BBPV (Benign Paroxysmal Positional Vertigo) - When your world spins for no good reason!
Ever felt like you were on a merry-go-round, but without the fun part?
Welcome to the world of BPPV (Benign Paroxysmal Positional Vertigo), where the simplest tilt of your head can make you feel like you are spinning, when in fact you are not.
Welcome to the world of BPPV (Benign Paroxysmal Positional Vertigo), where the simplest tilt of your head can make you feel like you are spinning, when in fact you are not.
If you've ever experienced this sensation, you know it's no joke. Understanding this condition can be confusing and frustrating for many people, so we will attempt to answer the question we hear a lot in the clinic…
What in the World is BPPV?
BPPV stands for Benign Paroxysmal Positional Vertigo. Let's decode this tongue-twister:
Benign: not life-threatening.
Paroxysmal: coming in sudden, brief spells.
Positional: triggered by changes of head position.
Vertigo: spinning sensation.
In simpler terms, BPPV is a condition where tiny calcium crystals in your inner ear decide to go rogue, causing a sudden onset of dizziness.
Why Does It Happen?
Imagine your inner ear as a high-tech balance system working 24/7.
When we move our head, those small crystals move, telling our brain where our head is.
For example, when your eyes are closed and you nod your head, your brain recognises this. Now, imagine tiny crystals (otoconia) in your ear breaking free and floating into places they shouldn’t be. These little rebels disrupt the normal fluid movement in the ear's canals, sending your brain mixed signals about your position.
The result of this is an uncomfortable spinning sensation, almost like you are spinning on a piece of playground equipment. This is usually accompanied by an unpleasant nauseous feeling in your stomach, which can occur when you move your head or lie down, and commonly lasts less than 30 seconds.
What can be the cause?
Ear infections, antibiotics, a knock to the head, or just no reason at all. Annoying right?
How to make it go away!
Now, without getting too technical, the crystals can move into different areas of the ear which will change our approach to treatment.
When you come in to see us, we will first ask questions such as when did it start, how long does it last and so on.
From there, we will determine if it is appropriate to perform testing.
Testing for this usually involves two maneuvers; the Epley Maneuver and the Horizontal Maneuver - which can then be treated on the spot.
Posterior Canal: (epley and dix-halpike)
This is the most common, usually with upbeating torsional nystagmus.
Sitting on a bed with your head turned 45 degrees to the side you will quickly lie back so your head is slightly leaning back.
We watch your eyes intensely for any flickering as this gives us an idea of the type and location of your BBPV.
After 30 seconds you will turn your head to the other side and wait another 30 seconds (the wait is because they reaction can be delayed)
Then you will roll to your side, hold again for 30 seconds and then slowly come into sitting.
This test checks for crystals in the posterior canal of the ear and will be performed on both sides to check in both ears.
Horizontal canal: (Supine Head Roll Test and BBQ log roll)
Lying on your back, we will quickly turn your head to the right with your chin slightly toward your chest and watch your eyes; again holding for 1 minute.
Then we will turn your head to the center, wait 1 minute and then the opposite side for 1 minute.
After this, you will roll onto your opposite side with your head turned into the bed and then onto your stomach.
When you are ready you will then come into standing with your head still turned down.
These maneuvers help to coax those rebellious crystals back to their proper place, restoring balance to your inner ear and peace to your world.
Despite the effectiveness of these tests, they can be accompanied by said nausea and dizziness effects, so it is important to know that you may feel a bit yucky afterwards.
As you can imagine, these tests also involve a large amount of neck turning, so this is only performed if it can be tolerated. If the neck turning cannot be tolerated, we will perform a different test.
Tips to Keep Vertigo at Bay while you wait for your appointment.
While these maneuvers are highly effective, here are a few extra tips to help you manage BPPV:
Sleep with your head slightly elevated: Use an extra pillow to prop yourself up.
Avoid sudden head movements: Take your time when changing positions.
Stay hydrated: Dehydration can exacerbate dizziness.
BPPV might turn your world upside down, but usually within one to two appointments, you can reclaim your balance and say goodbye to those dizzy spells.
Key Differences:
Location of Otoconia: In cupulolithiasis, otoconia are stuck to the cupula, whereas in canalithiasis, they are free-floating in the canal.
Duration of Vertigo: Cupulolithiasis causes longer vertigo episodes compared to the brief episodes in canalithiasis.
Onset: Cupulolithiasis causes immediate vertigo upon positional change, while canalithiasis has a brief delay before vertigo onset.
Treatment Response: Canalithiasis generally responds better to repositioning maneuvers compared to cupulolithiasis, which may require more extensive or repeated treatments.
Understanding these differences is crucial for accurate diagnosis and effective treatment of BPPV.
Written by Fleurieu Coast Physiotherapist,
Kara Ballard
