BPPV Explained: Symptoms, Causes and How Physiotherapy Can Help
Dizzy when you roll over in bed? A few months ago, while visiting family in Canada, a relative asked whether I had experience with dizziness and vertigo. “Yes actually,” I said, “it’s more common than you might think.”
She described rolling in bed and suddenly feeling the room spin around her. It sounded like an inner ear issue, so I suggested she see her physio for a full assessment. A few weeks later she told me she was feeling much better. Her physio had diagnosed benign paroxysmal positional vertigo (BPPV) and started treatment.
Her story is a great example of how common, and how treatable, this condition is. Here’s what BPPV is, what causes it and how physiotherapy can help.
This blog will discuss the symptoms, causes and treatment options for BPPV.
This blog will cover the following topics on BPPV:
- What is BPPV?
- What causes BPPV?
- What are the symptoms of BPPV?
- How is BPPV diagnosed?
- How can physiotherapy help with BPPV?
- How long does BPPV take to improve?
- When should I seek medical attention?
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What is BPPV?
So, what is BPPV or Benign Paroxysmal Positional Vertigo? Well, it’s a very common cause of dizziness stemming from the inner ear. Let’s break it down into the meaning of each word:
Benign - meaning your life is not in danger,
Paroxysmal - meaning it can come on suddenly and is brief
Positional - meaning it depends on how your head and inner ear canals are positioned, and
Vertigo - is a certain type of dizziness often described as a ‘room spinning’ sensation.
Symptoms from BPPV, while brief, are often quite unpleasant and enough to hamper activities of daily living and like my family member told me, can also discourage attending social events. Hearing that broke my heart and I am so glad that physiotherapy assessment and treatment can be a very effective for diagnosed BPPV.
Dizziness has many possible causes, including the inner ear, the neck and other conditions that need medical attention. That’s why an accurate assessment is important before any treatment begins, including positional tests like the Dix-Hallpike manoeuvre to confirm whether BPPV is the cause.
Not sure if your dizziness could be BPPV?
Book in with one of our experienced physiotherapists today for a comprehensive assessment and personalised management plan.
What Causes BPPV?
The inner ear has a structure referred to as the bony labyrinth containing three main parts:
The Cochlea: A spiral-shaped compartment for hearing.
The Vestibule: A compartment in the centre connecting the cochlea and the semicircular canals.
The Semicircular Canals: Three loops (anterior, posterior, and lateral) for sensing movement of rotation.
A further structure of the inner ear, referred to as the membranous labyrinth, contains an additional three parts:
The Cochlear Duct: houses sensory hair cells with that detect waves of movement in the inner ear fluid.
The Utricle and Saccule: Located in the vestibule, where the otoconia crystals reside, and membranes to detect gravity and changes in movement speed. The otoconia crystals are microscopic calcium carbonate crystals that normally sit embedded in the gel-like membrane. The ‘ear crystals’ act as gravity sensors. Because they are heavier than the surrounding fluid, gravity and head movements cause them to shift, bending tiny hair-like nerve cells (cilia) underneath them. This movement sends vital signals to the brain regarding gravity, linear acceleration (moving straight forward or backward), and head tilt.
Semicircular Ducts: Tubes inside the bony canals housing the crista ampullaris for balance.
This delicate balance of the inner ear can become disrupted when an otoconia crystal loses its foothold in the membrane and travels into the fluid filled semicircular canals.
Some common causes of this crystalline displacement may be as follows:
Age-Related: Common in adults over 50, natural age related wearing of membranes holding the crystal otoconia.
Head Trauma: A direct hit, fall or jarring motion can be strong enough to dislodge a crystal.
Infections: Inner ear conditions like labyrinthitis or vestibular neuritis can damage or inflame the membrane.
Associated Conditions: BPPV is more common in those with osteoporosis, migraines, or prior ear surgeries.
Once the crystal is displaced from its original housing and has travelled into a semicircular canal, it will disrupt the normal sense of balance. Abnormal signals are then sent to the brain that don’t match up with signals from other sensory organs like the eyes. This leads to a mismatch of information in the brain until the crystal slowly settles again and the signals can be normalised. This is why the dizzy symptoms are often sudden and brief and the room can feel like its spinning.
What are symptoms of BPPV?
