymph and otoconia, triggering the expected symptoms. A positive result, indicating canalithiasis of the posterior canal, occurs when the test provokes vertigo and short-duration nystagmus.
Physiotherapy treatment for BPPV can vary based on the affected canal, as well as the age and condition of the patient. All treatments involve the clinician moving the patient's head to reposition the otoconia back into the maculae, thereby reducing or stopping BPPV symptoms.
General practitioners can prescribe medication to alleviate the symptoms of BPPV; however, this does not address the underlying issue. At Ultimate Physio, we treat BPPV using various head maneuvers such as the Epley's Maneuver. Senior Chartered Physiotherapist and Clinical Owner Darragh Bolton has undergone specialised training in vertigo rehabilitation to assist you in overcoming your vertigo.
It is advised that if you are being treated for BPPV, you do not drive yourself to the appointment, as the treatment can provoke some symptoms. Ultimate Physio is conveniently located in Coral Leisure Tuam, Co. Galway.
© Copyright Ultimate Physio