Benign Paroxysmal Positional Vertigo (BPPV)

What Is BPPV?

Benign – is not life-threatening
Paroxysmal – comes in sudden, brief spells
‍Positional – gets triggered by certain head positions or movements
Vertigo – sensation that the environment around you is spinning or moving

BPPV is the most common vestibular disorder among the general population. Each year approximately 9% of the population are expected to suffer from BPPV. It is a mechanical problem in the inner ear. Within the inner ear is an organ called the vestibular labyrinth which consists of 2 main structures:
1.    Semicircular Canals - these contain fluid and hair-like sensors that monitor the rotation of your head.
2.    Utricle and Saccule - these monitor our head movements and our head's position related to gravity. Inside these, there are calcium crystals (otoconia) that make you sensitive to gravity.

‍BPPV occurs when the crystals become dislodged and migrate into one or more of the 3 fluid-filled semicircular canals. These interfere with the normal fluid movement within the canals leading to altered sense of head motion and causing the inner ear to send false signals to the brain. This leads the semicircular canals becoming hypersensitive to changes in head position during normal movements, leading to dizziness with movement that can severely interfere with usual daily activities.

What Are The Symptoms Of BPPV?

Vertigo
Nausea & vomiting
Sense of disorientation
Imbalance  

These symptoms come on suddenly, usually with movement/change of position, and will be intense for seconds to minutes. You may have feelings of dizziness or instability at a lesser level once the main episode has passed.

How Does Physiotherapy Help?

Diagnosis:
Through a comprehensive history and a series of tests that involve moving the head into specific orientations. These tests aim to move the dislodged crystals within a canal and cause the eyes to move in a very specific pattern called nystagmus. At Vestibular Rehab we use Frenzel goggles to accurately check for nystagmus during these tests.

Treatment:
‍Based on findings from the exam, those with BPPV will then undergo a treatment technique called canal repositioning manoeuvres. These consist of a specific series of head movements to liberate and guide crystals out of the canal and back to where they should reside. The specific movements change depending on what canal is effected.  
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Your physiotherapist will also provide you with specific exercises to restore the balance to the vestibular system so that your sense of orientation and the stability of your vision particularly when moving your head improves and you feel more confident in your balance.

After the Session:
You may feel an instant change in your symptoms. Your physiotherapist will provide a structured program with exercises to complete at home. 89% of patients see a significant improvement in their symptoms after one session. On average patients will find significant or complete resolution to their symptoms following two or three sessions.