BPPV (benign paroxysmal positional vertigo) is a condition that causes a sudden onset of vertigo when the head is moved into certain positions. Vertigo is felt as dizziness and is often combined with nausea. BPPV is caused by a dislodging of tiny crystals within the inner ear. The inner ear contains three semicircular canals which are responsible for telling us whether we are still or moving. Crystals found within these canals stimulate the nerves that sense head movement, and if dislodged can cause the feeling of dizziness.

BPPV is often worse first thing in the morning, with rolling over/getting out of bed being a common complaint for onset of vertigo. This type of vertigo is also bought on when looking up, such as opening a blind or hanging washing on a line. BPPV usually affects one ear only and the affected ear becomes very obvious during a physiotherapy assessment.

Vertigo Case Study 

Below is a case study of Mrs W – a woman who presented to PMPP with acute-onset BPPV last year.

Presentation:

Mrs W presented to PMPP with acute dizziness and nausea without vomiting, following a long-haul flight a few days prior. She was referred to Physiotherapy by her GP and upon assessment.  Mrs W’s vertigo and nausea was bought on when she looked over her right shoulder, rolled over to her right side on the bed or looked straight up to the ceiling. She also demonstrated nystagmus, an involuntary and repetitive movement of the eyes seen with BPPV. It was apparent that her vertigo was in fact due to crystal displacement within the inner ear canals. Other forms of vertigo such as Meniere’s disease, vestibular migraines or labyrinthitis will present differently.

Treatment:

The Hallpike-Dix is a test which is specific to BPPV and will bring on the patient’s vertigo when the patient is placed into a provocative position. Mrs W had no positive signs with her left ear but was very dizzy and nauseous when the test was performed on her right side. Fortunately, this test can be made into a treatment called the Epley manoeuvre. This helps to move the dislodged crystals and treat the BPPV on the spot. The test was then repeated and Mrs W had no dizziness or nystagmus upon reassessment. As BPPV can come back, Mrs W came back for another assessment two days later. She reported a significant improvement in her dizziness since her initial assessment and treatment.

The vestibular system is very plastic which means it is adaptable to stimuli. This is great news for people suffering from dizziness. With repeated, graded exposure to provocative environments or positions, the vestibular system will improve resilience and become less hypersensitive. In light of this, Mrs W was given two forms of exercise to practice. 1. gaze stability (aimed at improving visual acuity while the head is moving ) and 2. habituation (to decrease sensitivity to specific tasks).

Outcome:

Mrs W returned to PMPP a few weeks later and she had had minimal vertigo and nausea since last seen. She was happy to report that she was able to go shopping in the city without feeling nervous about a potential flare of her BPPV. Busy surroundings and increased visual stimulation can worsen dizziness in patients with a hypersensitive vestibular system. Mrs W sent me a Christmas email and noted that she had been hiking up a mountain in Vanuatu without any vertigo. This is an impressive feat for anyone, let alone someone who had experienced crippling vertigo only a few months prior.

If you or anyone you know has experienced any form of dizziness, Physiotherapy can be a wonderful form of treatment. Treatment may also help prevent/minimise future episodes. To book an appointment with Ali contact reception on 96817255 or  BOOK ONLINE

– Ali