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Benign Paroxysmal Positional Vertigo (BPPV)

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What Is BPPV?

Benign paroxysmal positional vertigo (BPPV) is an inner-ear problem that causes short periods of dizziness when your head is moved in certain positions. It occurs most commonly when lying down, turning over in bed, or looking up. This dizzy sensation is called vertigo.

A layer of calcium carbonate material is present naturally in one part of your inner ear (the utricle). BPPV occurs when pieces of this material break off and move to another part of the inner ear, the semicircular canals (usually the posterior canal). These tiny calcium crystals (otoconia) are sometimes called “ear rocks.”

When you move your head a certain way, the crystals move inside the canal and stimulate the nerve endings, causing you to become dizzy. The crystals may become loose due to trauma to the head, infection, conditions such as Meniere disease, or aging, but in some cases there is no obvious cause. It’s possible that BPPV might run in families. Some people report that their BPPV symptoms recur predictably, perhaps seasonally or with changes in the weather.

How Does it Feel?

BPPV occurs most commonly when lying down, turning over in bed, and looking up. This dizzy sensation, called vertigo, usually lasts only a few seconds up to a minute but can make you feel like the room is spinning around you. It may also make you feel lightheaded, off balance, and nauseous.
How Is It Diagnosed?
The diagnosis of BPPV is based on whether you have a particular kind of involuntary eye movement (called “nystagmus”) and whether you have vertigo when your head is moved into certain positions. Your physical therapist will perform tests that move your head in specific ways to see whether vertigo and involuntary eye movement results. If you have neck or back problems, the therapist might use a test that allows you to lie on your side while movements are made. These tests will help the therapist determine the cause and type of your dizziness and whether you should be referred to a physician for any additional testing.
How Can a Physical Therapist Help?
No medication has been found to be effective with BPPV and, in some cases, medication could cause more harm. Fortunately, most people recover from BPPV with a simple but very specific head and neck maneuver performed by a physical therapist. The maneuver is designed to move the crystals from the semicircular canal back into the appropriate area in the inner ear (the utricle).

The most common treatment is called the Epley maneuver. The physical therapist shows you how to move your head through a series of 4 positions, with the head staying in each position for about 30 to 60 seconds. In the Semont maneuver, the body is rapidly moved from lying on one side to lying on the other.

Depending on information from your test results, you might be asked to perform Brandt-Daroff exercises, which need to be performed several times per day for several days; however, these exercises have not yet been shown to be effective in clinical trials.

In a very few cases, BPPV cannot be managed with treatment maneuvers, and a surgical procedure called a “posterior canal plugging” may be considered—but that’s usually a last resort. It’s rarely ever done.

Can this Injury or Condition be Prevented?

There is no known way to prevent BPPV. Symptoms can return if new crystals break off and get into the semicircular canal or if you dislodge loose crystals by placing your head in a certain position.

It’s estimated that within 3 years of having BPPV, about 50 percent of people may have a recurrence. If a head injury caused your BPPV, your risk of recurrence is even greater. Although your BPPV might return, you’ll be able to recognize the symptoms and keep yourself safe until you can get help. Your physical therapist will apply the appropriate maneuver to return the crystals to their correct position in the inner ear and also will teach you how to do exercises that can reduce or get rid of the problem.

Real Life Experiences

Laura B. is a 68-year-old woman with vertigo that began one morning 2 weeks ago when she got out of bed and the world started to spin. Since then, she’s been having vertigo, nausea, and problems with her balance. When she visits her physical therapist, he gives her a special questionnaire to find out exactly what brings on her dizziness and balance difficulty. Turning over in bed and bending over or looking up cause her the most severe symptoms.

The physical therapist reviews Laura’s medical history to make sure that there is no past condition that might be important to her problem. He performs an examination, explaining what tests he will use and that Laura should try to keep eyes open and stay in position. The tests show that in certain positions, Laura’s eyes move when they shouldn’t, and she has vertigo that lasts 5 seconds. The therapist determines that she has the “canalithiasis form” of vertigo, which means that some crystals are displaced and are located in her semicircular ear canals, causing her vertigo.

The therapist uses “canalith repositioning” to move the crystals into a proper position, using the Epley maneuver. Afterwards, he asks Laura to wait in the waiting room for a while. He then does a re-test. Laura no longer has the symptoms that she had when the therapist tested her the first time, so he shows her how to do the canalith repositioning maneuver at home. She is to do the maneuver once every day in the morning for one week and then will return to the clinic to make sure that she is progressing as expected.[/vc_column_text][/vc_column][vc_column width=”1/3″][vc_widget_sidebar sidebar_id=”diagnoses”][/vc_column][/vc_row]

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