BPPV: Benign Paroxysmal Positional Vertigo

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BPPV stands for Benign Paroxysmal Positional Vertigo and it is the most common form of vertigo.

It is an inner ear dysfunction that causes short-lasting (few seconds to few minutes) Vertigo or Room spinning sensation when you move your head in a gravity-dependent position such as tilting your head back or lying flat, rolling, or getting up from bed. BPPV is a vestibular disorder which can be treated by physiotherapy.


The Vestibular System

Our inner ear has two main functions which are to help you hear and keep your balance. The balance portion of the inner ear consists of three semicircular canals (posterior, anterior and horizontal) and the otolith organs. The semicircular canals filled with liquid and lined with hair cells called cilia.

When your head moves, the fluid in the semicircular canals shifts around causing cilia to move as well, sensing movement. This information then sent and processed by the brain to help you stay balanced. These semicircular canals connected by otolith organs called the saccule and utricle which houses calcium carbonate crystals called otoconia.

Why does BPPV occur?

BPPV happens when these “crystals” dislodged from the utricle into the semicircular canals which causes the “hair cells” in our semicircular canals to stimulated thus producing a sudden sensation of a movement called vertigo. This sensation of vertigo typically stops once head movement stops and the “crystals” have settled down and hair cells will no longer stimulate in the semicircular canals. This takes about a few seconds to a few minutes upon cessation of head movement.

BPPV assessed with positional testing that places you in a gravity-dependent position to produce your vertigo symptoms.

What causes it?

The most common cause of BPPV is idiopathic. However, as one age, degenerative changes can be a potential cause of BPPV. Head injuries can also often result in multiple canals affecting, leading to BPPV. Based on a large cohort study of 1599 patients (Chua et al, 2020) factors that cause BPPV to include:

  • The age group most commonly affected between 71-80 years old at 32% followed by 61-70 years old at 24%
  • Unilateral posterior canal BPPV the most commonly affected canal
  • 72% of patients required a median number of one treatment session to complete the resolution of their BPPV, 91.4% required two sessions to complete the resolution of their BPPV
  • Females are 2.4 times more likely to experience BPPV compared to males

Symptoms of BPPV

  • Vertigo (room-spinning sensation) lasting seconds to a few minutes
  • Nausea and vomiting
  • Postural imbalance

Physiotherapy treatment for BPPV

Vestibular Physiotherapy treatment is an effective way to resolve disorders like BPPV. Medications may only reduce the symptoms of nausea and vomiting but it is not effective in treating the root cause. Physiotherapy treatment includes repositioning manoeuvres to relieve the symptoms of BPPV. Your head will placed in different movements and angles to move the otoconia from your semicircular canals back into your otolith organs.

If you experience symptoms that severe and persist, we would advise seeking a vestibular physiotherapist for review. Book an appointment with our team of physiotherapists to get assessed.