Benign Paroxysmal Positional Vertigo (BPPV) - A Guide

This blog post is designed for individuals who are experiencing issues with Benign Paroxysmal Positional Vertigo (BPPV). Our aim is to provide you with a comprehensive understanding of BPPV, its causes, symptoms, and treatment options.

What is BPPV?

Benign Paroxysmal Positional Vertigo (BPPV) is a condition of the Inner Ear. It is a non-cancerous nor serious (Benign) and involves recurring sudden episodes of vertigo (Paroxysmal) which is triggered by certain positions of the head (Positional). Vertigo is the sensation of movement, causing dizziness and a feeling as though the worlds is spinning around you.

Positional Vertigo has history dating back to 1879. The term BPPV was coined in 1952 by two British Otologists – Margaret Dix and Charles Hallpike. They conducted a study on 100 patients exhibiting symptoms of positional dizziness and recorded the movement of eyes when the head was in different positions.

What causes BPPV?

Within the inner ear we have the cochlea and the vestibular system. The cochlea converts sound vibrations into nerve signals that the brain perceives as sound. The vestibular system, consisting of the bony labyrinth, membranous labyrinth, and semicircular canals, provides essential information about body position, aiding in balance and coordination.

Benign paroxysmal positional vertigo (BPPV) occurs when calcium carbonate crystals, usually found in the membranous labyrinth, move to one or more semicircular canals. This crystal buildup disrupts fluid movement in the canals, altering the brain’s signals.

This disruption can cause vertigo, a spinning sensation, as the solid crystals react to gravity. Certain head movements and positions can trigger this vertigo in people with BPPV, including turning the head, lying on one side, rolling over in bed, bending the head forward, and leaning the head back. BPPV can also be caused by conditions like osteoporosis, gout and diabetes, head injuries, aging (more common in over 50’s) and changes in environmental pressure.

What are the signs & symptoms of BPPV?

The signs and symptoms of BPPV include dizziness, a sense that your surroundings are moving or spinning (Vertigo), nausea, light-headedness, vomiting and unsteadiness. Often these symptoms will be in conjunction with abnormal rhythmic eye movements, (involuntary movements from side to side, repetitive movements, and/or inability to control eye movements). Symptoms are almost always brought on by changing the position of the head.

BPPV does not cause any hearing loss. If experiencing Vertigo with hearing loss this could be related to ear wax build up, get in touch with Ear View today for a consultation.

How long does BPPV last?

Each episode of BPPV will normally last from 5 seconds – 30 seconds but can last for up to 2 minutes. While some people may have brief periods experiencing BPPV others may have prolonged symptoms.

Will BPPV go away on its own?

Benign Paroxysmal Positional Vertigo can sometimes resolve on its own. However, if the condition persists for more than a week seeing a specialist is advised.

Is having BPPV a health risk?

BPPV is rarely serious. However, the symptoms of unsteadiness and vertigo can increase the likelihood of falls which can cause potentially serious injuries.

How is BPPV diagnosed?

The first step to diagnosis of BPPV is speaking to a specialist. The symptoms of Benign Paroxysmal Positional Vertigo are quite characteristic so they may be able to ascertain you have this condition just from your symptoms. To confirm the diagnosis, they will do a test called the Dix-Hallpike manoeuvre – this involves laying down and asking you to move your head into different positions. These positions will usually trigger symptoms in those with BPPV.

If unable to diagnose that it is BPPV from the Dix-Hallpike test they may refer you for additional tests such as Electronystagmography (ENG) or videonystagmography (VNG) which detect abnormal eye movements. MRI and CT scans are also used to rule out any other potential causes of Vertigo.

What treatments and/or cures work for BBPV? 

There are a few different methods for treatment of BPPV, these include:

Repositioning Manoeuvres:

The most used repositioning manoeuvre is the Epley Manoeuvre but there are many different variants. The Epley manoeuvre is a simple treatment for BPPV which can be done at home or performed by a specialist. It involves a series of head movements designed to use gravity to move the crystals back to their correct location in the inner ear. The manoeuvre should be performed on the side where symptoms occur. It’s recommended to have someone present when first performing the exercise for safety if doing so at home. The steps include sitting up with your head turned 45 degrees to the right, quickly lying down with your head hanging over the bed’s edge, turning your head to the left, lying on your left side with your head slightly turned towards the floor, and finally sitting up slowly with your head tilted down. It is not recommended or suitable for those with reduced mobility, neck or back problems or history of a detached retina amongst other issues.

Self-Resolution:

Sometimes BPPV will resolve on its own without intervention, if symptoms last longer than a week seeing a medical professional is advised.

Micro-suction

If BPPV is exacerbated by excess or hard wax a specialist may recommend cleaning of the ears. If so, Micro-suction can be used along-side repositioning. Micro-suction is a safe, comfortable, and efficient way to remove excess or hard ear wax. A specialist will gently vacuum out any excess or hard wax from the ear canal.

What's the next step if the above treatments don't work? 

Repositioning procedures are typically effective in preventing the recurrence of BPPV. However, if symptoms persist for a prolonged periods of time and do not improve spontaneously or with treatment, then surgery or therapies for symptom management are available:

Surgery:

Surgical intervention for benign paroxysmal positional vertigo is highly uncommon, given that the condition typically resolves on its own or can be remedied through a repositioning technique. However, if the symptoms continue unabated for an extended period and cannot be alleviated, a procedure to disable the affected semicircular canal in the inner ear might be considered. Consultation with an ear specialist is recommended in such cases.

Vestibular Rehabilitation Therapy (VRT):

This is a form of physical therapy aimed at managing and alleviating any issues related to balance and dizziness.

If experiencing symptoms of BPPV which do not resolve with or without treatment it is recommended to see a medical professional. If you are experiencing vertigo symptoms with hearing loss, have wax build up issues or have been recommended for ear wax removal (due to wax exacerbating BPPV symptoms) contact us today for a consultation.