Benign Paroxysmal Positional Vertigo (BPPV)
Benign paroxysmal positional vertigo (BPPV) is the most common disorder of the inner ear in the adult population. The age of onset of BPPV is often from between the ages of 40 – 60 years old, with between 11 and 64 people per 100,000 being affected each year. Females are more likely to get BPPV than males.
BPPV is a disorder of the inner ear which is characterised by episodes of vertigo that are position dependant. The name benign paroxysmal positional vertigo in itself describes the disorder. ‘Benign’ refers to the fact that this condition is not due to any serious pathology and that the prognosis for recovery is good. ‘Paroxysmal’ refers to the swift onset of the vertigo, and ‘positional vertigo’ refers to the spinning/dizzy sensations which patients complain of that occur when they are in certain positions.
The inner ear is home to the vestibular system, which monitors the head’s position and movement in space and relays this information to the brain. When information from this system is incorrect and conflicts with information from other sensory systems it can cause feelings of vertigo and nausea.
The semicircular canals within the vestibular system respond to movements of the head. The 3 canals are arranged at approximately right angles to each other, and are filled with fluid. When head movement occurs, the fluid causes the sensory hairs in the semicircular canals to bend and send off nerve impulses which give the person the sensation of movement.
The cause of BPPV is related to the presence of abnormal debris within the semicircular canals. The debris is usually small crystals which have dislodged from another part of the inner ear. This debris causes abnormal stimulation of the sensory hair cells in the semicircular canal and leads to the sensations of dizziness and vertigo experienced in BPPV.
BPPV is the most common vestibular disorder. Of patients presenting with vertigo, BPPV accounts for 42% of cases. However, BPPV can be under diagnosed or misdiagnosed. Other conditions which may cause similar symptoms to BPPV include Vestibular neuritis, Meniere’s disease, vascular disorders, and metabolic or autoimmune disorders (e.g. Diabetes, lupus). It is important to seek accurate diagnosis as this will affect the expected prognosis, treatment methods, and the potential for related serious medical problems.
Signs and symptoms
The main symptom that people with BPPV report is intermittent episodes of vertigo. Vertigo is an abnormal feeling that you or your surroundings are in motion. The vertigo is often reported to be brought on by changes in head position (e.g. rolling over in bed, looking upwards or bending forwards), and lasts less than one minute. Other symptoms that people with BPPV may experience include light-headedness, dizziness, nausea, and feeling off balance.
Although BPPV is not a serious condition, these symptoms can have a substantial impact on people suffering from them and severely impair their ability to function. In older patients particularly, BPPV may increase risk of falls which can then cause serious injury.
Physiotherapists are able to asses for and treat BPPV. Performing certain head movements according to semicircular canal positioning can work to remove the debris from them. This means that the stimulus that was causing the BPPV will no longer be present so symptoms are alleviated. Physiotherapists are able to asses which semicircular canal is affected and based on this assist patients to perform the appropriate head movements required to treat the condition. Physiotherapists may also prescribe home exercises and give home advice on management; which can be particularly important for decreasing rate of re-occurrence and minimising risk of falls. Although BPPV often responds well to treatment, there is a considerable rate of re-occurrence (around 15% per year), so follow up with your Physiotherapist is important.
If required your physiotherapist will be able to refer you onwards for specialist assessment and treatment.
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