Benign paroxysmal positional vertigo (BPPV) is a condition affecting the vestibular system which causes acute episodes of intense dizziness with positional changes of the head. The vestibular organ (depicted below) has three semicircular canals which are surrounded by fluid and relay information to the brain about the heads position in space. There are also crystals contained within the vestibular organ, which can get dislodged into the semicircular canals. The presence of the crystals within the canals causes the symptoms associated with BPPV.
Causes of BPPV and risk factors
In most cases the cause of BPPV is unknown, however it can be linked to the following:
Head trauma can cause the crystals to become dislodged into the semicircular canals and in this population, it commonly occurs on both sides
Age related changes to the vestibular organ
Previous history of BPPV
Meniere’s disease and vestibular neuritis have been shown to be strongly associated with BPPV
Placing the head in sustained positions
Signs and symptoms
Intermittent dizziness lasting less than 60 seconds
Vertigo sensation (often described as the room spinning)
Aggravated by head movements, typically to either the left or the right-hand side, rolling in bed or when looking up
Eased when the head is still
Nystagmus (irregular eye movement) associated with symptoms
What will an assessment with a vestibular physiotherapist involve?
A thorough background gained through a thorough subjective assessment
Clinical testing to rule out the influence of the brain and other vestibular conditions
Positional testing where nystagmus (eye movement) can be observed to determine which of the semicircular canals has been affected and hence which treatment is needed.
Specific positional techniques which are performed by a physiotherapist to relocate the crystals out of the semicircular canal and the technique used will be determined by which semicircular canals the crystals have located to.
Educational on strategies to avoid dislodging crystals after treatment.
After your BPPV symptoms have resolved you may require further physiotherapy or exercise physiology if you also have ongoing imbalance or an additional vestibular disorder in combination BPPV.
If you are currently experiencing symptoms of BPPV please book an appointment with a vestibular physiotherapist who will be able to perform a thorough assessment, provide an accurate diagnosis and appropriate treatment plan to address your condition.
BPPV Exercise Recommendations
We recommend undertaking a thorough assessment and working through a plan with a qualified physiotherapist/exercise physiologist that has undergone further training in vestibular rehabilitation to best ensure your BPPV exercises are prescribed and supervised appropriately. You would also need a proper assessment to validate a diagnosis before proceeding with treatment to ensue that you are moving with the right approach.