What is BPPV?

BPPV is a vestibular disorder found in the inner ear that causes short bursts of false spinning sensations (generally lasting less than a minute) after moving one’s head in a certain way.

The acronym says a lot about BPPV:

• Benign — not harmful

• Paroxysmal — a sudden attack

• Positional — relating to one’s head position

• Vertigo — false sensation that the world around you or you are spinning

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Although BPPV has a lifetime prevalence of 2.9%, which means 2.9% of the population will get BPPV over the course of their lifetime. BPPV tends to increase with age and is more common in people over the age of 50 due to the gradual use of the otolithic membrane over time.

There are possible connections that may be associated with BPPV. These include, but are not limited to head injuries, migraine, Meniere’s disease, viruses that affect the ear (like vestibular neuritis and labyrinthitis), otologic surgeries, vascular issues, vitamin D deficiency, medications, and infection. However, for the most part, BPPV is spontaneous in origin.

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Why Do I Get Dizzy?

Most commonly, patients report getting their vertigo attacks when they:

• Get out of bed in the morning

• Bend over to tie their shoes

• Turn to look at something while driving, walking, or sitting

 

 

The reason that vertigo flares up in these specific head movements is that one of our main balance centers is located in the inner ear.

We have three semicircular canals in our inner ear which are filled with fluid.

 

 

As we turn our heads, that fluid moves and helps inform our body of our head’s location in space. A part of the inner ear called the utricle is thought to be the location of ‘ear crystals’ (officially called otoconia). In people with BPPV, those crystals get dislodged, find themselves with the fluid in your semicircular canals, and throw off your body’s sense of position.

The vertigo you feel is your body trying to understand this new information in the wrong part of your inner ear. In other words, your body is trying to make sense of mixed signals.

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BPPV Symptoms

BPPV patients often realize over time which motions and head movements will set off a vertigo attack. It’s important to take note of exactly when you routinely experience vertigo attacks, as it is helpful for the diagnosis and treatment process. These are the common symptoms of BPPV:

• Dizziness when the head is moved: a sense of spinning or dizziness during head motion. Can occur with or without nausea.

• Internal Vertigo: the false sensation that your body is rotating, twirling, swaying, or wobbling.

• External Vertigo: the false sensation that the world around you is spinning or flowing.

• Risk of Falling: these sudden vertigo attacks greatly increase the risk of falling or tumbling.

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How is BPPV Treated?

Fortunately, BPPV has one of the highest resolutions of all the vestibular disorders.

Commonly, BPPV can be resolved through procedures known as repositioning maneuvers. These involve rotating the head and body in a series of movements to put the dislodged crystals back where they belong. There are six different canals within your inner ear that may have the misplaced crystals — the posterior and horizontal canals being the most common. Each canal requires a different repositioning maneuver for treatment.

We use Frenzel goggles during the initial diagnosing process and throughout the maneuvers to get the exact measurement of the eyes recorded during the procedures. This ensures appropriate diagnosis and treatment.

Prior to performing these maneuvers, though, we need to understand any issues with the neck & spine, neurological abnormalities, and other physical limitations. This way we know if any maneuvers should be ruled out. That’s why a comprehensive case history is critical for new patients.

Although resources online will tell people that they can treat their BPPV on their own by self-administering these maneuvers, we highly advise against this as you can move the crystals around making your symptoms worse than before.

For some patients, it only takes one treatment to get them back to a dizzy-free life. Others require a few treatments along with ongoing check-ins when the vertigo returns months or years later.