Benign Paroxysmal Positional Vertigo (BPPV)

By: Valerie Davi, SPT

            Benign Paroxysmal Positional Vertigo, also commonly known as positional vertigo or even more simply as BPPV,  is a condition that affects and challenges the vestibular system. This condition affects primarily the inner ear (one part of our vestibular system) and results in multiple bouts of positional vertigo.1 This is a long name that may sound  intimidating so let’s first break down all these four words to help better understand how this condition works.

1. Benign: meaning it is not life threatening
2. Paroxysmal: meaning the episodes are brought on suddenly and quickly
3. Positional: meaning that the episodes of vertigo are caused by certain positions of your head
4. Vertigo: which is that feeling or sensation of room spinning or you are spinning and is often accompanied by dizziness

            Most people who go to see their doctors about dizziness or room spinning often get the diagnosis of vertigo. They are then sent to physical therapists that specialize in vestibular rehabilitation, much like the therapists at the Willow Grove, Hatboro and Glenside Physical Therapy. But some patients do not get all the information as to why this condition happens, how to treat it or what BPPV even is. Let's begin with some general information about this condition!

1. BPPV is the MOST COMMON vestibular disorder when considering all ages1
2. Between 17 - 42% of people who have vertigo get the diagnosis BPPV1
3. Lifetime prevalence of BPPV is 2.4%1
4. Women are typically more affected than men1
5. Most common in individuals between their 50s and 70s1 (but it can happen to anyone)
6. Recovery can occur without treatment within 1 month in 20% of people with BPPV and 50% in 3 months (although we highly suggest getting treatment when possible)1
7. The effects of BPPV can put you at an increased risk of falls and affect how well you can perform everyday activities.1

How BPPV works

• While this can be quite a complicated process, here is a simplified version of what happens. In each side of our inner ears we have 3 canals and 2 otolith organs which are all connected (no one can actually see any of these structures because they are so tiny and so deep within our heads). Within these otolith organs there are otoconia crystals made of calcium carbonate. With BPPV, these crystals can get dislodged (the cause can be hard to determine) and end up in one of these 3 canals where they do not belong. This then leads the symptoms of room spinning, nausea and  sometimes vomiting. 

            Diagnosis:

• Based on the report you give us, we begin to do testing in order to rule out any other possible causes of vertigo, test your balance and assess your walking. We then begin positional testing specific for BPPV (Hallpike and Roll positions). The reason for this is because we are unable to see your inner ear; we have to use your eye movements in response to these different positions to be able to determine which canals the crystals are in.  We do this at Willow Grove, Hatboro and Glenside PT by using specialized goggles that give us an amplified picture of your eyes while you are completely in the dark throughout these positions.  Once that is determined we move on to the next step which is treatment!

            Treatment:

• Once we figure out where these crystals are out of place, we begin to use certain maneuvers (Canalth Repositioning Maneuvers, Barbecue Repositioning Maneuvers, Liberatory Maneuvers etc) to get these crystals out of the canals where they do not belong!
  • We also teach you how to do these treatments at home in case of a re-occurrence of BPPV
  • And if you are uncomfortable with self treatment you are always welcome to come into one of our offices for further treatment
• Another part of treatment is addressing balance!
  • Balance can be affected with BPPV so it is also important to make sure your balance is as good as it can be so that you are not at a risk of falling!
  • Some ways we can improve balance include:
    • Statically (sitting or standing) or dynamically (walking)
    • With eyes open and closed (closed typically makes maintaining your balance harder)
    • Using foam pads, hurdles and stepping blocks to really challenge your balance systems!
    • Strengthening your hips, knees and ankles as they are a part of maintaining your balance too!
  • Medications such as Meclizine/antivert which are vestibular suppressants are often ordered for patients, but according to the Clinical Practice Guideline for BPPV these cause more harm than good and are NOT indicated for BPPV as they may increase falls risk and do not correct the problem of displaced crystals. These medications are only beneficial for significant nausea. (1)

References:

1. Bhattacharyya N, Gubbels SP, Schwartz SR, et al. Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update). Otolaryngology–Head and Neck Surgery. 2017;156(3_suppl):S1-S47. doi:1177/0194599816689667
2. You P, Instrum R, Parnes L. Benign paroxysmal positional vertigo. Laryngoscope Investig Otolaryngol. 2018;4(1):116-123. Published 2018 Dec 14. doi:10.1002/lio2.230