Benign Paroxysmal Positional Vertigo: Causes and Treatment

What is BPPV?

Benign Paroxysmal Positional Vertigo (BPPV) is a condition primarily caused by issues related to the inner ear's balance system. The exact cause of BPPV can sometimes be challenging to pinpoint, but there are common causes and risk factors associated with BPPV.

The good news is that this condition is non-life-threatening and, once diagnosed, can easily be managed.

What Causes BPPV?

1. Otoconia Displacement: The most widely accepted cause of BPPV is the displacement of tiny calcium carbonate crystals known as otoconia within the semicircular canals of the inner ear. This displacement can disrupt the normal flow of fluid in the canals, resulting in issues with balance and spatial awareness and causing an uncomfortable sensation of "spinning" in our heads.

2. Head Trauma: Trauma to the head, such as a blow to the head or a motor vehicle accident, can dislodge otoconia within the inner ear, leading to BPPV.

3. Age-Related Changes: BPPV becomes more prevalent with age, as the inner ear structures and balance system may deteriorate over time.

4. Viral Infections: Some studies suggest that viral infections affecting the inner ear, such as vestibular neuritis or labyrinthitis, can lead to BPPV.

5. Ear Surgery or Ear Disorders: Ear surgeries or chronic ear disorders can disrupt the inner ear's delicate structures and potentially lead to BPPV.

6. Idiopathic: In some cases, the cause of BPPV may remain unknown, and it is referred to as idiopathic BPPV.

It's important to note that while these factors are associated with BPPV, the condition is highly treatable with interventions like the Epley maneuver and Brandt-Daroff exercises, both of which can be guided by a healthcare provider or physical therapist.

If you suspect you have BPPV, seek professional evaluation and appropriate management based on your specific condition and medical history.

Anatomy of BPPV

Nestled between the cochlea and the semicircular canals is a region known as the vestibule. It houses the body's balance organs—the saccule and the utricle. These organs contain hair cells that are covered with a jelly-like substance and "crystals," which are also referred to as otoconia or otoliths.

Semi Circular Canal

When these crystals break away, they disturb the ear's balance system. They cluster and bend the hair cells, which sends conflicting signals to the brain. Consequently, this leads to problems with our balance and spatial awareness.

The Role of Physical Therapy

So, what can you do if BPPV suddenly affects the way you move? That's where physical therapy comes into play.

Physical therapists expertly guide you through specific techniques to relocate those wayward crystals to their proper position.

These maneuvers, like the Epley or Semont maneuver, are designed to reposition the crystals and relieve vertigo symptoms. The beauty of physical therapy is that it offers a non-invasive, drug-free solution to BPPV. It's a quick and simple process that puts you back in control of your balance.

Here are the steps to perform the Epley's maneuver:

Important Note: Before attempting Epley's maneuver, it's advisable to consult with a healthcare professional or physical therapist who can properly diagnose BPPV and guide you through the procedure if necessary.

Step 1: Preparation

• Sit upright on a bed or examination table with your legs extended in front of you.

• Identify which ear is affected by BPPV (left or right).

  
  

Step 2: Head Turn to the Affected Side

• Begin by turning your head 45 degrees toward the side where you're experiencing vertigo. For example, if it's your right ear, turn your head 45 degrees to the right.

  

  
  

Step 3: Quick Transition to Lying Down

• Quickly lie down with your head on the bed or table while keeping your head turned at the 45-degree angle. Your shoulders should now be touching the surface.

  
  

Step 4: Wait for 30 Seconds

• Remain in this position with your head turned for approximately 30 seconds to one minute or until symptoms subside, whichever comes first. This allows any displaced otoconia to move within the affected semicircular canal.

  
  

Step 5: Head Turn to the Opposite Side

• Keeping your head still, turn it 90 degrees in the opposite direction. So, if you started with a 45-degree turn to the right, you'll now turn it 90 degrees to the left. Your head will now be facing the opposite direction.

  
  

Step 6: Wait for 30 Seconds

• Stay in this position for another 30 seconds. This helps further guide the displaced otoconia through the canal.

  
  

Step 7: Roll Onto Your Side

• Now, slowly roll your entire body, including your head, so that you're lying on your side and tuck your chin towards your chest.

  
  

Step 8: Return to Upright Sitting Position

• Finally, slowly sit up with your legs hanging off the bed or table. Keep your head in the same position (facing downward) for a few moments, then slowly lift your head to a level, upright position.

  
  

Step 9: Rest

• Sit quietly for a few minutes to allow any remaining dizziness to subside. It's common to experience some brief dizziness during this process.

Epley's maneuver is usually effective after one or two repetitions. .

While Epley's maneuver is safe for most people, it may not be suitable for individuals with certain medical conditions or neck problems. Always consult a healthcare provider for proper evaluation and guidance.

Some extra recommended tips are to sleep at a 30-45 degree angle for the following 1-2 nights. This allows ample time for your vestibular system to readjust to the changes.

Conclusion

While BPPV can sometimes be a scary and frustrating experience, remember that it typically can be resolved within a few days of repeating the technique mentioned above.

References

Kim JS, Zee DS. (2014) Benign Paroxysmal Positional Vertigo. New England Journal of Medicine.

Von Brevern M, Radtke A, et al. (2007) Epidemiology of Benign Paroxysmal Positional Vertigo: A Population Based Study. Journal of Neurology, Neurosurgery & Psychiatry.