Are crystals in your ear from BPPV causing your dizziness?

What is Benign Paroxysmal Positional Vertigo (BPPV)?

Benign Paroxysmal Positional Vertigo, commonly referred to as BPPV, is a disorder of the inner ear that causes sudden episodes of vertigo. Vertigo is the sensation that you or your surroundings are spinning or moving, even when there is no actual movement. BPPV is called "benign" because it is not life-threatening, "paroxysmal" because the episodes are sudden and brief, and "positional" because the symptoms are triggered by changes in head position.

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How Does BPPV Occur?

BPPV occurs when tiny calcium carbonate crystals, known as otoconia, become dislodged from their usual location in the utricle, a part of the inner ear, and move into the semicircular canals. These canals are responsible for sensing head movements and maintaining balance. When the head moves, the dislodged crystals shift, stimulating the hair cells in the semicircular canals and sending false signals to the brain, which results in the sensation of spinning.

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Symptoms of BPPV

The primary symptom of BPPV is vertigo, which is a false sensation of spinning or moving. This sensation can range from mild to severe and usually lasts less than a minute. However, the episodes can recur frequently over days or weeks. Other symptoms may include:

• Dizziness
• A sense of unsteadiness or loss of balance
• Nausea
• Vomiting
• Abnormal eye movements known as nystagmus, where the eyes make repetitive, uncontrolled movements.

These symptoms are typically triggered by specific head movements, such as lying down, sitting up, or turning over in bed. Although BPPV is not dangerous, it can increase the risk of falls, especially in older adults.

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Causes of BPPV

BPPV can occur without any apparent cause, but several factors may contribute to its development:

• Age: BPPV is more common in people over the age of 50, possibly due to natural changes in the inner ear structures as we age.
• Head Injury: Trauma to the head can dislodge the otoconia, leading to BPPV
• Ear Disorders: Other inner ear conditions, such as labyrinthitis or vestibular neuritis, may increase the risk of BPPV.
• Prolonged Bed Rest: Lying down for extended periods can sometimes lead to BPPV.

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Diagnosing BPPV

Doctors typically diagnose BPPV based on a patient's symptoms and a physical examination. One common test used is the Dix-Hallpike maneuver. During this test, the patient is quickly moved from a sitting to a lying position with their head turned to one side. If BPPV is present, this movement will trigger vertigo and nystagmus.

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Treatment of BPPV

The most effective treatment for BPPV involves a series of head and body movements known as canalith repositioning maneuvers. These maneuvers aim to move the dislodged crystals out of the semicircular canals and back into the utricle, where they no longer cause symptoms. The most well-known maneuver is the Epley maneuver, which involves a series of specific head and body movements performed by a healthcare provider.

Epley Maneuver

The Epley maneuver is performed as follows:

1. The patient sits upright on an examination table with their legs extended.
2. The patient's head is turned 45 degrees toward the affected ear.
3. The patient is quickly laid back with their head hanging slightly off the edge of the table.
4. After about 30 seconds, the head is turned 90 degrees to the opposite side.
5. The patient then rolls onto their side, turning their head another 90 degrees in the same direction.
6. Finally, the patient is brought back to a sitting position, completing the maneuver.

This procedure is highly effective, with most patients experiencing relief after one or two sessions. However, additional sessions may be necessary if symptoms persist.

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Vestibular Rehabilitation Therapy

Vestibular rehabilitation therapy (VRT) is another important aspect of treating BPPV. VRT involves exercises designed to improve balance and reduce dizziness by retraining the brain to process signals from the inner ear more effectively. These exercises can help patients regain confidence in their balance and reduce the risk of falls.

Vestibular rehabilitation is crucial for patients who experience persistent symptoms or have difficulty with balance even after successful canalith repositioning maneuvers. Through a series of customized exercises, patients can improve their balance, coordination, and ability to perform daily activities without dizziness. This therapy is especially beneficial for older adults who are at a higher risk of falls due to BPPV.

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Living with BPPV

While BPPV can be uncomfortable and disruptive, it is usually manageable with treatment. Patients are encouraged to:

• Avoid Sudden Movements: Move slowly and carefully, especially when changing positions.
• Stay Safe: Use handrails and avoid walking in the dark to reduce the risk of falls.
• Follow Up with Healthcare Providers: Regular check-ups can help monitor symptoms and adjust treatment as needed.

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Take home message

Benign Paroxysmal Positional Vertigo is a common and treatable condition that causes brief episodes of vertigo due to dislodged crystals in the inner ear. With proper diagnosis and treatment, including canalith repositioning maneuvers and vestibular rehabilitation, most patients can find relief and return to their normal activities.

So if you're experiencing dizziness and vertigo from BPPV, come see one of our Physiotherapists, Chiropractors, or Exercise Physiologists at Blacktown Health. To make a booking, call us on 02 8662 0496 or book an appointment online now.