What is BPPV?
In the otoliths, there are calcium carbonate crystals or otoconia that occur naturally. These ‘ear rocks’ are fixed to a membrane within the saccule and utricle. If they dislodge, they can migrate into one of the semicircular canals where they don’t belong. If this happens, then the problem that is caused is termed BPPV. In BPPV, the dislodged otoconia can move when the individual moves their head into certain positions. This movement of the crystals can trigger a nerve to send off erroneous information to the brain, creating the sensation of vertigo (spinning), abnormal eye movements (nystagmus) and usually nausea. The head movements that typically provoke the vertigo are looking up, looking down, lying down flat quickly and rolling over while lying down. The vertigo is usually short in duration (less than 60 seconds) and goes away if the person stays in the provoking position. Common movements in
everyday life that can provoke the vertigo associated with BPPV involve turning over in bed, looking up int a cupboard as well as tilting your head back in a dentist’s chair or having your hair washed at the salon.
What causes BPPV?
In most cases (35%) there is no known cause for the BPPV (idiopathic onset). Prior head trauma, which can be minor, is present in approximately 15% of cases. In the remainder of cases, BPPV occur in relationship with a variety of vestibular dysfunctions such as Meniere’s disease, vestibular neuritis/labyrinthitis (15%) and ear surgeries. There is a higher incidence of BPPV in persons who experience migraine headache.
How is BPPV assessed by a Vestibular physiotherapist?
Typically, two tests will be performed by the physiotherapist in the clinic to look for the presence of Otoconia in one or more of the semicircular canals. These tests are the Dix–‐Hallpike and Head Roll tests.
Sometimes a different test, the Side Lying test will be conducted.
How is BPPV treated and Why sees a physiotherapist?
Most BPPV involves loose or free floating otoconia in the posterior semicircular canal of the vestibular system. Sometimes the otoconia can be in the horizontal semicircular canal. The basis of all the treatment techniques is to move or ‘float’ the loose otoconia around the semicircular canal in order to reposition them in the saccule where they belong. The treatment usually takes about 10 minutes. If the otoconia are in the posterior canal (80% to 90%) of all BPPV, then manual treatment such as the Epley maneuver will likely be used. There are other techniques that can be used if necessary. Your physiotherapist would be able to find out the cause of it and will perform the appropriate treatment required. Manual Physiotherapy is performed if you experience suboccipital tightness and headaches along with it. Suboccipital release and soft tissue massage are some of the different techniques done.
How successful is the Vestibular Physiotherapy treatment?
Fortunately, the various Vestibular Physiotherapy treatment techniques for BPPV are usually very successful. Many studies have demonstrated success rates of over 80% with one treatment. Some people require multiple treatments and rarely, the BPPV can be difficult to resolve.
Can the BPPV recur?
Yes, the BPPV does recur in many persons. The recurrence rate has been reported as varying from 18% to 37%. It can recur at any time although during the first year after treatment, the recurrence rate is the highest.
Will BPPV spontaneously resolve if not treated?
In many cases, BPPV will spontaneously resolve on its own. One study indicated that the spontaneous remission rate might vary from 33% to 50%. However, it might take a long time for the spontaneous remission to occur and if it does not go away on its own, it might be present for many years.
If you or any of your loved ones is suffering from balance issues or dizziness due to any of these symptoms, call us or email us to book an appointment at 905 997 4333. If you are not sure whether you need Physiotherapy or some other services, you can call and have a 10 mins over the phone consultation with our physiotherapist.
