Author: Jenna Clements, physiotherapist at All About Physio with a special interest in vestibular disorders
What is vertigo?
Vertigo is not a diagnosis, but rather a symptom of the sensation of self-motion when no self-motion is occurring or the sensation of distorted self-motion during an otherwise normal head movement. Patients suffering from vertigo often undergo several consultations and excessive costs without a clear diagnosis and treatment plan.
One of the most common conditions that can cause vertigo is known as Benign Paroxysmal Positional Vertigo or BPPV.
Benign meaning – not life threatening
Paroxysmal – sudden, brief episodes
Positional – triggered by certain head movements
Vertigo – as defined above
What is BPPV?
BPPV is a mechanical problem in the inner ear. It occurs when the otoconia (calcium carbonate crystals) dislodge from the utricle and make their way into the semi-circular canals that are filled with fluid (where they shouldn’t be). These crystals send a mixed signal to the brain interrupting the normal fluid movement that the canals use to sense the speed and direction of head movements.
What are the common symptoms of BPPV?
- Room spinning vertigo
- Short bursts usually less then 1 minute
- Exacerbated by head movements – rolling in bed, looking up or down, bending forward to pick something off the floor or pull weeds out of the garden
- Nausea and vomiting can occur
- Foggy in the head
- Unsteady on feet for a period after the attack of vertigo
Who can get it and how common is it?
BPPV is common, particularly as we age and is extremely rare in children. The majority of presentations can happen without an underlying cause or previous pathology, with many people complaining of a sudden onset of vertigo upon waking in the morning or when turning in bed. You are more likely to develop a BPPV if you have a history of concussion or head trauma, migraine, previous inner ear pathology or infection, diabetic, osteoporosis, intubation (after spending a long time lying flat).
How is BPPV treated?
Firstly, BPPV cannot be picked on via imaging. Though many people are given medication for BPPV, it may help to settle your symptoms but there is no evidence to support its use for the treatment of this condition.
Vestibular trained Physiotherapists are have the advanced skills to diagnose and treat BPPV. This is done by thoroughly assessing the patients eye movements in certain positions otherwise known as positional testing. When your Physiotherapist completes the positional testing, the movement of your eyes will allow us to accurately diagnose which ear and canal may be affected and also what type of BPPV you may be suffering from. Once we have diagnosed your BPPV accurately, we then are able to treat your BPPV using what is known as a Canalith Repositioning Technique or CRT. The technique will depend on which BPPV you are suffering from, however the one most commonly used is the Epely manoeuvre.
Many studies have been conducted looking into the effectiveness of the treatment manoeuvre for BPPV, with the results showing well into 90% effectiveness after 1-3 treatments.
Can BPPV return once treated?
BPPV is a condition that can return, with long term recurrence rates as high as 50% within the first 5 years.
There are also other conditions that can mimic a BPPV, and there are also so many variations of BPPV, a manoeuvre that works one time may not be the treatment indicated in the future if your vertigo re-occurs so it is always recommended that if it does re-occur to see your vestibular physiotherapist for further assessment and referral on if necessary.
Jenna is a physiotherapist at All About Physio with a special interest in the diagnosis and management of vestibular disorders. Jenna has experience working closely with general practitioners and ear nose and throat specialists on the Gold Coast, assisting with the diagnosis and management of patients suffering from vertigo and dizziness. She has also worked closely with extended scope physiotherapists in the emergency department at GCUH assessing and diagnosing acute presentations of vertigo. Jenna has completed further professional development in the area of vestibular diagnosis and rehabilitation.
If you would like to book an appointment with Jenna, click the ‘Book Now’ button below or call our Nerang location on 07 5596 5766 or Kingscliff location on 02 6670 1400. To learn more about All About Physio’s vestibular physiotherapy service click the ‘Learn More’ button below.
* The information provided in this article is for educational purposes only and not intended to be a substitute for professional advice. You must consult your healthcare professional before acting on the information in this article, especially if you have concerns regarding health related issues for yourself and your family.