Vertigo is a common symptom but it can be caused by lots of different things.
Benign Paroxysmal Positional Vertigo (BPPV) is the most common disorder of the inner ear (vestibular system) which results in vertigo, dizziness, nausea and unsteadiness. It is the most common cause of vertigo especially in the older population (>65 years).
But what is BPPV exactly?
It is a long string of words which defines exactly what it is
- Benign: Not life threatening but feels awful!
- Paroxysmal: Short recurrent bouts of vertigo
- Positional: Only occurs in specific positions
- Vertigo: Sensation the world is spinning
Common Symptoms
People often describe the vertigo symptoms quite intense and can last for a few seconds to a minute. It is triggered by different positions most commonly:
- Getting up from bed
- Rolling onto your side
- Bending/Looking Down
- Looking Up
- During yoga/pilates
Why does it occur?
Vertigo from BPPV is caused by disruption to the inner ear often referred to as the vestibular system which is important in balance. The inner ear is embedded in your skull and you have one on either side. They act as GPS units that picks up on head/body position which then sends a signal to your brain which interprets the information and sends signals to your eyes and muscles used for balance.
There are 3 canals as part of the inner ear system. These canals are hollow and filled with fluid that moves. There are little hair receptors in the canal (think of seaweed floating in water), so when you turn/move your head, the fluid moves and the hair receptors pick up on this information and sends it to the brain which determines if your head is moving left, right, up, down.
BPPV occurs when otoconia (often referred to as crystals) become dislodged in another section of the inner ear and gets trapped in one or more of the canals. When you change position/move your head, the crystals will fall with gravity until they reach the most gravity dependent position. Therefore, even if your head has stopped moving, the crystals continue to “fall” in the canal which pushes the fluid and sets off those hair receptors. This in turn sends incorrect messages to your brain and eyes that you are still moving which gives you the sensation of the room spinning. Once the crystals fall to the most gravity dependent position (often takes few seconds-minute), the vertigo will stop and can occur again with position changes.
Assessment, Treatment and Medications
Patients are often prescribed Stemitol and Serc to help treat BPPV. However, it should be noted Vertigo is a SYMPTOM and not a DIAGNOSIS. There are conditions such as BPPV that causes vertigo. Although these medications may assist in reducing symptoms, it will not fix the underlying condition causing the vertigo. Therefore, it is important to seek appropriate assessment and management to get down and treat the root cause of your vertigo.
BPPV can easily be treated. Our trained vestibular physiotherapist will perform tests to determine which inner ear is affected and which canal the crystals are in. This will often involve re-producing your symptoms to allow accurate diagnosis. This is important as this will determine which repositioning manoeuvre is performed which aims to move the crystals out the affect canal. Once the crystals are out of the canal the vertigo will be gone. This often takes 1-2 sessions but at times can take longer.
John Ma
Vestibular Physiotherapist