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BPPV (Benign Paroxysmal Positional Vertigo)
Facts about BPPV
Symptoms
What causes BPPV
Types of BPPV
Diagnosis
Treatment / Rehabilitation for BPPV
Facts about BPPV
BPPV is the most common cause of dizziness in the adult population. It is conservatively estimated to affect 64 to 100 out of every 100,000 people. While BPPV can occur in children, it more commonly affects adults. It can occur insidiously (without any cause and without warning) at any age to men and women alike. It can also occur as a result of various factors: mild to severe head injuries, viral infections, severe or prolonged dehydration, extended bed-rest, and as a natural process of aging. Back to Top
Symptoms
The symptoms of BPPV are characterized by brief episodes of vertigo (spinning sensation) and/or unsteadiness with certain head positions or head movements. Nausea frequently accompanies these symptoms and occasionally vomiting is seen. These symptoms tend to be provoked by a quick or prolonged change in the position of the head. The most common activities that will produce symptoms include:
- looking / reaching up
- looking / reaching down
- rolling over in bed
- getting into / out of bed
What causes BPPV?
BPPV is caused by microscopic calcium carbonate crystals which have become displaced from an area in the inner ear, called the utricle, and have migrated and accumulated in one or more of the semicircular canals. These crystals, properly called otoconia, are sometimes referred to as “ear rocks.” They naturally reside within the membranous sac-like area of the utricle. (While the saccule also contains otoconia, they are not able to migrate into the semicircular canal system). The otoconia can occasionally become dislodged and travel in the fluid to become located in one or more of the 6 semicircular canals (thin, highly-sensitive tube-like organs) where they could possibly remain indefinitely. Back to Top
Types of BPPV
There are 2 main forms of BPPV, canalithiasis and cupulolithiasis. With the more common canalithiasis type, the crystals are displaced into the arm of the semicircular canals. The cupulolithiasis type is where the crystals have migrated to the dilated area of the semicircular canal (ampulla) and have become stuck on the cupula. Back to Top
Diagnosis
The diagnosis for benign paroxysmal positional vertigo is based on history, physical examination, and the results of diagnostic testing. Each ear has three semicircular canals and with the two different forms of BPPV, there are many possible diagnoses. Back to Top
Treatment
Successful treatment of BPPV is dependent on the accurate identification of both the type (canalithiasis vs. cupulolithiasis) and location (right, left, anterior, posterior, horizontal) of the involved canal or canals. A diagnosis-specific maneuver is performed to relocate the otoconia back into the utricle where it belongs. Appropriate diagnosis and treatment of BPPV by a trained clinician can effectively resolve this issue, in most cases, within one or two office visits. In addition to the maneuvers performed in the clinic, the patient will be instructed to perform a simple daily exercise designed to ensure clearance of the otoconia and facilitate full resolution of vertigo symptoms.
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