| |
| EAR DISORDERS & TREATMENTS > Vertigo from BPPV |
|
Introduction
Vertigo is defined
as an illusion of movement, which could be spinning, rocking,
tilting or dropping. This is caused by a peripheral or central
vestibular disorder. The peripheral vestibular disorders can be
divided into:
Benign paroxysmal positional vertigo
Vestibular neuronitis / viral labyrintitis
Ménière's disease
Trauma
|
|
The condition of BPPV is seen on a fairly regular basis. It is
characterised by brief episodes of vertigo when the head is moved
into certain positions. The vertigo appears to be triggered with
lying down, rolling over in bed, bending over or looking up. It may
occur spontaneously but may also follow head trauma, labyrinthitis,
or ischaemia in the region of the anterior vestibular artery1
.
There are two theories regarding the mechanisms for fragments
of otoconia to be displaced from the Otolith organs (saccule and
macula) into the semi-circular canals (SCC). In the
canalithiasis theory the otoconia are mobile therefore when
the head-position is tipped, the otoconia begin a gravity assisted
plunge down the semi-circular canal like a coffee-plunger. Since it
obstructs most of the canal, the plunging movement of the otoconia
stimulates the cupula to oscillate. In the cupulolitiasis
theory the tipped head causes the cupula to swing like a
pendulum. This oscillating movement through the process of the VOR,
produces the torsional nystagmus associate with positional induced
vertigo.
|
The diagnosis of BPPV is made by performing the Dix-Hallpike Manoeuvre
|
Physiotherapists have been involved in the treatment and
management of Peripheral vestibular disorders for a long time. Since
the age of Cawthorne in the Cawthorne-Cooksey exercises, Daroff in
the Brandt-Daroff exercises, and more recently the EBM work done by
Herdman in Atlanta, the treatment of peripheral vestibular disorders
have become more evidence based.
1Vestibular Rehabilitation - S J Herdman
|
|
|
| |
|
|
