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Benign Paroxysmal Positional Vertigo (BPPV)

In Australia, 30% of adults over the age of 65 years of age experience a type of vertigo that is caused by changing their head or body position. This type of vertigo feels as though you or the room are spinning. Many people who experience this vertigo only have to roll over in bed or turn their head quickly to one side when someone calls their name to feel this spinning sensation. This sensation is often brief and intense, lasting less than one minute in duration. This vertigo can occur in adults of any age, but it is much more common in older adults with the prevalence increasing linearly with age. This vertigo can also occur in children, although it is rare.

This false sense of spinning with a change in position is the most common cause of vertigo and is known as Benign Paroxysmal Positional Vertigo or BPPV. It is called ‘benign’ because it is not life-threatening, but it can be a very distressing and unpleasant feeling. ‘Paroxysmal’ means that it starts suddenly lasting only a short time and it can come and go over time. ‘Positional’ is in the name as it is triggered by a change in posture and head or body movements while vertigo refers to the false sense of rotational movement or spinning present.

These sensations may be caused by tipping your head up or down, laying down, turning over, sitting up or turning left or right quickly. These sensations can be mild to intense, depending on the individual. With this spinning sensation, people often also experience a loss of balance or unsteadiness, light-headedness, nausea, and vomiting. These signs and symptoms can disappear for periods of time from months to years but reoccur at any time.

These symptoms can increase a person’s fall risk as it causes a sense of unsteadiness and may make the individual feel off balance.

BPPV is caused by a mechanical problem in the inner ear. In the inner ear, tiny carbonate crystals called Otoconia are usually attached to a gel in an organ called the utricle. Sometimes, these tiny crystals become dislodged and start to move into one or more of the 3 fluid-filled semicircular canals in the vestibular system. These canals in the vestibular system can be seen in the image below. A lot of research has conducted on BPPV, however, unfortunately it is still not known why or how these crystals become dislodged and move through the semicircular canals. The crystals floating through the semicircular canals cause the inner ear to send a false signal to the brain which in turn creates the false sense of spinning or dizziness.

When individuals experience these symptoms, it is important that tests are performed to determine if what they are experiencing is BPPV or another form of vertigo. If it is BPPV, it is then essential that the semicircular canal where the crystals are floating is identified. This will determine how the vertigo is treated. The test that is used to identify these things is called a Dix Hallpike Manoeuvre or the Roll Test. This involves an audiologist or qualified healthcare professional moving your body through different positions as you lay on the clinic bed. Unfortunately, if you do have BPPV, these tests will cause you to feel the spinning sensation again. Although, it is only for a short duration, and it is vital for the symptoms to be correctly treated. If these tests do not show that what you are experiencing is BPPV or any other vestibular system dysfunction, other tests may need to be completed with your general practitioner. This is because pathologies such as low iron or low blood sugar levels can present similarly to BPPV, and many people experience slight dizziness when standing up too quickly that lasts a short time.

Fortunately, BPPV is one of the few causes of vertigo that can be effectively treated, and this can be done in the same initial appointment when the vertigo is assessed. This again involves the audiologist or qualified healthcare professional moving your head and body through a repositioning manoeuvre. This manoeuvre is used to put the crystals back where they belong in the utricle to stop your symptoms and help you feel balanced again.

EAR STUDIO now offers balance and dizziness testing to determine whether the symptoms you are experiencing are caused by BPPV or another vestibular system dysfunction. These tests are needed to understand where the dizziness is coming from and what is causing these symptoms. EAR STUDIO utilises the Dix Hallpike and Roll Test to test for BPPV.  This information can then be used to treat your symptoms and help you feel like you again! We use different repositioning manoeuvres to get the crystals back where they belong, stop your symptoms of spinning and dizziness, and help to reduce your risk of falls.