COMMON VESTIBULAR ISSUES
BPPV Physiotherapy Melbourne
The Vertigo Co will assess your symptoms and provide tailored treatment options.
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What is Benign Paroxysmal Positional Vertigo (BPPV)?
Benign Paroxysmal Positional Vertigo (BPPV) is an inner ear disorder. BPPV causes short bursts of intense dizziness known as vertigo – or a feeling like the world is spinning.
BPPV is a common cause of dizziness, with up to 17% of all cases of dizziness presenting to medical clinics being attributed to this condition (1, 2).
This intense dizziness is triggered by changes in the position of your head. It can happen during a range of common activities, including looking up or down, quickly turning your head, or turning in or getting up out of bed.
Are you experiencing BPPV symptoms? For a detailed assessment and treatment options, get in touch with us today.
Common BPPV Symptoms
The symptoms of BPPV vary from person to person. They may be experienced for very short periods, or last for a long time without treatment.
In addition to vertigo, symptoms of this condition can include:
Dizziness or light-headedness
Nausea and/or vomiting
Unsteadiness and Imbalance with walking and/or
Difficulty concentrating, a feeling of fogginess or a general sense of feeling “Not Quite Right (NQR)”
About BPPV
BPPV occurs as a result of a disorder of the vestibular system (the balance organ of the inner ear). The vestibular organs in each ear include the utricle, saccule, and three semicircular canals. In cases of BPPV, tiny crystals of calcium carbonate known as otoconia detach from their normal location in the inner ear’s anatomy and roll into one of the semicircular canals. This sends false signals to the brain, producing a sense of vertigo.
What Triggers BPPV?
BPPV symptoms are triggered by changes in the head’s position. When the head is still, gravity causes the otoconia in the ear to clump and settle. When the head moves, the otoconia shift and trigger the vertigo sensation.
A person with BPPV may experience symptoms as a result of a number of common activities, including moving in bed, standing up from a seated position, bending down, or looking up or down.
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What Causes BPPV and Who Does It Affect?
When the head is still, gravity causes the otoconia to clump and settle. When the head moves, the otoconia shift and send false signals to the brain, producing a sensation of vertigo. For example, overnight, the calcium crystals often clump together while lying down sleeping and when a person with BPPV goes to get out of bed in the morning, they experience a strong sensation of vertigo.
BPPV is most commonly attributed to the below events and risk factors.
Deterioration due to age
In people over 50 years of age, BPPV is most commonly idiopathic, meaning it occurs for an unknown reason. However, it is generally associated with natural age-related deterioration of part of the inner ear, called the otolithic membrane (3, 4).
Head Trauma
The most common cause of BPPV in people under 50 is a head injury, and is presumably a result of concussive force that displaces the otoconia (5).
Other vestibular disorders
BPPV is more likely to occur alongside other disorders of the vestibular system including Vestibular Neuritis (inner ear infection) (6), Migraines (7), or occasionally post-surgery (8).
Other risk factors
Other conditions that may put a person at risk of BPPV include Osteoporosis and Osteopenia, High Blood Pressure, High Cholesterol, Diabetes, Low Thyroid Function and a Sedentary Lifestyle.
Idiopathic
If a person with BPPV does not have any of the above risk factors, and has not experienced a concussion, then their condition will likely be considered idiopathic (occurring for an unknown reason).
Benign Paroxysmal Positional Vertigo
How Is BPPV Diagnosed?
BPPV is diagnosed based on your symptoms and thorough medical history, along with specific tests for this condition.
One particular test is known as the Dix-Hallpike test. This test involves lying down whilst the therapist observes your eye movements (called ‘nystagmus’) to determine which semicircular canal is affected by BPPV.
If you have symptoms of BPPV, we can perform a full physical assessment of your symptoms and guide you through potential causes and treatment options. Book an appointment with our team to get started.
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Treatment For BPPV
Your physiotherapist can treat BPPV with a series of movements called particle repositioning manoeuvres. They are a safe, simple and fast method of resolving BPPV symptoms.
As the name suggests, particle repositioning manoeuvres target the otoconia, or the tiny crystals of calcium carbonate that, in cases of BPPV, roll into one of the semicircular canals and send false signals to the brain. The manoeuvres help move the crystals back to where they came from.
To perform these manoeuvres, your therapist will move your body and head through a series of slow, controlled movements. One common manoeuvre performed is the Epley manoeuvre, which involves going from a seated to lying position and moving the head slowly from left to right or vice versa.
However, the exact treatments required will vary depending on which canal the crystals are in, and whether the crystals are free floating or attached to part of the ear canal.
For most patients, dizziness can be stopped after just one treatment, though occasionally the treatment will need to be repeated on a number of occasions. In rare cases, BPPV may require a referral for alternative treatment such as the Omniax chair at the Royal Victorian Eye and Ear Hospital (RVEEH) or the Thomas Richard-Vitton (TRV) chair at the University of Melbourne. If this is the case, your physiotherapist can guide you through this process.
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Will I Get BPPV Again?
BPPV tends to be a recurrent condition. On average it occurs every 3 to 5 years (8), however this is highly variable from person to person. Some people have episodes a number of times a year, some every few years, others every 10, some never again. There is some evidence that Vitamin D has been shown to reduce the rate of recurrence of BPPV, particularly in osteoporotic individuals. Around 2000 – 4000 IU per day is adequate dosing for BPPV for a minimum of 3 months (9, 10).
