Balance Awareness Week to Defeat Dizziness- September 12 -18, 2016

What is BPPV?

Have you or a loved one ever experienced a short episode of motion induced dizziness or a spinning sensation after moving your head too fast? If yes is the answer, then you may be experiencing a condition related to motion-induced vertigo. One common type of vertigo is Benign Paroxysmal Positional Vertigo (BPPV). Benign Paroxysmal Positional Vertigo is a common disorder in adults that occurs in 2.4% of the general population. It is estimated that approximately 20% of patients who present with vertigo have BPPV. BPPV is characterized by a sudden onset of a spinning sensation that occurs with certain head movements. The onset of BPPV has been associated with trauma, migraine, inner ear infection, osteoporosis, and blood flow restriction to the inner ear.

The characteristics of Benign Paroxysmal Positional Vertigo, BPPV, can be derived from its name. The word “benign” refers to the fact the condition is not life threatening. “Paroxysmal” means the disorder is episodic, it presents in brief spells or a sudden onset. “Positional” indicates that the vertigo symptoms are triggered by specific head positions or movements. Common provocative positions are lying down, rolling in bed, bending over and looking up. Finally, “Vertigo” refers to the false sense of rotational movement or spinning sensation people experience. During an episode of vertigo, a reflexive eye movement called nystagmus can be observed.

The cause of BPPV can be related to a problem within the vestibular (balance) organ which is part of the inner ear, located deep inside the skull. The vestibular organ is composed of 3 semi-circular canals which control our sense of motion. In people without BPPV, calcium carbonate crystals or otoconia are attached to the utricle (balance organ) deep inside the inner ear. The attachments of these tiny crystal particles can weaken and break as a result of age, trauma and blood flow restrictions. Typically, when the calcium particles break away the body is able to reabsorb them and no symptoms are produced. However, in some cases, the calcium crystal particles migrate and become stuck inside the semicircular canals sensing motion. While stuck in the canals, the particles activate the nerve endings in the canals which result in a false signal that the head is moving. This false information is recognized as the characteristic of a spinning sensation or vertigo.

Traditional methods, such as MRI and X-ray, are not effective in diagnosing benign paroxysmal positional vertigo. To diagnosis BPPV, a trained practitioner takes the patient through a series of specific head movements assessing for a provocative position that reproduces the patient’s dizziness. Diagnosis is confirmed by the presence of reflexive eye movements called “nystagmus,” which allows the clinician to determine the semi-circular canal affected by the calcium particles.

The majority of BPPV cases can be treated mechanically using canalith repositioning maneuvers. The canalith repositioning maneuver is comprised of specific head movements used to guide the calcium crystals out of the canals and into the correct chamber (utricle). Once the crystals have been moved out of the canals, patients should experience a reduction or abolishment of symptoms. The most common repositioning maneuver is called the Epley maneuver. The maneuver is comprised of 4 positions that the patient maintains for 30-60 seconds each. Research has shown that the Epley maneuver for BPPV can eliminate vertigo symptoms in 1-3 visits in 90% of patients. In the case dizziness is not related to BPPV, a larger comprehensive evaluation can be completed to determine if therapy is appropriate. Other forms of vertigo and dizziness related to the vestibular nerves or the brain may result in longer treatment times.

At Goodlife Physical Therapy in Orland Park we are committed to using an effective, evidence-based approach to vestibular rehabilitation. At our Dizzy and Balance center, we treat a high number of patients with BPPV and other vestibular disorders with successful results. To speak with a qualified Physical Therapist, please contact Goodlife Physical Therapy for more information regarding Vestibular Rehabilitation at 708-966-4386. For more information visit www.goodliferehab.com.

Author: Steven Tijerina PT, DPT

References:

Woodhouse, S. BENIGN PAROXYSMAL POSITIONAL VERTIGO (BPPV). Vestibular Disorders Association. www.Vestibular.org