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Finding Balance: Understanding and Treating Benign Paroxysmal Positional Vertigo (BPPV)



Finding Balance: Understanding and Treating Benign Paroxysmal Positional Vertigo (BPPV)

Have you been suffering with dizzy spells lately? In Canada, during the winter months and into early Spring, certain health conditions tend to emerge with increased frequency, one of which is Benign Paroxysmal Positional Vertigo (BPPV). During this time, individuals often find themselves grappling with the disorienting sensations and bouts of dizziness characteristic of this vestibular disorder. BPPV, although benign in nature, can significantly disrupt daily life and throw off one’s sense of balance and stability.

So, let’s break it down: what is BPPV, who is at risk,  and how can we treat it? By unraveling the mysteries surrounding BPPV, individuals can empower themselves to seek appropriate treatment and support.

What is Benign Paroxysmal Positional Vertigo (BPPV)

doctor investigating patient for Benign Paroxysmal Positional Vertigo BPPV

BPPV is a common vestibular disorder characterized by sudden episodes of dizziness or vertigo triggered by certain head movements. It occurs when tiny calcium carbonate crystals in the inner ear become dislodged and float into the canals responsible for balance. These displaced crystals disrupt the normal fluid movement, sending false signals to the brain about the body’s position in space. As a result, individuals with BPPV experience brief but intense sensations of spinning or imbalance, often triggered by changes in head position. While BPPV is generally not serious, it can significantly impact daily activities and quality of life.

Who is at Risk for BPPV?

Several factors can contribute to the risk of developing BPPV. Here are some common risk factors associated with BPPV:

  • Age: BPPV is more common in older adults, particularly those over the age of 60. Age-related changes in the inner ear structures and the accumulation of debris or crystals in the inner ear can increase the risk of BPPV.
  • Previous head injury: Individuals who have experienced head trauma, such as a concussion or whiplash injury, may be at higher risk for developing BPPV. Trauma to the head can dislodge the calcium carbonate crystals in the inner ear, leading to BPPV symptoms.
  • Inner ear disorders: Certain conditions affecting the inner ear, such as Meniere’s disease or vestibular neuritis, can predispose individuals to BPPV. Inner ear disorders disrupt the normal function of the vestibular system, increasing the likelihood of crystal displacement and BPPV episodes.
  • Female Gender: The exact reasons for the higher prevalence of BPPV in females compared to males are not fully understood. However, some research suggests that hormonal fluctuations and differences in inner ear structure may play a role.
  • Insufficient vitamin D levels: Vitamin D affects the tiny crystals in the inner ear called otoconia. When vitamin D levels are low, these crystals can become less dense, possibly contributing to BPPV symptoms.
  • Migraines: The exact connection between migraine and BPPV remains unclear. Some research suggests that migraine attacks may impact the blood vessels in the inner ear. This could potentially lead to the displacement of otoconia, a key component in BPPV.
  • Total cholesterol level: While there’s no direct evidence linking total cholesterol levels to BPPV, some studies suggest a potential association between cardiovascular risk factors, including high cholesterol levels, and vestibular disorders like BPPV. High cholesterol levels may affect blood flow to the inner ear, which could potentially impact vestibular function.

Understanding these risk factors can help individuals identify potential triggers and take preventive measures to reduce their risk of developing BPPV or manage the condition effectively if it occurs.

How do the Seasons Play a Role with BPPV?

flowers in the snow

While BPPV is typically considered a condition with unpredictable onset and duration, emerging research suggests potential seasonal tendencies in its occurrence. While there isn’t conclusive evidence that directly links BPPV to a certain season, more researchers are starting to look at trends over the year. More specifically, studies have identified that lower serum vitamin D levels and vitamin D deficiency is more prevalent in patients with BPPV compared to controls. In North America, our serum vitamin D levels typically fall during winter, reaching a low point each year in early spring (March-May). A recent study tested out this theory and assessed the number of BPPV visits seen at a hospital in Boston in March, April, and May and compared this with the number of visits during the remaining months of the year. 

Their results of 956 visits for BPPV during the 5 years, showed that the highest visits for BPPV were during the months when serum vitamin D level were the lowest (March-May). Further investigations are needed to address whether vitamin D deficiency is a risk factor for a seasonal form of BPPV.

