What is BPPV?

Benign paroxysmal positional vertigo (BPPV) is the most common disorder of the inner ear’s vestibular system, which is a vital part of maintaining balance. BPPV is benign, meaning that it is not life-threatening nor generally progressive. BPPV produces a sensation of spinning called vertigo that is both paroxysmal and positional, meaning it occurs suddenly and with a change in head position.

What causes BPPV?

The most common cause of vertigo, BPPV, happens when tiny particles in the balance centre of the inner ear are disturbed, usually by sudden movement. This causes the spinning sensation. It is a common problem that can affect people of all ages and is the cause of approximately 50% of dizziness in older people. Activities that bring on a dizzy spell can vary. They often involve moving your head into a certain position suddenly, such as looking up, lying on one ear, rolling over in bed, getting out of bed and bending over.

What are the symptoms?

The symptoms of BPPV are dizziness: this begins seconds after a certain head movement and lasts less than a minute; feeling light headed; balance problems, and nausea: feeling like you are going to vomit. These symptoms usually get better once you are in a different position. Pain, ringing in the ears (tinnitus) or deafness is not common. If you have more serious symptoms – speech difficulty, double vision, unsteady walking, difficulty swallowing, altered strength or feeling in your legs or arms, ringing in your ears or deafness – you should seek medical help.

What will the physiotherapist do?

The condition is diagnosed by a test called the Hallpike-Dix which involves moving you from a sitting position to lying down with your head over the edge of the bed. Your physiotherapist can treat BPPV by moving your head through a number of different positions. The aim is to move the crystals back out of the canal where they will be reabsorbed by your body. This treatment is very effective. Many people have complete resolution of symptoms in one to two treatments. However, the problem can recur in up to 30% of people. You may need to perform some balance exercises to treat any remaining balance problems once the BPPV has resolved.

Outcome

Research indicates a greater than 80% success rate within two physiotherapy sessions. If BPPV is an ongoing problem then it is best to do Brandt-Daroff exercises at home (see below). Brandt-Daroff exercises assist in dispersing the tiny particles from the balance centre in your ear, therefore getting rid of the cause of your dizziness.

You may be anxious that the exercises will bring back your symptoms. This is normal. However, the exercises will only work if you feel dizzy as you do them. The dizziness will get less with time.

Sit on the edge of the bed. Turn your head 45 degrees (look to the left). Lie down quickly on the right side. Ensure the back of the head rests on the bed. Wait 20-30 seconds or until the dizziness stops.
Sit upright. Wait 20-30 seconds for any dizziness to settle.
Repeat on the other side. Turn the head slightly to the right before lying down quickly on the left side.

Do five times on each side (takes about 10 minutes). Repeat three times a day.