What is BPPV?
Benign Paroxysmal Positional Vertigo (BPPV) is a condition that affects the semicircular canals in the inner ear. There are three canals, all with a slightly different position, which provide information to the brain about where our head is moving in space relative to gravity. There is an anterior canal, a posterior canal and a horizontal canal in each ear.
This condition occurs when sediments from other parts of the vestibular system dislodge from where they are supposed to be, and enter the fluid in these canals. The sediment causes fluid to move incorrectly inside the canal and this sends signals to the brain that indicates our head is moving in a way that it is not. The confusion caused by these messages causes dizziness, a feeling of instability, and sometimes nausea.
Here is a short video that shows a simplified explanation of how these canals work.
Why is it called ‘benign’? It’s pretty awful!
Yes, BPPV is awful. I’ve not only treated people with BPPV, but I’ve had it myself – so I know exactly how disabling the disorientation can be! It is not ‘benign’ in that sense. What ‘benign’ means here is that the cause of the vertigo is not ‘sinister’ – it is not caused by stroke or haemmorage or by something wrong with the brain itself (such as a tumour). In this context, benign means ‘non sinister’.
‘Paroxysmal’ means that the symptoms come rapidly and suddenly in a discrete episode – they come, then they will go. Over half of people with BPPV can sometimes feel a sensation of lightheadedness between episodes.
What are the symptoms of BPPV?
People with BPPV can experience slightly different symptoms depending upon which of the canals are affected in which ear.
- Over 85% of people will feel dizzy more strongly when they roll their head (such as rolling over in bed, or leaning forward and turning as when doing shoelaces, looking up etc).
- Fewer will feel a spinning sensation when they shake their head side to side
- Some unfortunate people will feel dizzy with many movements
- You will stop feeling dizzy between 10 and 30 seconds after your head stops moving
- You will never feel BPPV dizziness when your head is still
How is BPPV diagnosed and treated?
The ‘Dix Hallpike’ Maneuver
The ‘Dix Hallpike’ test is highly reliable in detecting BPPV affecting the posterior canal – the most common variant of BPPV. Over 85% of people with BPPV will have sediment in the posterior canal. This Maneuver positions the head very specifically and creates a sudden movement of the body which provokes movement of the sediment in the canal. The only thing that is moving relative to gravity once the head stops moving into this position is the movement of the sediment. So, if there is sediment in the canal, it will keep moving and around 10 seconds after your head stopped in position, you will begin to feel dizzy.
If I do this test on you, I will be looking for several things:
- A delay before the dizziness starts. If the dizziness is immediate, it may not be BPPV
- More importantly, a delay between the positioning of the head and what is called ‘nystagmus’ – a flickering of the eyes
- I will be looking carefully at what direction the ‘fast’ part of the eye flicker takes. This tells me where the sediment is.
If there is no nystagmus, the dizziness is not caused by BPPV.
This test is ideally done on both sides to check both posterior canals. It also indirectly tests the anterior canals – but it’s more rare to have sediment in those canals.
The Lempert Maneuver
As we will discuss, the Dix Hallpike is the test as well as part of the treatment positioning. The same goes for the Lempert or BBQ Roll Maneuver. The Lempert Maneuver tests the horizontal canal for sediment. Many times this test is skipped because a clinician assumes that there is sediment in the posterior canal – where it is most common. This doesn’t mean there is no sediment in the horizontal canal, so especially in people who get BPPV more than once, this test should be done and if it is positive, treatment of the horizontal canals should be performed.
If you feel dizzy, the most important thing is that you are properly examined. Sometimes dizziness can be serious. Sometimes it is unclear, and so your osteopath will refer you for further screening before treating you. This keeps you safe.
If you feel dizzy, book in for an assessment. You will need to allow extra time for this particular examination, so allow 1 hour 15 minutes and please request a note in the system indicating you are suffering from dizziness. This will allow me to block a bit of extra time, or to contact you to rearrange so that enough time can be allocated for you.