Could You Have BPPV?
It is quite possible as BPPV is the most common form of vertigo that is characterized by brief episodes of dizziness and a spinning sensation when moving the head.
What Is BPPV?
It is typically triggered by changes in head position, such as rolling over in bed, looking up, tilting the head or any sudden head motion. BPPV occurs when small calcium crystals in the inner ear become dislodged and move into the sensitive fluid-filled canals of the inner ear, disrupting the normal flow of fluid and sending false signals to the brain about the body's position in space.
Symtoms & Causes of BPPV:
Symptoms of BPPV may include dizziness, vertigo, nausea, and unsteadiness. It can be diagnosed by a healthcare provider through a physical examination and specific tests to assess eye movements and balance. Most often BPPV occurs spontaneously in the majority of patients (approximately 35-70%), but may also follow head trauma (7-17%), inner ear infections (approximately 15%) such as labyrinthitis and neuritis or Ménière’s disease. (1&2). One study (3) suggested horizontal canal was more commonly affected in Meniere’s related BPPV. Another indicated that females were predominantly affected (4). BPPV has been independently associated with age, hypertension, hyperlipidemia, migraine (less than 5%), giant cell arteritis and stroke suggesting a relationship to vascular mechanisms (insufficiency). More recently, a relationship has been suggested between BPPV and osteoporosis as well as vitamin D deficiency. (5, 6) It could imply that an abnormal calcium metabolism may underlie BPPV.
BPPV will not:
Give you constant dizziness that is unaffected by position
Cause hearing loss or fainting feeling
Cause headache, numbness or other neurological symptoms (pins/needles/trouble speaking/change in coordination)
*These above symptoms above need further evaluation by your physician and are important to mention to your physiotherapist.
Assessment of BPPV
Involves taking a detailed history of a person’s health, physical investigation such as using a diagnostic test called the Dix-Hallpike maneuver or the Head Roll test. If details of the subjective assessment and patient history indicate BPPV, then further physical investigation is needed to confirm a diagnosis. Physical diagnosis maneuvers involve a series of movements which aim to provoke nystagmus and symptoms of vertigo. The two diagnostic maneuvers used clinically are the Dix-Hallpike maneuver and the Supine Roll Test. A positive result on either of these tests indicates a diagnosis of BPPV. They also help to distinguish the type of BPPV and identify the ear involved.
Treatment of BPPV
Involves a series of simple head movements called canalith repositioning procedures (CRT), such as the Epley maneuver, which help to move the dislodged calcium crystals out of the inner ear canals.
There are 2 Mechanisms of BPPV:
Canalithiasis
o otoconia are moving within a canal
o Vertigo and nystagmus cease in less than a minute
Cupulolithiasis
o otoconia are located at the bundle of sensory nerves at the base of the canal
o vertigo lasts until the head is moved out of the provocative position more than one minute
Medications such as Bonine (meclizine) or dimenhydrinate (Dramimine) are often prescribed for vertigo, however this will not correct or treat BPPV, instead it dampens the symptoms such as nausea. If taken long term, research indicates that it can result in other issues of the vestibular system.
Overall, BPPV is a benign condition that can resolve on its own but can often resolve quickly with treatment which is important as this condition can be quite debilitating and cause falls/injuries.
It is important to consult with a healthcare provider for proper diagnosis and management of symptoms.
References:
1) Whitney, SL et.al.Efficacy of vestibular rehabilitation. Otolaryngol.Clin.NorthAm, 2000, June.33 (3): 659-672
2) Balatsouras DG et al.Benign Paroxysmal Positional Vertigo Secondary to Mild Head Trauma.Ann Otol Rhinol Laryngol. 2017 Jan; 126 (1):54-60 3)
3) Lee NH et al. Benign Paroxysmal Positional Vertigo secondary to inner ear disease. Otolaryngol Head Neck Surg.2010 Sept: 143 (3): 413-7
4) Yetiser S.Co-existence of benign paroxysmal positional vertigo and Meniere’s disease. J Int Adv Otol 2017 Jan 13
5) Talaat HS et al. Low bone mineral density and vitamin D deficiency in patients with benign paroxysmal positional vertigo. Eur Arch Otorhinolaryngol, 2014, June 29
6) Yu S et al. Association between osteoporosis and benign paroxysmal positional vertigo: a systematic review. BMC Neurol 2014 May 20:14: 110
Heidi Lacasse
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