Resources
- Vestibular Disorders Association (VEDA) Website
https://vestibular.org/article/diagnosis-treatment/types-of-vestibular-disorders/benign-paroxysmal-positional-vertigo-bppv/ - Dr. Timothy Hain (Vestibular neurologist, University of Chicago) offers extensive educational information: https://dizziness-and-balance.com/disorders/bppv/bppv.html
Frequently Asked Questions
Your first appointment will last between 45-60 minutes and will include an assessment with a physiotherapist for BPPV or other vestibular disorders. BPPV is generally identified and treated during these initial appointments. If you have BPPV, you will be provided with education and treatment, including repositioning manoeuvres, home exercise programs and, if appropriate, recommendations for supplements.
Every person is different. The number of sessions required depends on the cause of the symptoms and how you respond to treatment. Your physiotherapist will inform you of the expected number of sessions required and their frequency during your first consultation. This may change according to how you respond to treatment.
We do not require a referral from a GP or other medical practitioner for private patients. If you are a Workcover or TAC patient, we require a referral, and request that you please contact the clinic before booking your appointment. If you have been given a referral, please bring it along to your appointment along with any other relevant test results or reports.
An Initial Vestibular Physiotherapy Assessment is $180, or if conducted via Telehealth, $160. Please view our FAQs page for further fee information and our policies regarding private health insurance claims, Enhanced Primary Care Plan (EPC)/Chronic Disease Management Plans, and Medicare claims.
Benign Paroxysmal Positional Vertigo involves a range of symptoms also connected to other conditions, including other vestibular disorders like Vestibular Migraine and Meniere’s Disease. These symptoms include vertigo, dizziness, nausea and vomiting. If you are experiencing any of these symptoms on a frequent or chronic basis, please seek advice from our physiotherapists or other trusted medical professionals.
The Vertigo Co
Book a BPPV Assessment
If you’re suffering from intense dizziness, there is support available. Our highly experienced and friendly physiotherapists will assess your symptoms for BPPV and provide a tailored treatment plan.
For more information or to book an appointment, contact us today.
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References:
- Bösner S, Schwarm S, Grevenrath P, Schmidt L, Hörner K, Beidatsch D, et al. Prevalence, aetiologies and prognosis of the symptom dizziness in primary care – a systematic review. BMC Fam Pract. 2018;19(1):33. https://pubmed.ncbi.nlm.nih.gov/29458336/
- Parnes LS, Agrawal SK, Atlas J. Diagnosis and management of benign paroxysmal positional vertigo (BPPV). CMAJ. 2003;169(7):681-93. https://pubmed.ncbi.nlm.nih.gov/14517129/
- Hornibrook J. Benign Paroxysmal Positional Vertigo (BPPV): History, Pathophysiology, Office Treatment and Future Directions. Int J Otolaryngol. 2011;2011:835671. https://pubmed.ncbi.nlm.nih.gov/21808648/
- Chen L, Bradshaw A, Halmagyi GM. Benign Paroxysmal Positional Vertigo. In: Aminoff MJ, Daroff RB, editors. Encyclopedia of the Neurological Sciences (Second Edition). Oxford: Academic Press; 2014. p. 409-10.
- Kim M, Lee D-S, Hong TH, Joo Cho H. Risk factor of benign paroxysmal positional vertigo in trauma patients: A retrospective analysis using Korean trauma database. Medicine (Baltimore). 2018;97(49):e13150-e. https://pubmed.ncbi.nlm.nih.gov/30544375/
- Balatsouras DG, Koukoutsis G, Ganelis P, Economou NC, Moukos A, Aspris A, et al. Benign paroxysmal positional vertigo secondary to vestibular neuritis. Eur Arch Otorhinolaryngol. 2014;271(5):919-24. https://pubmed.ncbi.nlm.nih.gov/23575935/
- Kim SK, Hong SM, Park I-S, Choi HG. Association Between Migraine and Benign Paroxysmal Positional Vertigo Among Adults in South Korea. JAMA Otolaryngology–Head & Neck Surgery. 2019;145(4):307-12. https://pubmed.ncbi.nlm.nih.gov/30676633/
- Kong TH, Song MH, Shim DB. Recurrence Rate and Risk Factors of Recurrence in Benign Paroxysmal Positional Vertigo: a Single-Center Long-Term Prospective Study With a Large Cohort. Ear Hear. 2022 Jan/Feb;43(1):234-241. https://pubmed.ncbi.nlm.nih.gov/34320525/
- Abdelmaksoud, A.A., Fahim, D.F.M., Bazeed, S.E.S. et al. Relation between vitamin D deficiency and benign paroxysmal positional vertigo. Sci Rep 11, 16855 (2021). https://pubmed.ncbi.nlm.nih.gov/34413436/
- Lee A, Hassannia F, Bergin MJ, Al Zaabi K, Misale P, Rutka JA. The Relationship Between Disorders of Bone Metabolism and Benign Paroxysmal Positional Vertigo: A Systematic Review. Ear Hear. 2021 Nov-Dec 01;42(6):1462-1471. https://pubmed.ncbi.nlm.nih.gov/34010250/