BPPV (or Dizziness in normal speak)
Are you currently experiencing that feeling of having just hopped off a merry go round and the room is spinning and you feel a little nauseous?
Is this sensation brought on with certain types of head movements?
It may be that you are suffering from a common condition called benign paroxysmal positional vertigo (BPPV).
BPPV is a disorder of the inner ear which brings on a specific type of vertigo dependant on the heads position with respect to gravity. Vertigo is often felt as a spinning, tilting or swaying sensation with the “room spinning” the most commonly reported sensation from people suffering BPPV. The condition itself is not serious and with accurate diagnosis and appropriate treatment the symptoms can be eliminated in a matter of days (sometimes even within one session with a physiotherapist). Does it sound too good to be true? Well thankfully it isn’t. Let me explain why, but first we need to get through the not so exciting anatomy stuff.
BPPV is a condition caused by loose calcium crystals known as octonia moving within the semicircular canals of the inner ear (in most cases it is the posterior or back canal). Octonia are normally situated within the utricle (see figure 1) and over time can migrate to the semicircular canals were they can wreak havoc. When you move your head into provocative positions the calcium deposits move through the fluid (endolymph) within the semicircular canals creating an abnormal displacement of this fluid and thereby stimulation the small hairs that detect head movements. Signals are then sent to the brain telling the brain that head movement is occurring (even though the head is being held still). The issue arises when the opposite inner ear is sending signals to the brain that there is no head movement occurring (the opposite semicircular canal doesn't have calcium debris moving through it). The resultant mismatch coming from the left and right vestibular systems causes the sensation of vertigo.
Figure 1: The Vestibular System
So now that you know what’s happening within those inner ears of yours, let’s talk about what you can expect when you come to see a physiotherapist regarding BPPV. The main test that is used to diagnose BPPV is the dix Hallpike test (see figure 2). During this test they will be looking for a movement of the eye called nystagmus. This is a rotational and upward flicking of the eye that occurs once you have been laid down with the head rotated towards the affected side along with a 30dg backward head tilt. You may experience anything from mild to severe spinning sensations along with nausea. The symptoms can feel quite unpleasant however it is essential to perform the test to make an accurate diagnosis. That’s because other issues which can bring on vertigo include Meniere's disease and more rarely posterior circulation stroke. There are some important characteristics of BPPV vertigo which can help confirm that it truly is the cause of your symptoms. The nystagmus (rapid uncontrolled eye movements) is positional and comes on with certain head positions. It has a delayed onset of 5-10 sec and will only last 5-30 sec in duration. Long bouts of vertigo (30 min to 3 hours) may be a sign of Meniere's disease and posterior circulation stroke should be considered if there is associated neurological symptoms like numbness and weakness.
The fortunate thing for you if your suffering from BPPV is that the condition is easy to treat and it involves a manoeuvre called Epley’s. This manoeuvre involves a series of 30sec holds in very specific positions (head rotation to the side, side lying and sitting) in order to drain the calcium deposits from the posterior semicircular canal of your vestibular system into the utricle. The calcium deposits can rest in the utricle without causing you any vertigo symptoms. Now I do not want to put a damper on all things said here however, it is possible for your vertigo to return because just as you can drain the octonia from your posterior semicircular canal into the utricle it also possible for the calcium deposits to return there in the future. I know, frustrating isn’t. However, once you have been diagnosed by a physiotherapist and are able to perform the Epley’s manoeuvre then you can likely self manage at home and perform the manoeuvre when required. Now that’s kinda cool
Figure 2: Dix-Hallpike Position
So what now you may ask? Well if you feel that you can relate to the symptoms described above then come see one of the physiotherapists at Central Baldivis Physiotherapy and we will help diagnose and treat this frustrating condition for you. Please do not try to self-diagnose and self-treat at home as it’s important that other potential more serious conditions (like those mentioned earlier) are cleared.