BPPV (Benign Paroxysmal Positional Vertigo)
Introduction:
Commonly used terminology in relation to BPPV:
Vertigo is a specific type of dizziness defined as the illusion of movement occurring in the environment. Whether Dizziness is used to describe a variety of sensations (lightheaded, swaying, disorientated etc.)
Nystagmus is rapid, uncontrollable eye movements in one or both eyes.
It’s important to know that these are symptoms of the BPPV, not the condition or diagnosis.
BPPV is the common cause of the vertigo, and the diagnosis is made based on the clinical test called Dix-hallpike. Usually, vertigo is triggered by changes in head position. BPPV is caused by calcium crystals, which get dislodged from their original place and move into semicircular canals. Due to this movement, the inner ear send wrong signals to the brain about our head position – which triggers symptoms like, dizziness, vertigo.
Causes and risk factors:
Mostly, its sudden onset
Falls
More prone in Adults
Concussion or any other traumatic brain injury
Surgical trauma to inner ear
More common in female, Menopause
Vit D deficiency
High cholesterol
Migraine
Symptoms:
Sudden vertigo – short-term
Dizziness with certain head movements (Feels like you’re in a boat)
Nystagmus - Visual disturbance
Nausea
Vomiting
Loss of balance
Sweating
Elevated heart rate
Diagnosis:
BPPV can easily be diagnosed and treated through simple clinic-based procedures. Along with detailed subjective history, clinical tests like, Dix-Hallpike and Head Roll tests are diagnostic tolls to confirm BPPV. Early diagnosis of BPPV is important and may help improve quality of life for patients. Even under BPPV, there are various possible diagnosis based on the directions of Nystagmus (Eye movements), which tells us about the crystals’ position in the specific canal. Based on that diagnosis, the treatment is planned for the individuals.
Physiotherapy Approach:
The foremost treatment for BPPV is a series of repositioning maneuvers, which are designed to move those crystals back to its original place. As mentioned above, based on the diagnosis, the specific maneuvers are performed, which can include one or more from the list given below:
Epley Maneuver
Gans Maneuver
Semont
Brandt-Daroff exercises
Barbeque roll
Along with these maneuvers, Lifestyle changes, balance training and vestibular therapy also play significant roll to manage symptoms.
Call to Action:
Before trying any home exercises for BPPV, it’s necessary to take an advice from your Doctor or Physiotherapist to determine the appropriate course of treatment. At our clinic, the physiotherapists will help you to learn about your condition and make a customized treatment plan for you.
References:
Physiopedia. (n.d.). Benign paroxysmal positional vertigo (BPPV). Physiopedia. Retrieved May 6, 2025, from https://www.physio-pedia.com/Benign_Positional_Paroxysmal_Vertigo_%28BPPV%29
EducatedPT. Supine Roll Test for Horizontal Canal BPPV. Available from: https://www.youtube.com/watch?v=ns8XZ4rKiJc [last accessed 24/10/2024]
Chen, Z., Chang, C., Hu, L., Tu, M., Lu, T., Chen, P., & Shen, C. (2016). Increased risk of benign paroxysmal positional vertigo in patients with anxiety disorders: a nationwide population-based retrospective cohort study.BMC Psychiatry,16(1). doi:10.1186/s12888-016-0950-2
Gaur S, Awasthi SK, Bhadouriya SKS, Saxena R, Pathak VK, Bisht M. Efficacy of Epley’s Maneuver in Treating BPPV Patients: A Prospective Observational Study. International Journal of Otolaryngology. 2015;2015:1-5. doi:10.1155/2015/487160.
