Benign Paroxysmal Positional Vertigo
Benign Paroxysmal Positional Vertigo (BPPV) is a type of vertigo that is brought on with certain movements of the head in relation to gravity, and is a disorder caused by problems within the inner ear. First, let's explain the major differences between vertigo and other types of 'dizziness':
To understand how this specific type of vertigo known as BPPV occurs, we need to have a look at the anatomy & physiology of the inner ear.
As can be seen in the picture above there is a snail-like shape known as the 'cochlea', and at the top of it are three 'semicircular canals'. These semicircular canals are positioned specifically to detect angular acceleration, and are filled with a fluid called 'endolymph'. At the base of each of these semicircular canals are 'cupula' which are essentially a gelatinous mass that is attached to polarised hair cells. When we move our head in relation to gravity, the movement of endolymph in these canals interacts with the cupula & hair cells causing a neurological response telling our brain what position our head is in (our spatial awareness). This is a normal and important interaction between the vestibular system and the brain.
However, the issue with BPPV occurs with another piece of anatomy known as 'otoconia' - these are little collections of calcium crystals that normally are found within the labyrinth of the inner ear in a section called the 'utricle'. In those suffering from BPPV these otoconia are dislodged from the utricle and enter the semicircular canals; when this happens, these relatively heavy calcium crystals affect the movement of the fluid (endolymph) in the canals causing abnormal stimulation of the hair cells. The result of this abnormal stimulation of hair cells is an issue in the neurological signal between the vestibular system and the brain which causes vertigo.
This vertigo can be triggered by any movements that stimulate the affected canal. Examples of this could be looking up or down, tilting your head, turning over in bed or any sudden movements of the head. Fortunately, most cases of BPPV will resolve on their own after a brief period of time.
In some cases manual therapy by your chiropractor or physiotherapist can prove very effective in treating BPPV. Assessment often includes an orthopaedic test known as the Dix-Hallpike test which can confirm the diagnosis of BPPV. It is then typically followed by a non-invasive treatment called the Epley manoeuvre; in this treatment the patient is positioned in a way to allow gravity to help move the otoconia (calcium crystal) build-up that is causing the vertigo. Once this build-up has been cleared the BPPV should also be gone.
Ben Howard
Ben has a Master's Degree in Clinical Chiropractic and holds various qualifications in the health & fitness industry. He has been helping clients achieve their health & fitness goals for over 7-years now and has had great success utilising his synergistic approach of passive care, active care & nutritional advice.
Vertigo
The feeling of spinning or movement while you are not actually moving. This can be felt as either yourself moving (subjective vertigo), or the room moving around you (objective vertigo).
Dizziness
Can be described as feelings of unsteadiness (feeling a loss of balance while standing or walking), lightheadedness (feeling as though you might faint), and weakness.
To understand how this specific type of vertigo known as BPPV occurs, we need to have a look at the anatomy & physiology of the inner ear.
However, the issue with BPPV occurs with another piece of anatomy known as 'otoconia' - these are little collections of calcium crystals that normally are found within the labyrinth of the inner ear in a section called the 'utricle'. In those suffering from BPPV these otoconia are dislodged from the utricle and enter the semicircular canals; when this happens, these relatively heavy calcium crystals affect the movement of the fluid (endolymph) in the canals causing abnormal stimulation of the hair cells. The result of this abnormal stimulation of hair cells is an issue in the neurological signal between the vestibular system and the brain which causes vertigo.
This vertigo can be triggered by any movements that stimulate the affected canal. Examples of this could be looking up or down, tilting your head, turning over in bed or any sudden movements of the head. Fortunately, most cases of BPPV will resolve on their own after a brief period of time.
In some cases manual therapy by your chiropractor or physiotherapist can prove very effective in treating BPPV. Assessment often includes an orthopaedic test known as the Dix-Hallpike test which can confirm the diagnosis of BPPV. It is then typically followed by a non-invasive treatment called the Epley manoeuvre; in this treatment the patient is positioned in a way to allow gravity to help move the otoconia (calcium crystal) build-up that is causing the vertigo. Once this build-up has been cleared the BPPV should also be gone.
References:
1. Tang, H., & Li, W. (2017). Advances in the diagnosis and treatment of benign paroxysmal positional vertigo. Experimental and therapeutic medicine, 14(3), 2424-2430. doi:10.3892/etm.2017.4837
2. You, P., Instrum, R., & Parnes, L. (2018). Benign paroxysmal positional vertigo. Laryngoscope investigative otolaryngology, 4(1), 116-123. doi:10.1002/lio2.230
3. Sushil Gaur., et al. (2015). Efficacy of Epley's Maneuver in Treating BPPV Patients: A prospective Observational Study. International Journal of Otolaryngology. doi:10.1155/2015/287160
4. Bhattacharyya, N., et al. (2017) Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update). Otolaryngology - Head and Neck Surgery. doi: 10/1177/0194599816689667
Ben Howard
Ben has a Master's Degree in Clinical Chiropractic and holds various qualifications in the health & fitness industry. He has been helping clients achieve their health & fitness goals for over 7-years now and has had great success utilising his synergistic approach of passive care, active care & nutritional advice.
