Vertigo from BPPV

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