Benign Paroxysmal Positional Vertigo (BPPV)

Benign Paroxysmal Positional Vertigo (BPPV) is one of the most common causes of vertigo and can be extremely uncomfortable, yet this is one condition that can be treated very successfully.

This sensation of vertigo usually occurs when you roll or sit up in bed, or even when you bend to pick up an object off the floor. The attack which is classically sudden and violent, lasts for about half a minute but can leave you feeling 'out of balance' for quite some time.

BPPV occurs when tiny calcium carbonate crystals (like grains of sand) move from one chamber (otolith) where it is perfectly normal, to another semi-circular canal (SC) of the inner ear. When the SC's orientation is changed the crystals roll down to produce brief vertiginous sensations.

Treatment is aimed at moving the crystals out of the semi-circular canal by a repositioning manoeuvre that should initially be performed by a medical practitioner or physiotherapist.

The three main systems that help us balance are:

• The visual system - input from the eyes
• The somatosensory system - input from our senses of feeling (skin, muscles, joints, etc)

The vestibular system

The vestibular system (VS) is one of the major parts of our balance system. It consists of the vestibular apparatus, the vestibular nerve, and the balance centres in the brain. Most of its input comes from the vestibular apparatus in the inner ear. This is the primary sensor providing information to the brain about movement, gravitational effects and where we are in space in relation to the ground.

The vestibular apparatus (like a spirit level system) in the inner ear has five different sensors that detect movement and gravity. These sensors are stimulated by head movement and send very accurate information to the brain which is important for good balance function. There is also reflex nerve connections from the inner ears to the muscles that move the eyes (Vestibular Ocular Reflexes or VORs). The accuracy of these VORs keep the surroundings perfectly stable when we are in a state of motion or travelling on corrugations (bouncy roads). Disorders affecting the VS due to a disruption of the inner ear mechanism, nerve infections, or brain problems can result in a feeling of vertigo (spinning, tilting, dropping or falling), dizziness (a sense of loss of control), or disequilibrium (postural unsteadiness).

Treatment

Physiotherapy treatment uses targeted exercise programmes to treat the vestibular apparatus and reduce the negative effects of vestibular disorders. Once the primary cause is addressed, the exercises work at reprogramming the brain by habituation (reducing the avoidance of certain positions), adaptation (teaching the unaffected balance organ to take over function) and substitution (teaching the other parts of the body to compensate).

Treatment is aimed at:

• Improving the ability to maintain vision during head motion
• Reducing intolerance to motion using repetitive eye, head, and body movements
• Balance retraining

Inner ear disorders, which can be helped with a targeted vestibular physiotherapy treatment program, include:

• Benign paroxysmal positional vertigo (BPPV)
• Vestibular neuronitis / labyrinthitis
• Acoustic neuroma (post-op)
• Oto-toxicity
• Ménière's disease
• Perilymph fistula

Dizziness and imbalance can also be the result of other general medical problems like high or low blood pressure or trauma (concussion), and therefore need to be properly diagnosed by a medical practitioner before a decision is made regarding the most appropriate treatment.

When providing physiotherapy treatment of inner ear disorders, the physiotherapist works with an Ear Nose and Throat (ENT) specialist, Neurologist, and other health professionals to develop the best possible program for each individual patient.