What is BPPV?

Benign Paroxysmal Positional Vertigo or BPPV is a prevalent cause of vertigo, a sensation of spinning or dizziness. BPPV is episodic, meaning it occurs in abrupt, brief periods. The name itself is descriptive of the condition:

• Benign: Although it can cause discomfort and fear, it is not life-threatening or a symptom of a serious illness.
• Paroxysmal: It happens suddenly and usually lasts less than a minute.
• Positional: The vertigo is triggered by certain head movements or changes in position.
• Vertigo: The main symptom is a sensation of movement or spinning.

Who Does BPPV Affect?

BPPV can occur in anyone, at any age. However, statistics suggest that it impacts roughly 50% of individuals at some point in their lives and the prevalence increases with age.

Symptoms of BPPV

The primary symptom of BPPV is vertigo, which could be rotational (like stepping off a carousel) or a feeling of falling or being thrown backward when lying down or standing up. These feelings are usually elicited by certain movements, including:

• Laying flat
• Sitting up from a lying down position
• Turning over in bed
• Looking up or bending down, especially when turning the head to the side

The duration of these episodes is generally brief, typically lasting between 5 to 30 seconds, but occasionally, they can persist for up to two minutes.

What Causes BPPV?

The cause of BPPV lies within the inner ear, specifically, the semi-circular canals which are responsible for sensing rotation. These canals contain microscopic crystals that are normally embedded in a jelly-like substance. The weight of these crystals makes this part of the ear responsive to the force of gravity.

Over time, these crystals can become dislodged and make their way into the wrong part of the inner ear. When the head moves in a certain way, these loose crystals trigger the sensation of movement, resulting in vertigo.

Diagnosing BPPV

Diagnosis of BPPV is primarily made from the patient's history and by ruling out other conditions that can cause similar symptoms. When episodes of vertigo are occurring, a diagnostic test known as the Hallpike positional test can be used. This test involves moving the patient's head in specific directions to trigger vertigo and observe eye movements (nystagmus). In the most common form of BPPV, the test is positive when the affected ear is lowermost. It's important to note, however, that up to 10% of BPPV cases may affect both ears.

Treating BPPV

In about half of cases, BPPV will resolve on its own over time, although this may take several months. As BPPV is fundamentally a mechanical issue, medications are typically ineffective and are generally not recommended.

For cases that do not spontaneously resolve, a treatment called a Particle Repositioning Manoeuvre can be used. The most commonly performed manoeuvre is known as the Epley manoeuvre. This procedure involves moving the head in specific ways to guide the loose crystals back to the correct part of the inner ear. This treatment offers immediate relief of symptoms in about 90% of patients.

Further Information

If you have any questions about BPPV, our team at Southwest Balance is ready to help. Contact us to schedule an appointment today.