Benign Paroxysmal Positional Vertigo (BPPV)

BPPV

Benign Paroxysmal Positional Vertigo (BPPV or BPV) is a disorder of the inner ear that effects individuals’ sense of balance especially in older people.

Benign: means not serious cause

Paroxysmal: refers to the fact that dizziness comes in sudden short bursts usually lasting only few seconds

Positional: meaning onset is induced by change in position

Vertigo: is the medical name for Spinning sensation felt

Symptoms of BPV

• The main symptom is intense dizziness(vertigo) which lasts for 10- 20 seconds, but no longer than a minute.
• It is often associated with imbalance or unsteadiness during walking and nausea. The nausea may last an hour or so even though the vertigo lasts few seconds.
• Symptoms are provoked by a change in head position, example from rolling over in bed, bending down or looking up in a cupboard, lying down from an upright position, sudden head movements etc.
• In most cases, the symptoms resolve in a few weeks or months.

Diagnosis of BPV

• Diagnosis is based on the patient’s history and symptoms
• By performing positional test called the Dix-Hallpike manoeuvre. The clinical test involves patient sitting on a couch, and then the therapist will lie patient back supporting the patient’s head and moving in certain directions throughout. These set movements trigger an episode of vertigo if the diagnosis is BPPV.

Vestibular Treatment & Rehabilitation

The most common treatment option is called an ‘Epley manoeuvre ‘or canalith repositioning manoeuvre. Physiotherapist can treat this condition by moving patient’s head through a number of different head and body positions holding each position for about 30 seconds. The aim is to re-position or relocate the crystals out of the semicircular canals, where they will be re absorbed by patient’s body. It is normal for patient to feel dizziness symptoms during or residually lasting short term following the treatment.

Post Epley manoeuvre the following recommendations are advised in order to allow the otoconia to settle into their new position in the vestibule.

• Do not lie flat for 48 hours- use two pillows or sleep sitting in a chair
• Do not lie on the affected side for a week
• Try and avoid bending over, standing up too quickly or moving the head in jerky quick movements for a wee

Many individuals have complete resolution of symptoms in one to three treatments. A home exercise program is usually provided to guide self-management and reduce the chances of dizziness or vestibular symptoms associated with BPPV from returning anytime in the future.