How Can Physiotherapy Help with BPPV?

Physiotherapy can be highly effective in managing and treating BPPV. Here are several ways in which physiotherapy can help:

Canalith Repositioning Maneuvers (CRM): Physiotherapists are trained to perform specific maneuvers designed to reposition the displaced calcium carbonate crystals (otoconia) in the inner ear canals, which are the underlying cause of BPPV. The most common CRM techniques include the Epley maneuver, the Semont maneuver, and the BBQ roll. These maneuvers aim to move the crystals out of the semicircular canals, where they are causing symptoms, and into a different part of the inner ear where they do not cause symptoms.

vertigo treatment at Sheddon physio clinic Oakville

Assessment and Diagnosis: Physiotherapists are skilled in performing comprehensive assessments to accurately diagnose BPPV and differentiate it from other vestibular disorders. Through a series of tests and maneuvers, they can determine which specific canal is affected and develop an appropriate treatment plan tailored to the individual’s needs. The special “glasses” shown below can also be used to assess nystagmus during assessment.

vertigo assessment at Sheddon physio clinic Oakville

Education and Home Exercises: Physiotherapists educate patients about BPPV, its causes, and how certain movements trigger symptoms. They provide guidance on lifestyle modifications and strategies to minimize the risk of symptom recurrence. Additionally, they teach patients specific exercises and techniques that can be performed at home to alleviate symptoms and improve balance and stability.

Vestibular Rehabilitation Therapy (VRT): In addition to canalith repositioning maneuvers, physiotherapists may incorporate vestibular rehabilitation exercises into the treatment plan. VRT aims to improve vestibular function, enhance balance, and reduce dizziness and vertigo symptoms. These exercises typically involve eye-head coordination exercises, balance training, gait exercises, and habituation exercises to help the brain adapt to abnormal sensory input.

Monitoring and Follow-up: Physiotherapists closely monitor patients’ progress throughout the treatment process and make adjustments to the treatment plan as needed. They provide ongoing support, guidance, and encouragement to help patients achieve optimal outcomes and minimize the impact of BPPV on their daily lives.

Overall, physiotherapy plays a crucial role in the management of BPPV by providing targeted interventions to alleviate symptoms, improve vestibular function, and enhance overall quality of life. It is important for individuals experiencing vertigo or dizziness to consult with a physiotherapist or healthcare professional for proper evaluation and personalized treatment.

How Sheddon Physiotherapy & Sports Clinic can help you!!

Vestibular Rehabilitation service Oakville Burlington

At Sheddon Physiotherapy and Sports Clinic, we understand the challenges posed by BPPV and are committed to providing comprehensive care and support to individuals experiencing vertigo and imbalance. Our team of skilled physiotherapists is equipped with specialized training and expertise in vestibular rehabilitation and BPPV management techniques. Through personalized assessment, diagnosis, and targeted interventions, we strive to alleviate symptoms, improve balance and stability, and enhance overall quality of life for our patients. From canalith repositioning maneuvers to vestibular rehabilitation exercises, we tailor our treatment approach to meet the unique needs and goals of each individual. Sheddon Physiotherapy and Sports Clinic in both Oakville and Burlington is here to guide you on your journey toward better vestibular health and well-being. Let us help you regain your equilibrium and get back to enjoying life to the fullest.

Frequently Asked Questions

  1. How soon can I expect relief from BPPV symptoms with physiotherapy? Many individuals experience significant improvement in symptoms after just one or two sessions of physiotherapy, particularly following successful repositioning maneuvers. However, the exact timeline for symptom relief may vary depending on the severity of BPPV and individual response to treatment.
  2. Are there any precautions or lifestyle modifications recommended for managing BPPV? It is generally recommended not to sleep on the side affected by BPPV. Sleeping on the side with BPPV can potentially exacerbate symptoms of vertigo by triggering the displacement of the calcium carbonate crystals (otoconia) within the inner ear. 
  3. Can BPPV recur after successful treatment? While many individuals experience long-term relief from BPPV symptoms following successful physiotherapy, the condition can recur in some cases.

Whitman, G. T., & Baloh, R. W. (2015). Seasonality of benign paroxysmal positional vertigo. JAMA Otolaryngology Head & Neck Surgery, 141(2), 188-189. https://doi.org/10.1001/jamaoto.2014.2941

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