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Benign Paroxysmal Positional Vertigo (BPPV)

Benign paroxysmal positional vertigo (BPPV), or positional vertigo, happens when a person experiences intermittent, short-duration vertigo (less than one minute) that always shows up on the same side. BPPV happens when there is a dysfunction in the vestibular system, which is located in the inner ear. The role of the vestibular system is to detect the body’s movements and orientation in space in order to maintain its balance.

This complex system is comprised, among other elements, of three semi-circular canals (posterior, anterior and horizontal) and two organs (utricle and sacculus vestibuli). In these organs are located small calcium carbonate crystals, called “otoliths” (see image below). Sometimes, these otoliths become loose and can move around in the canals during movements of the head. It is their presence in the canals that causes vertigo, because the otoliths prevent the canals from functioning properly.

L’oreille interne

The symptoms

  • Intense, short-duration vertigo (less than a minute); more severe in the morning when getting up, and brought on by sudden changes in head position, such as when getting up or lying down, tilting the head forward, looking up or turning over in bed;
  • Nausea and vomiting associated with the episodes;
  • Loss of balance during – and sometimes between – episodes of vertigo.

The causes

  • In the majority of cases (60%), the cause is unknown;
  • Probable associations with osteoporosis, osteopenia, hypertension and hyperlipidemia.

Secondary causes:

  • Trauma (20% of cases), such as a cranial trauma or a bump to the head;
  • Associated with other vestibular conditions, including labyrinthitis and migraines.

Incidence of BPPV

The incidence of benign paroxysmal positional vertigo increases after age 55 and affects twice as many women as men.

Physiotherapy treatments

Any individual who has experienced this type of vertigo (or who suspects it is the case) should see a health professional as soon as possible, because a loss of balance can trigger a bad fall or cause dangerous involuntary movements, be it at work or during leisure activities.

The goal of physiotherapy treatments is to return the crystals (otoliths) to their normal position. To do that, the physiotherapist uses techniques called “repositioning” or “freeing”, of which there exist several variations. The good news is that these techniques are all equally effective, with a success rate of over 90%. The patient can therefore be healed within a few days, after one to five sessions, depending on the location of the otoliths. The physiotherapist will also prescribe exercises to do at home in order to speed up the healing and avoid a relapse.

Examples of exercises to do at home:

  1. Sit on the edge of the bed, feet touching the floor;
  2. Lie down on your right side until the vertigo appears;
  3. Sit up and do the same thing on the left side.

This technique has to be done fairly quickly in order to be effective. By repeating it three to six times a day, you will feel a lessening of the vertigo’s intensity, and after a few days or weeks, the vertigo will be completely gone. Get in touch with your physiotherapist for advice or to get additional treatments.

Please note that the risk of relapse is higher in the following cases:

  • The individual has experienced three episodes of vertigo before the first treatment; this shows how important it is to get treated as soon as possible after the first episode;
  • For individuals about sixty years of age;
  • For women, who are twice as much at risk than man.

Remember: the faster you get treatment, the better your chances of success!

Contact our physiotherapists if you need more information.