May 14 , 2018
Vertigo De-Mystified: All You Need to know about BPPV and Vertigo

Earlier this year I delved into the topic of dizziness. As described in that post, there are a lot of causes of dizziness, and a lot of different descriptions of dizziness. As a PT I often have patients come into the clinic and say “I have vertigo” but not really understand what that means or involves. True vertigo is a symptom that is best described as either the room spinning, or a feeling of rotational movement. Usually vertigo is a result of a disorder called BPPV or Benign Paroxysmal Positional Vertigo (say that 10 times fast). Not everyone who has dizziness has BPPV, but in regards to vertigo, BPPV is the most common cause.

What is BPPV?
The description is all in the name.
Benign: Not life threatening, and easily treated
Paroxysmal: Short lived, when you experience a BPPV episode it will only last from seconds up to 2 minutes. If it lasts longer than that, it probably isn’t BPPV.
Positional: The episodes are brought on by head position. Most common positions include rolling in bed, sitting up in bed, or bending over.
Vertigo: The episodes consist of a false feeling of rotational movement

What Causes BPPV?
This is where it gets really wacky or interesting if you’re a nerd like me. BPPV is caused by loose crystals in your inner ear. Your inner ear has nothing to do with hearing, but instead it is involved with orienting and coordinating your eye and head movements. BPPV occurs when crystals in the inner ear get dislodged and stuck in tiny fluid filled canals. Normally, the fluid in the canals move with changes in head position. When the fluid moves it sends a message to your brain so that it can coordinate/orient your eyes in response to the head/fluid movement. When the crystals are loose in the canals (during BPPV), they cause the fluid to move when it shouldn’t. This leads to a false message being sent to your brain. Which results in your eyes moving abnormally and you getting the feeling of an intense but false sensation of rotation.

Who Gets BPPV?
Sometimes BPPV occurs as a result of head trauma loosening/relocating the crystals. Most often it occurs suddenly without warning in adults. As you age, the likelihood of it occurring increases.

How Do I Treat BPPV?
If the cause of BPPV is loose crystals, the cure or treatment is to put the crystals back into the correct place. Simple right? Sometimes the crystals can find they’re way back on there own. However, it does not always resolve on its own, and that is when a vestibular physical therapist, a trained audiologist or ENT can help. The PT/audiologist/ENT who is trained, will be able to use certain maneuvers to locate where the crystals are likely loose (which canal in which ear) and then guide you through a rolling maneuver to put the crystals back in place. This can take 1 to 3 visits and then voila the vertigo is gone.

What Not to Do
If the short duration vertigo that is caused by BPPV does not resolve on its own, it is not advised to treat with vestibular suppressants such as meclizine or antivert. This is because they dull or mask the indicators a PT/audiologist/ENT needs to see to diagnose the problem. And most importantly because the medicine is not addressing the cause, only the symptoms.