BENIGN PAROXYSMAL POSITIONAL VERTIGO (BPPV):
Benign Paroxysmal Positional Vertigo (BPPV) is one of the most common causes of vertigo and dizziness.
BPPV means...
- Benign - a non-progressive condition;
- Paroxysmal - sudden and unpredictable in onset;
- Positional - episodes are caused by a change in head position;
- Vertigo - a sense of dizziness or spinning.
BPPV, or benign paroxysmal positional vertigo, is an inner ear condition that leads to brief and intense episodes of vertigo, where you feel like the room is spinning. Although it can affect children, as you age, the likelihood of your dizziness being caused by BPPV increases. Approximately 50% of dizziness cases in older individuals can be attributed to BPPV.
The inner ear plays a critical role in maintaining balance and detecting head movements. Inside the inner ear's labyrinth are tiny calcium carbonate crystals known as otoliths, sometimes referred to as "ear rocks." In BPPV, these otoliths become dislodged from their normal position and move into the semicircular canals. These canals are situated at approximately ninety-degree angles to each other, filled with a fluid called endolymph, and contain sensory receptors that are activated during head movements, providing a sense of motion and balance. In BPPV, when these crystals in the semicircular canals become dislodged, they inappropriately stimulate sensory nerve receptors, resulting in sensations of motion (vertigo) even when there is no actual movement.
Click here for "VEDA: Benign Paroxysmal Positional Vertigo (BPPV)"
More About BPPV:
- Approximately 65% of cases of vertigo are diagnosed as Benign Paroxysmal Positional Vertigo (BPPV), a condition that comes and goes depending on the position of the head and neck. When triggered, the dizziness can persist for a few seconds to several minutes, and sometimes even longer.
- Commonly, symptoms are provoked by actions such as getting out of bed, tilting the head, rolling over in bed, looking upward, or sudden head movements. This type of vertigo is associated with inner ear issues, with the most frequent cause being a sudden trauma, like a fall.
- The primary treatment for BPPV typically involves the Epley maneuver. This procedure swiftly shifts the patient from lying on one side to lying on the other, repositioning calcium debris in the inner ear to a less sensitive location.
- Research indicates that up to 80% of patients experience recovery after a single Epley maneuver treatment. However, in most cases of BPPV, two to three Epley treatments may be necessary. It's important to note that the Epley maneuver is not recommended for patients with severe carotid stenosis, heart conditions, or significant neck issues such as cervical spondylosis with myelopathy or advanced rheumatoid arthritis.
- Even without treatment, BPPV often resolves on its own within weeks or months, but it may also have a tendency to recur.
- Vestibular rehabilitation exercises, known as the Brandt-Daroff exercises, can be performed at home to aid in the treatment of BPPV.
Causes of BPPV:
Typically, BPPV accounts for roughly 20% of all dizziness cases, and among older patients, it constitutes about 50% of all dizziness cases. Other frequent culprits include acute vestibular neuronitis or labyrinthitis. In approximately half of all BPPV cases, it's classified as "idiopathic," which means it occurs without a known reason.
In individuals under the age of 50, the primary cause is often head trauma and whiplash injuries, which may eventually lead to or exacerbate degenerative disc disease (osteoarthritis) in the neck (cervical spine) vertebrae. Among older individuals, the most prevalent cause is the deterioration of the vestibular system within the inner ear, and BPPV becomes increasingly common with advancing age.
There are other, more serious, causes of vertigo such as:
1. Head injury
2. Due to the aging process
3. Minor strokes
4. A severe cold or virus
5. Tumours
6. Use of ototoxic medications, e.g. gentamicin
7. Neurological diseases such as MS.
In addition to the mentioned conditions, there are often other accompanying symptoms that are typically identified during chiropractic and neurological examinations. In some cases, these symptoms may necessitate a referral for further medical evaluation.
A precise diagnosis and appropriate treatment can effectively alleviate this disabling condition, often swiftly. BPPV is sometimes overlooked and managed symptomatically with prescribed medications like Stemetil and Compazine (prochlorperazine), which have sedative effects and can lead to pronounced drowsiness. If you're prescribed these medications, it's essential to avoid operating machinery or driving, as they can also produce various other side effects.
