Benign Paroxysmal Positional Vertigo (BPPV)

feeling dizzy when you roll over in bed or get up from laying position? Could be BPPV!

What is BPPV?

Benign paroxysmal positional vertigo (BPPV) is the most common cause of dizziness and type of vertigo. The condition is characterized by brief episodes of dizziness, nausea, nystagmus (eyes involuntarily moving side to side) triggered by a certain movement of the head. BPPV can be resolved through a canalith repositioning maneuver, which may be performed by a chiropractor.

Over 7% of the population may experience BPPV at some point in their life and 80% of those people will require a medical consultation. Although this condition can affect any age group, it is most commonly found within the fourth or fifth decade of life. Since this condition is common in the elderly population it will often go unreported.

Additional risk factors for the development and recurrence of BPPV include a sedentary lifestyle, diabetes mellitus, hyperinsulinemia, hyperglycemia, hypertension, hyperlipidemia, osteoporosis, nutritional deficiencies, particularly vitamin D deficiency.

The anatomy of the ear that are included with this condition are three semicircular canals, each filled with a viscous fluid called endolymph. As the head moves the fluid moves within those canals. This stimulation is then transmitted to the brain, while working with input from the eyes and your cervical proprioception, to help with balance. BPPV develops when calcium carbonate particles (crystals) dislodge within one of these canals.

A majority of benign paroxysmal positional vertigo cases have an idiopathic origin. There are other issues that can cause this condition including cranial trauma, infection, ovarian hormonal dysfunction, syphilis, psychological disorders, cardiovascular disease, and more. BPPV patients may have vascular abnormalities that contribute to this condition.

Symptoms

A classic for BPPV includes sudden episodes of rotary vertigo that last about 10-20 seconds following different movements of the head. Typical activities that provoke this include transitioning between upright and recumbent (laying down), rolling from side to side, bending forward, and moving head to look up, down, or side to side. Benign paroxysmal positional vertigo symptoms are generally episodic, provoked by movement and eased with maintaining a stable position.

BPPV is often accompanied by an increased anxiety, impaired postural control, and a reduced quality of life.

Diagnosis

The diagnosis of BPPV is generally established with a history and clinical examination. Diagnostic imaging such as thin section CT and MRI typically have no findings when it comes to BPPV, however it can rule out other intracranial pathologies, as well as internal auditory abnormalities.

Clinicians may assess vital signs to provide further insight. Blood pressure measurements may help identify patients that are predisposed due to hypertension or orthostatic hypotension. Clinicians will also palpate (touch) the head and neck for any signs of lymph node swelling.

Otoscopic (tool to look inside the ear) evaluation may be used to identify any middle ear problems.

Management