You just got up, the room is spinning, you feel like throwing up, you are more dizzy than you have ever been and the day hasn’t even started.
Benign Paroxysmal Peripheral Vertigo, or BPPV, is a common reason for intense and debilitating dizziness. It is characterised by a feeling of the room spinning or “vertigo”, symptoms worsening on head movement but lasting for less than 1-2 minutes each time and a sudden onset. BPPV can be commonly confused for other inner ear pathologies like vestibular neuritis (an infection of the fluid in the ear) or much more serious conditions like a stroke. However, when diagnosed correctly, BPPV can be managed effectively by a physiotherapist.
Our inner ear system has an important role in regulating our balance and sense of position in space. Each ear has a set of 3 semicircular canals which contain floating crystal-like calcium carbonate material, known as otoconia. These otoconia, or crystals, move within the ear with respect to gravity inside the semicircular canals. This movement of the floating crystals happens each time we move our heads to give us a sense of movement, the right ear working in tandem with the left ear.
However, when the crystals float out of the correct canal into a different one it does not belong in, the wrong messages regarding our sense of movement are sent to the brain. This results in BPPV and the feeling of severe vertigo.
Physiotherapists use the Hallpike assessment as the gold standard test to determine if the patient truly has BPPV. If this is confirmed, the Epley manoeuvre is performed on the patient where it uses gravity to tip the crystals back into the correct canal. The Epley manoeuvre often results in an almost immediate improvement but usually the procedure will need to be performed regularly but the person themselves at home, or with a physio, over a 3-4 day period until symptoms fully settle, depending on the patient.
BPPV is highly treatable but it is very important to have an assessment with a Physiotherapist or Doctor to ensure that the dizziness you are experiencing is not another more serious condition requiring different medical intervention.