What is Benign Paroxysmal Positional Vertigo (BPPV)?
BPPV is one of the most common (and treatable) causes of episodic vertigo, dizziness, and imbalance. BPPV stands for Benign Paroxysmal Positional Vertigo. As the name suggests, it's not life threatening (benign), although it may cause severe or debilitating symptoms.
It’s important to note that vertigo itself is not a diagnosis. Rather, it’s a symptom of something else (like how pain is a symptom and not a diagnosis). The term vertigo is usually used to describe a symptom of spinning dizziness, as if you or your surroundings are moving.
BPPV commonly causes symptoms of episodic room-spinning vertigo, which is typically triggered by change in position, such as getting in and out of bed, rolling over in bed, bending over, or reaching overhead. It’s common to also experience symptoms of nausea, vomiting, imbalance, or disequilibrium.
BPPV occurs when crystals that are housed inside of your inner ear break off and travel to a different area of your inner ear. Yes- we all have crystals in our inner ears! More specifically, it’s calcium carbonate particles, also known as otoconia. Normally, the otoconia are embedded in a membrane inside of your inner ear, where they help to sense gravity, linear accelerations, and head position.
The otoconia can break off of their membrane, leading to free floating particles inside of your inner ear (which is filled with fluid). Since they are detached, the otoconia can migrate into a different area of your inner ear, called the canals. The canals normally do not house any otoconia, and function to sense rotation. When otoconia enter one of your canals, they will tend to settle on the bottom-most surface (like how snow inside of a snow globe settles at the bottom). When you move the position of your head, such as when bending over, looking up, or rolling over in bed, the otoconia will move and again settle on the bottom-most surface. This movement of the otoconia triggers the sensors inside the canal, causing a false sense of rotation or movement (vertigo)
Image credit: Mayo Clinic. Benign paroxysmal positional vertigo (BPPV) - Diagnosis and treatment - Mayo Clinic
Luckily, BPPV is very treatable! A trained healthcare professional can perform a few simple tests, which will reveal which canal and which ear the otoconia are located inside (you have three canals inside each of your inner ears). Although your healthcare provider is unable to directly view inside of your inner ear, the test positions will trigger a reflex that exists between your inner ears and eyes. If BPPV is present, it will create specific reflexive eye movements when you’re in the test position. The exact eye movement will help your healthcare provider determine which inner ear and canal to treat.
Ideally, the healthcare provider should be using specialized equipment, which will allow them to better see your eye movements. Very often, the reflexive eye movements are suppressed in normal room light and can only be seen with this equipment. The equipment looks very similar to virtual reality goggles, but function to block out light. They are usually connected to a computer or screen, where your healthcare provider can visualize your eye movements in detail.
Once your healthcare provider determines the location of the otoconia, they can then bring you through a series of head and body positions to move the otoconia out of the canal. Yes, it’s possible to resolve BPPV in just one treatment session! However, depending on the person, and if multiple canals are involved, it may take a few more sessions to treat. If you are not seeing any improvement after 4-5 visits, it may be time to reassess or get a second opinion from a healthcare provider who specializes in dizziness and vertigo.
The most common treatment maneuver for BPPV is called the “Epley Maneuver.” It’s possible to perform this on your own at home. However, it’s important to understand which ear is affected first. I highly recommend working with a trained professional to assure that you are performing the correct maneuver. Remember, you have three canals in each ear, and there are different maneuvers for each canal. Your healthcare provider can also help to rule out other causes of vertigo.
I hope this was helpful! If you live in the Rochester, New York area, Bloom Physical Therapy offers BPPV treatment in the comfort and convenience of your own home. We are even able to bring our specialized equipment (mentioned above) right to your home.