Written By Ali (Physiotherapist)
Benign Paroxysmal Positional Vertigo (BPPV)
Feeling the room spin while you stand up or roll over in bed? This false sensation of spinning could be a condition called Benign Paroxysmal Positional Vertigo (BPPV). BPPV is the most common cause of dizziness in elderly people (over 60). BPPV is the most common cause of vertigo which causes a false sensation of spinning.
How and why does it happen?
We have 3 semicircular canals: posterior, anterior and horizontal. They measure where our head is in space. BPPV occurs when the naturally occurring small crystals in our inner ear are dislodged into these canals. When they fall into the canals, they inappropriately trigger the canals to fire. One ear is providing feedback to the brain that our head is moving when it is not. This results in vertigo.
There are a few reasons that might cause these crystals (otoconia) to dislodge. Trauma (car accident, whiplash, fall), middle ear infection, degeneration, prolonged surgery and dental treatment. However, the cause is idiopathic in most cases (no known cause).
Where can I get tested?
BPPV often goes undiagnosed – particularly in the elderly population – as most people believe it is a normal part of ageing. A Physiotherapist can perform a physical assessment by performing a manoeuvre to assess vertigo symptoms and confirm the diagnosis – which is the gold standard! Diagnostic imaging is not indicated.
Can this go away?
Good news! Physiotherapy can help.
If you have been diagnosed with BPPV, recovery rates are usually good following advice and education. A repositioning manoeuvre is performed aiming to direct dislodged contents out of the canals so they can no longer trigger vertigo. 90% of cases are successfully managed with two repositioning manoeuvres. If the symptoms reoccur (up to 50% reoccurrence rate within 5 years) just get back into your repositioning manoeuvres.
In 2014, a study was conducted and showed that 100% of patients recovered after five sessions with their physiotherapist treating BPPV. If you’re unsure if you have the condition, or want to get it fixed, book in with one of our physiotherapists today!
1Shim, D. B., Song, C. E., Jung, E. J., Ko, K. M., Park, J. W., & Song, M. H. (2014). Benign paroxysmal positional vertigo with simultaneous involvement of multiple semicircular canals. Korean journal of audiology, 18(3), 126–130. https://doi.org/10.7874/kja.2014.18.3.1262Parnes, L. S., Agrawal, S. K., & Atlas, J. (2003). Diagnosis and management of benign paroxysmal positional vertigo (BPPV). CMAJ : Canadian Medical Association journal = journalde l’Association medicale canadienne, 169(7), 681–693.3Lorne S. Parnes, Sumit K. Agrawal and Jason Atlas.Diagnosis and management of benign paroxysmal positional vertigo (BPPV). CMAJ. September 30, 2003; 169 (7)4. Power L, Murray K, SzmulewiczDJ. Characteristics of assessment and treatment in Benign Paroxysmal Positional Vertigo (BPPV).J Vestib Res. 2019 Dec 13.[QxMDMEDLINE Link].5Hornibrook J. (2011). Benign Paroxysmal Positional Vertigo (BPPV): History, Pathophysiology, Office Treatment and Future Directions.International journal of otolaryngology,2011, 835671. https://doi.org/10.1155/2011/8356716Reinink, H., Wegner, I., Stegeman, I., & Grolman, W. (2014). Rapid systematic review of repeated application of the epley maneuver for treating posterior BPPV.Otolaryngology–head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery,151(3), 399–406. https://doi.org/10.1177/0194599814536530Benign: non-life threateningParoxysmal: brief, sudden episodes of vertigoPositional: changes in head position trigger symptomsVertigo: false sensation of spinning