What is BPPV?

Benign paroxysmal positional vertigo (BPPV) is a condition which causes brief/intense dizziness (and nausea). It occurs when particles (Otoconia) break off from the Cochlea and lodge themselves within the Semi-Circular Canals of the inner ear. This can occur via a head injury, infection or other conditions associated with the inner ear, as well as old age and migraines.

With Otoconia loose in the Canals, incorrect nerves in the Vestibular System are stimulated, leading to excess sensitisation. During head movements, the brain receives input that the head is spinning or moving excessively, even when the head has only moved slightly. Patients will describe their symptoms as if the world is turning while they are standing still, and their symptoms will come and go with no apparent reason many times throughout the day.

BPPV is predominantly diagnosed via physical examination (but can also be confirmed via auditory testing). Firstly, all central involvement must be cleared via oculomotor, balance and vestibular ocular reflex testing. Following all central signs being cleared, the three Semi-Circular Canals are then individually tested for involvement, with the Posterior Semi-Circular Canal most commonly being found at fault. Most patients generally present with Cervical issues, due to the nature of Vertigo symptoms causing upper body tension, as a ways to compensate.

Depending on the findings of the physical assessment, patients are provided with a Canalith Repositioning Program; which includes manoeuvres performed within the clinic and exercises to be performed at home. Generally, patients are also treated for any Cervical symptoms found in the initial examination.