What is Vertigo? A closer look at Benign paroxysmal positional vertigo (BBPV)
What is it BBPV Benign paroxysmal positional vertigo (BBPV)?
BBPV is a common disorder within the inner ear, causing symptoms of dizziness, unsteadiness, and nausea.
Within the inner ear, there are 3 fluid-filled semi-circular canals that sense the rotational movement of the head. However, when an otoconia (calcium carbonate crystal) from the utricle moves into one of the semi-circular canals, it causes inappropriate movement, resulting in vertigo symptoms. This commonly occurs when there is a sudden movement of the head, e.g., rolling over in bed.
What are Vertigo Symptoms of BPPV:
- Spinning sensation lasting approximately less than 60 seconds
- Nausea/Vomiting
- Loss of balance
- Visual disturbance
How can Physiotherapy help Vertigo?
After getting to know you, your Physiotherapist will ask a series of questions about when your symptoms started, what triggers your symptoms, and how long your symptoms last. From there, the Physiotherapist will do a series of visual, balance, and vestibular tests to determine your best treatment. The testing aims to trigger your symptoms so your Physiotherapist can better determine which semi-circular is affected. With a confirmed BPPV diagnosis, a manoeuvre called “Epley’s” (as seen in Figure 2) will help reposition the otoconia to its correct location. This manoeuvre will be performed 1-3 times in the clinic, and then you may be able to do a modified version at home until your symptoms have subsided for 24 hours. Your Physiotherapist will follow up with you in 2-3 days to re-perform the manoeuvre as necessary.
After treatment in the clinic, following the instructions listed below is best to help minimize the risk of the otoconia displacing and dizziness returning.
- Wait in the clinic for about 10 minutes and avoid fast head/neck movement to allow the otoconia to settle into the correct position.
- Arrange for someone to take you home after treatment, if possible.
- Avoid any fast head/neck movement that will trigger the dizziness for the next 2-3 days post-treatment.
- Try to keep your head in a neutral position. Thus, avoid any far tilting of the head forward or backward. Therefore, avoid going to the hairdressers, barber, and dentist for 2-3 days post-treatment.
- Avoid sleeping on the affected side (the side that causes the dizziness) and avoid laying flat. It is recommended that you sleep at a 45-degree angle, which is best achieved with a recliner or pillows under your upper back and head.
References and pictures:
Andrea Radtke, Hannelore Neuhauser, Michael von Brevern, Thomas Lempert Neurologische Klinik, Charité Berlin, Germany, 1999.
Cleveland Clinic (2022), Inner ear, digital image, Cleveland 2022, accessed 11 April 2024, <https://my.clevelandclinic.org/health/body/24340-inner-ear>.
Timothy C. Hain, MD, Janet Odry Helminski, PHD, PT., (2000), Benign paroxysmal positional Vertigo, Northwestern University, Accessed 11 April 2024, < https://dizziness-and-balance.com/disorders/bppv/resources/BPPV_brochure.pdf>.