Typical symptoms and symptoms behaviour related to BPPV:
- Can be triggered by rolling bed, lying down or getting up from bed, or looking upward
- Episodes of dizziness are brief and feel like the room is spinning
- Symptoms are usually quite short lasting - less than a minute
- The dizziness often leads to nausea and occasional vomiting
- Feeling off balance or not very confident in movement
How is BPPV diagnosed?
During consultation with your physiotherapist, providing a comprehensive history of your condition is important. Discussing how your dizziness began, what triggers it and how long it lasts are some of the questions that can help to determine the diagnosis. There will be specific positional tests you’ll need to do with your physiotherapist such as the Dix-Hallpike manoeuvre, during which the physio will observe your eye movements. Different eye movements (nystagmus) are associated with different inner ear canals, and getting a clear picture of eye movement can help to determine the best form of treatment.
There are multiple forms of dizziness, so it’s important to have a clear discussion with your physiotherapist and a proper assessment helps to determine the right treatment for you. You may also refer to our informative pages on headaches and hypermobility as some dizziness can originate from other sources like the neck.
Experiencing sudden spinning when you roll over in bed or look up? Feeling dizzy, nauseous or unsteady when you change position?
Book today and let one of our experienced PhysioTec physiotherapists assess your dizziness, identify the source of your symptoms, and create a personalised management plan to restore balance, stability, and confidence in movement.
Helping you move better and get back to the activities you love.
How Can Physiotherapy help with BPPV?
Once you and your physio have completed a thorough assessment to determine the inner ear canal that requires treatment, canal repositioning manoeuvres can be performed to help safely guide the displaced crystal back out of the semicircular canal.
The Epley manoeuvre is a common technique used for treatment of the posterior semicircular canal. This involves a series of head positions while laying down that your physio can help to guide you through.
The Semont manoeuvre is another technique performed holding a head position and laying down sideways with speed and should be performed with help from your physio to ensure a safe process.
Choosing a form of treatment for every patient is individualised based on condition and history and presentation, as not all treatments are appropriate for everyone. You and you physio can then reassess for changes in your symptoms and progress onto rehabilitation of balance and stability if balance issues linger following your treatment.
How long does BPPV take to Improve?
Fortunately, physiotherapy treatment of BPPV can help to resolve symptoms quite quickly, typically taking a small number of treatment sessions. Some cases do require multiple canal re-positioning treatments or may require a change of re-position treatment as crystals can travel into adjacent canals before returning to the centre.
If balance continues to be an issue despite resolution of dizzy symptoms, further sessions involving balance and stability exercises may be warranted to ensure a thorough rehabilitation. Unfortunately, BPPV can return, this doesn’t necessarily mean your treatment has failed, however it may require further assessment and treatment.
When should I seek medical attention?
Not all dizziness is from BPPV.
You should seek medical attention, if you are experiencing severe dizziness and are also experiencing vision changes, hearing loss, severe headache, newly developed neck pain, difficulty with coordination or walking, difficulty with speech or facial numbness or weakness.
If your symptoms are severe and developing rapidly you may require emergency medical attention.
Summary
BPPV is a very common cause of brief, position-related and triggered dizziness often described as spinning sensation. It is highly treatable with your physiotherapist performing repositioning manoeuvres once a proper assessment has been conducted to determine the affected inner ear canal.
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Author
This blog was written by Tyler Cultum, one of our Sports and Strength & Conditioning Physiotherapists. He has broad interests in sports and musculoskeletal physiotherapy, with special interests in strength and conditioning, the shoulder and hip. You can read more about Tyler here.
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References:
- Hornibrook, J. (2011). Benign Paroxysmal Positional Vertigo (BPPV): History, Pathophysiology, Office Treatment and Future Directions.International Journal of Otolaryngology,2011, 1-13.
- Neil Bhattacharyya, Reginald F. Baugh, Laura Orvidas, David Barrs, Leo J. Bronston, Stephen Cass, Ara A. Chalian, Alan L. Desmond, Jerry M. Earll, Terry D. Fife, Drew C. Fuller, MPH, James O. Judge, Nancy R. Mann, Richard M. Rosenfeld, Linda T. Schuring, Robert W. P. Steiner, Susan L. Whitney, and Jenissa Haidari. Clinical practice guidelines: Benign paroxysmal positional vertigo. Otolaryngology–Head and Neck Surgery, 2008, 139, S47-S81
- Nguyen- Huynh, A. T., MD PhD. (2012). Evidence-Based Practice: Management of Vertigo.Otolaryngeol Clin North Am. ,45(5), 925-940. doi:10.1016/j.otc.2012.06.001