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Benign Paroxysmal Positional Vertigo (BPPV)

One of the most common causes of Vertigo (the feeling of unsteadiness or dizziness that creates the false sense that you or your surroundings are spinning or moving) is called Benign Paroxysmal Positional Vertigo (BPPV). 

BPPV is a problem in the inner ear that can cause sudden dizziness, ranging from mild episodes to severe attacks. It is a condition caused by changes to the position of the head, such as sitting up, standing or tipping your head back and is most common in people over the age of 60. 

What can cause BPPV?

Within your inner ear there are structures called “Semicircular Canals” which are vital to your sense of balance. These canals are filled with a liquid which senses the position and movement of your head. As your head moves around, this liquid sloshes around and gently moves the tiny hairs that line each of the canals. These, in turn, let the brain know the position of your head in relation to your body. 

On top of these hair cells, are tiny calcium crystals (otoconia) and sometimes it happens that they dislodge from the hair cells and float around in the Semicircular Canals. This can result in the wrong signals being sent to the brain, consequently causing a sensation of vertigo (spinning) for the time that these calcium crystals are floating around in the Semi Circular Canals. 

What are the symptoms of BPPV? 

The onset of BPPV may happen very quickly and can be frightening for some people. Whilst a sense of spinning is the most frequent symptom, other symptoms can include: 

  • Nausea or vomiting
  • Loss of balance or fall
  • Unsteadiness
  • Lightheadedness
  • Blurred vision 
  • Nystagmus (abnormal rhythmic eye movements) 

If you feel dizzy, unsteady, disorientated and/or lightheaded and experience any of these symptoms IN ADDITION, please attend the nearest A&E hospital or call the emergency services as soon as possible.

How Is BPPV Diagnosed?

If you are suffering from the symptoms of BPPV, a Vestibular Physiotherapist will find out more about the severity, frequency, and triggers of your symptoms. They’ll ask you about your medical history and medications you take, conduct some checks on your balance and give you a physical examination. 

This physical examination involves performing movements of your head as you lie down, whilst they look closely at your eye movements. The most common tests are Dix- Hallpike, Side Lying Manoeuver, Supine Roll Test. 

As BPPV is not the only condition that can cause vertigo and dizziness, other tests can include audio-vestibular tests which examine your hearing pathways and neuro-vestibular assessments to test the Central Nervous System, checking for other conditions such as Vestibular Migraine, Ménière’s disease, Labyrinthitis or Vestibular Neuritis.

What are the treatments for BPPV? 

In some cases, GPs may prescribe medication to alleviate the symptoms of BPPV, such as anti-nausea medications or vestibular suppressants. However, these medications do not address the underlying cause of BPPV.

The treatment for BPPV typically involves a series of manoeuvers designed to reposition the displaced calcium crystals in the inner ear that are causing the symptoms. These moves are called canalith repositioning procedures (or particle repositioning manoeuvers) and can be performed by a trained Vestibular Physiotherapist.

The most commonly used technique is the Epley manoeuver, which involves a series of head movements that can help to move the crystals back into the correct position within the Semicircular Canal. The Semont and Barbeque manoeuvers are two other common treatments for BPPV. These techniques can offer relief of symptoms after a few sessions. 

It’s important to note that the specific treatment for BPPV may vary depending on the individual and the severity of their symptoms. Therefore, it’s best to consult with a healthcare professional such as a Vestibular Physiotherapist for a proper diagnosis and treatment plan.

When should you seek help?

If you are suffering from dizziness or vertigo, be assured that it is not a condition you should just put up with. Whilst most causes of vertigo and dizziness are benign, it is important to rule out other contributing factors such as neurological disorders, strokes or even ear infections.  

Find out more about our Balance and Vestibular Assessments and Rehabilitation here and book online or give us a call on 01223 661 399 to arrange an appointment with a member of our Vestibular team. 

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