Symptoms of BPPV can include the following:
1. Severe but brief episodes of dizziness, without hearing loss or ringing in the ears
2. Feeling light-headed
3. A feeling of imbalance and nausea.
The symptoms usually start suddenly and often when waking from sleep. Episodes are triggered by changes in the position of the head such as getting out of bed or turning over in bed, tipping your head back to look up and certain Yoga or Pilates positions such as the 'down dog'.
Testing to Diagnose BPPV:
Chiropractors are able to diagnosis this condition after taking a full case history and performing a physical and neurological examination. Specific tests, such as the hallmark 'Dix-Hallpike Maneuver', if positive, is used to differentiate peripheral from central vertigo. This test will reliably provoke the vertigo and cause rotary or horizontal nystagmus (involuntary eye movement). It also determines the side of ear involvement. Click here to view the Dix-Hallpike Maneuver to test and diagnose BPPV dizziness.
IMPORTANT: Please note that feeling dizzy in the absence of Nystagmus is not considered diagnostic for BPPV. Eye twitching MUST be present for BPPV to be diagnosed.
Chiropractic Care of BPPV:
BPPV can be corrected using either Semmont’s Maneuver or Epley’s Maneuver. These maneuvers are simple and well tolerated in the majority of patients.
The chiropractor will assist the patient to slowly move their body, head and neck into specific and appropriate 're-positioning' positions depending on what has previously been found in the assessment. Using gravity, the floating calcium carbonate crystals (otoliths) in the endolymph of the semicircular canals that stimulate the sensory nerve receptors are encouraged to move away into the correct location in an area of the inner ear where they will, hopefully, cause no further symptoms of vertigo.
Following the procedure, the patient is instructed to avoid sudden movements and to sleep for 2 nights in a recumbent position. This procedure has a 90% success rate and often only one treatment is required. If the dizziness returns, the procedure is repeated.
If chiropractic care requires adjunctive therapy, then the chiropractor may also recommend a medical referral to a qualified physiotherapist (PT) or an occupational therapist (OT) to provide an assessment and develop an individualized treatment plan called Vestibular Rehabilitation Therapy (VRT) (Vestibular Physiotherapy) that includes specific head, body, and eye exercises to be performed both in the therapy setting and at home... Click here for "Cleveland Clinic: Vestibular Rehabilitation Therapy (VRT)" publication.
1 - Click here to watch a demonstration of the standard 'Epley' Maneuver to treat Posterior Canal BPPV for patients with 'rotatory/torsional' nystagmus.
2 - Click here to watch a demonstration of the Epley Maneuver called the 'Lempert (BBQ)' Maneuver to treat Lateral Canal BPPV for patients with 'lateral/horizontal' nystagmus.
3 - Click here to watch a demonstration of the Epley Maneuver called the 'Deep Head-Hanging' Maneuver to treat Superior Canal BPPV for patients with 'vertical' nystagmus.
The treatment is very effective and within 3-4 treatments, 80% are symptom free. The symptoms can recur and research shows a relatively low recurrence rate of about 15 percent per year.
Nutrition and Stress Reduction:
- Alcohol, nicotine, fried foods and excessive salt intake are potential sources of trouble for patients of vertigo.
- Vincopectine, vitamin B6 and ginkgo biloba may be helpful in reducing vertigo.
- Chromium may be helpful in patients whose vertigo is caused by a blood sugar imbalance.
- Physical exercise and meditation, adequate sleep and other stress reduction techniques can all help contribute to recovery from vertigo and should be a part of the treatment regimen.
- Your doctor of chiropractic can help create an appropriate exercise program for you and counsel you regarding healthy lifestyle and stress relief.
Source: The Mystery of Vertigo - By Nataliya Schetchikova, PhD - The American Chiropractic Association
- Click here for link to vertigo and pain caused by neck movement and problems with the spinal neck vertebrae.
- Click here for link and video: "Colorado Doctor Discovered Natural Way To Treat Common Vertigo".
- Click here for Vertigo BPPV Treatment with Simple Self-Directed Exercise.
- Click here for an important systematic review regarding "Manual therapy with and without vestibular rehabilitation for cervicogenic dizziness."
- Click here for "Chiropractic Management of A Patient with Benign Paroxysmal Positional Vertigo: A Case Report"
