Benign Paroxysmal Positional Vertigo (BPPV)
What is BPPV?
BPPV (Benign Paroxysmal Positional Vertigo) occurs as a result of displaced otoconia, which are small crystals of calcium carbonate (also referred to as "otoliths" or "canaliths" that are normally attached to the membrane in the inner ear. Because of trauma, infections, or simple again the canaliths can become detached from the utricle and collect within the semicircular canals. Head movements can shift the detached canaltihs and stimulate sensitive nerve hairs to send false signals. to the brain, causing dizziness and other symptoms.
What is the Vestibular System?
Our vestibular system is situated in our ears and is made up of five sensory organs in total. These organs combinedly help to provide information to our brain regarding the body's position and various movements.
These five organs include:
3 semicircular canals (Anterior, Posterior and Horizontal),
2 otolith organs (Saccule and Utricle).
On both sides, one vestibular system is located and connected to the Cochlea which helps in the hearing mechanism. These vestibular organs detect every motion of the head including linear, rotational, and static movements regarding gravity.
What causes BPPV?
In most cases, the cause is idiopathic, with more chances to occur after the age of 50 years.
In the younger population, head trauma is a major cause.
Meniere’s disease, Vestibular neuritis/labyrinthitis
It can be due to Ischemia and cardiovascular disease.
Vitamin D deficiency and calcium metabolism.
Surgical trauma to the inner ear.
Migraine headache
In BPPV, above mentioned causes will create dysfunction in the vestibular system. There are crystals called otoconia in otolith organs. These crystals are fixed with a membrane within otolith organs. If they dislodge or get separated from the membrane, they can travel into semicircular canals, where they should not stay ideally. When a person moves or rotates his head, these crystals will move back and forth in canals, which can excite nerves situated over there and this nerve sends inaccurate info to the brain. Eventually, it results in nystagmus, vertigo, and nausea…
Signs & Symptoms of BPPV
Vertigo: Vertigo is a specific type of dizziness defined as the illusion of movement occurring in the environment, not in a person's head. Looking up & down, lying down quickly, or turning in bed can provoke vertigo, which only lasts for less than 60 seconds.
Nystagmus: If head rotation or linear movement is sustained, for example trying to read the signs while pulling into a subway station, the head moves to the right, and the eyes move to the left until they run out of room. This triggers a quick phase or saccade movement of the eyes to the right Sustained sequence of slow and quick phases is called NYSTAGMUS.
Loss of Balance
Visual disturbance
Physiotherapy Assessment and Treatment of BPPV
How to assess BPPV?
In the clinic, Physiotherapists usually perform two tests to check the presence of Otoconia in either semicircular canal which is responsible for BPPV symptoms. These two tests are Dix-Hallpike and Head Roll tests.
Dix-Hallpike test: https://youtu.be/7wMvTUPaNPo
Head Roll test: https://youtu.be/XSXwlUUpkow
How do Physiotherapists treat BPPV?
The goal of our treatment is to send the otoconia from any semicircular canal to the saccule (Origin place). In most cases, free Otoconia is present in the Posterior semicircular canal and for these people, Epley’s maneuver is likely to be used which takes approximately 10 minutes to perform. Other treatments are also used depending on symptoms like Habituation exercises, Vestibular exercises, Brandt-Daroff exercises, and many more.
EPLEY’S MANEUVER:
Lie on your back with your head over the back of a pillow extended by 30 degrees.
Rotate your head towards your affected ear by 45 degrees. You will feel dizzy at this point. Hold this position for 30-60 seconds until the symptoms start to settle.
Turn your head to the opposite side to 45 degrees and hold again for 30-60 seconds until the symptoms start to settle.
Roll your body onto this side (the side of your unaffected ear) and turn your head a further 90 degrees. Your face should be turned into the bed. Hold this position for 30-60 seconds until the symptoms start to settle.
Sit up on the edge of the bed. When you change from one position to another, ensure they are done at a moderate to quick speed. Moving too slowly can reduce the efficacy of the treatment.