Benign Paroxysmal Positional Vertigo (BPPV) dizziness is generally thought to be due to debris described as “ear rocks”, formally known as “otoconia”. When there has been damage to the inner ear either by head injury, infection, or advanced age, the ear rocks float through the ear canal stimulating small hair follicles that send signals of imbalance to the brain. About 50% of all dizziness in older people is due to BPPV. The most common cause of BPPV in people under age 50 is head injury. In half of all cases, BPPV is called “idiopathic,” which means it occurs for no known reason.
Symptoms of BPPV include dizziness/vertigo, lightheadedness, loss of balance, migraine and nausea. Symptoms are usually intermittent and also may present for a few weeks, then stop, then come back again. Most symptoms are triggered from a change of position of the head with respect to gravity. Examples would include getting out of bed or rolling over in bed, use of shampoo bowls in beauty parlors, bending forward or even the Yoga posture called the “down dog can sometimes be the trigger. ). While rarely encountered, BPPV is also common in persons who have been treated with medications that are toxic to the inner ear such as gentamicin (Black et al, 2004).
HOW IS THE DIAGNOSIS OF BPPV MADE?
Diagnosis of vestibular dysfunction can be performed by participating in extensive testing from large computerized test such as NeuroCom Balance Master and Equitest which can accurately differentiate which system of your balance is in dysfunction.
The modified CTSB test can be performed in place of expensive and time consuming computerized testing.
Diagnosis is confirmed by a physical therapist with history and physical examination alone including testing called the Dix-Hallpike or Modified Dix-Hallpike test. A positive Dix-Hallpike tests consists of a burst of nystagmus (jumping of the eyes) and most times nausea is associated with the testing.
PHYSICAL THERAPY TREATMENT OF BPPV: The Epley, Semont, and Gans Canalith Repositioning Maneuvers
The treatment for BPPV is very effective, with roughly an 80% cure rate, (Herdman et al, 1993; Helminski et al, 2010).
All the particle repositioning or canalith repositioning procedures, are intended to move debris or “ear rocks” out of the sensitive part of the ear (posterior canal) to a less sensitive location. The maneuver takes about 15 minutes to complete.
The Epley, Semont, or Gans repositioning maneuvers performed by a skilled and certified physical therapist can eliminate all symptoms of vertigo flare up and return you to your pre-dizzy state of function.
Elite Physical Therapy has therapists in each of its three locations certified in Advanced Vestibular Rehabilitation by the American Institute of Balance(AIB). We are proud to partner with AIB to provide the best care locally for our patients suffering from dizziness and balance disorders