• BPPV is one of the most common inner ear problems
  • For some people it will go away without any treatment, but for other people it can last years or come and go intermittently
  • It can be easily diagnosed based on history and physical examination from a physiotherapist with knowledge of the vestibular system. Other tests and scans are not usually required.
  • Medication is not an effective treatment option.
  • It can be treated very effectively with maneouvres performed by a physiotherapist or other healthcare professional.
What is BPPV?
  • It is a disorder of the inner ear balance organ.
  • It presents as sudden, short-lived episodes of vertigo/ dizziness / spinning, usually lasting less than a minute
  • The symptoms can be brought on by rapid changes in head position. The most common positions to trigger this is rolling over in bed or looking up.
What are the symptoms of BPPV?
  • Dizziness / spinning / vertigo
  • Imbalance and a general disorientation
  • Nausea and occasionally vomiting
  • Headaches may occur but should be relatively mild.
  • Patients may develop anxiety and avoidance behaviour, for fear of triggering or worsening symptoms.

Many people realise keeping the head still and upright relieves the spinning, and they may want to sleep propped up on several pillows. Some will therefore develop a stiff neck.

Who gets BPPV?

BPPV is the commonest cause of dizziness among the general population, accounting for one-fifth of referrals to specialised vertigo clinics. The possibility of developing BPPV also increases with age. Women are affected twice as often as men, and it is more frequent after the menopause. It can also come on after a head injury or following another form of inner ear problem (e.g. an infection).

What causes BPPV?

It is thought that BPPV is caused when the tiny chalk like crystals (otoconia) embedded within our inner ear become loose and get “stuck” in one of the canals of the inner ear balance system. As you then roll over or tilt your head, movement of these “ear crystals” sends abnormal messages to the brain and eyes, causing spinning dizziness. When you then keep your head very it settles within a minute.

How is BPPV diagnosed?
  • The therapist will start by asking you questions about your symptoms, such as when and how it started and what brings it on and eases it etc.
  • They will perform movements and maneouvres to provoke symptoms whilst looking closely at your eye movements. This will tell the examiner where the crystals are located so the best treatment can be advised.
  • Some medications can affect the tests so let whoever is assessing you know if you have taken any medication or alcohol in the last 48 hours.
  • Other tests may be advised to rule out other causes.
Repositioning manoeuvres
  • There are several different manoeuvres or exercises, which can be done by your therapist after a thorough assessment and explanation. These generally involve moving your head into various positions against gravity.
What happens after diagnosis and treatment?
  • This is not a life-threatening condition although the symptoms can be very disabling.
  • People may experience other problems associated with it, such as imbalance, loss of imbalance and anxiety.
  • Treatments are very successful and in 9 out of 10 of patients it will go away within a few attempts.
  • In a small number of people, you can feel woozy or more off balance for a few days after treatment. This will go away without the need for any treatment so don’t worry.
  • It may be useful to have someone else drive you home or take a taxi.
  • If the symptoms have gone away, then treatment may need to be repeated so it is important to go back to see your physiotherapist. It is also possible to complete these maneouvres at home, but you should discuss this with your healthcare professional first.
Keeping safe with benign paroxysmal positional vertigo
  • Tell your employer if dizziness could pose a risk to yourself or others e.g. if you use ladders, operate heavy machinery, or drive.
  • To avoid falls, get out of bed slowly and avoid jobs that involve looking upwards or downwards quickly. Remove rugs or other trip hazards.
  • Turn the light on at night if you need to go to the toilet.
Can it come back?
  • Once your vertigo is resolved it can still come back, which is more common if you have a history of head injury.
  • You should therefore discuss a relapse management plan with your physiotherapist.
Are there any other treatments?

Medications are usually not needed and will only be useful in cases of severe nausea for a one-off treatment. They do not treat the condition or make it go away. Surgery is extremely rare because the repositioning manoeuvres are so effective.

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