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| EAR DISORDERS & TREATMENTS > Benign Paroxysmal Positional Vertigo (BPPV) |
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Introduction
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.
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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.
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