Introduction
Vertigo is the perception of motion without movement which may be described as swaying, tilting, spinning, or feeling unbalanced.
BPPV is a vestibular disorder that leads to sudden episodes of vertigo, causing a spinning sensation typically triggered by changes in head position. These dizzy spells occur due to disturbances in the inner ear, specifically in the semicircular canals that help maintain balance.
The term “benign” indicates that it is not life-threatening; “paroxysmal” refers to the sudden onset and brief duration of vertigo episodes; “positional” signifies that it is triggered by specific head movements; and “vertigo” describes the sensation of spinning or movement
Etiology of BPPV
BPPV is due to the displacement of calcium carbonate crystals which known as the otoconia within the fluid-filled semicircular canals of the inner ear. The otoconia are important for proper functioning of the utricle of the otolithic membrane by helping deflect the hair cells within the endolymph, which relays on the positional changes of the head including tilting, turning and linear acceleration.
Symptoms of BPPV
BPPV symptoms are characterized by episodes of vertigo that last less than a minute but can still feel overwhelming. The vertigo typically occurs with certain movements, such as lying down, turning the head, sitting up, or rolling over in bed. Other symptoms associated with BPPV include:
- Nausea
- Vomiting
- Loss of balance
- A feeling of unsteadiness or swaying
These symptoms can vary in severity and frequency, but they are generally more common in adults aged 50 and older. BPPV can also disrupt daily activities and may contribute to falls, especially in older adults.
Clinical Test : Dix-Hallpike Maneuver
In the Dix-Hallpike maneuver, the patient is rapidly moved from a sitting to a supine position with the head turned 45 degrees to the right. After 20 to 30 seconds, the patient returns to the sitting position. If absent of nystagmus, the same procedure is repeated on the left side. While performing the Dix-Hallpike maneuver, some important tips to be mindful of are:
- The head should not be turned 90 degrees as this can bring about an illusion of bilateral influence.
- The briskness with which the Dix-Hallpike test is performed should be individualized for each patient.
- The Epley modification – The test should be performed from behind the patient as pulling the outer canthus in the superolateral direction makes it easier to observe the eyeball rotation.
- The axis of the nystagmus is near the undermost canthus. Directing the patient gaze toward the anticipated axis is useful to minimize suppression
Positive Test Result: Rotatory nystagmus (latency and short duration)
Lifestyle Modification
| Get up slowly | Moving slowly from a lying to a sitting position can help reduce dizziness. |
| Avoid sudden head movements | Sudden changes in head position can trigger vertigo, so it’s best to move deliberately. |
| Stay hydrated | Dehydration can worsen dizziness, so drinking plenty of water is essential. |
| Sleep with an elevated head | Using extra pillows to keep the head slightly elevated while sleeping may reduce symptoms in the morning. |
| Balance exercises | Practicing exercises to improve balance can help reduce the risk of falls. |
Conclusion
BPPV is a relatively common inner ear condition that can cause brief but intense episodes of vertigo. Although the symptoms can be unsettling, effective treatment options like the Epley maneuver and certain exercises are available. By understanding BPPV and practicing preventive measures, many individuals can manage the condition effectively and continue to live a balanced life.
References
Bhattacharyya, N., Gubbels, S. P., Schwartz, S. R., Edlow, J. A., El-Kashlan, H., Fife, T., … & Corrigan, M. D. (2017). Clinical practice guideline: Benign paroxysmal positional vertigo (update). Otolaryngology–Head and Neck Surgery, 156(3_suppl), S1-S47. https://doi.org/10.1177/0194599816689667
Fife, T. D., Iverson, D. J., Lempert, T., Furman, J. M., Baloh, R. W., Tusa, R. J., Hain, T. C., & Zee, D. S. (2017). Practice parameter: Therapies for benign paroxysmal positional vertigo (an evidence-based review). Neurology, 70(22), 2067-2074. https://doi.org/10.1212/01.wnl.0000313367.59961.68
Neuhauser, H. K., Radtke, A., von Brevern, M., Feldmann, M., Lezius, F., Ziese, T., & Lempert, T. (2016). Burden of dizziness and vertigo in the community. Archives of Internal Medicine, 168(19), 2118–2124. https://doi.org/10.1001/archinte.168.19.2118
Von Brevern, M., Bertholon, P., Brandt, T., Fife, T. D., Imai, T., Nuti, D., & Newman-Toker, D.E. (2015). Benign paroxysmal positional vertigo: Diagnostic criteria. Journal of Vestibular Research, 25(3–4), 105–117. https://doi.org/10.3233/VES-150553
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Tan Eng Jing
Your Physio Connaught