Benign Paroxysmal Positional Vertigo (BPPV)

Benign Paroxysmal Positional Vertigo (BPPV)

BPPV is the most common form of positional vertigo and it accounts for nearly half of all people with a peripheral vestibular system dysfunction. The prevalence Of BPPV in the general population is thought to be 2.4% but the prevalence increases with age. It is seven times more common in persons

Over the age of 60 compared to persons from 18 to 39 years of age. In people

Over the age of 65, the incidence may be as high as 35% to 40%. BPPV is more

Common in women than men in all age groups.

What is the vestibular system?

The vestibular system comprises five sensory organs that provide your

Brain with information about head position and movements. The

Vestibular system provides information to your brain about head rotational

Movements, linear movements as well as static positions of the head relative

To gravity.

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 into 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 the majority of 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?

Typically, two tests will be performed 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 of 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 the Epley maneuver will likely be used. There are other techniques that can be used if necessary.

How successful is the treatment?

Fortunately, the various 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 shoulder pain 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.