Benign Paroxysmal Positional Vertigo and Physical Therapy

Benign Paroxysmal Positional Vertigo (BPPV) occurs due to a mechanical disorder of the inner ear system.  Crystals (otoconia) become displaced from one section of the inner ear (macula of the utricle) and travel to another area of the inner ear (one of the three canals in the ear).  BPPV affects about 1-2% of the population each year, which increases to an annual 3.4% after age 60. (Neuhauser and Lempert, 2009) It is one of the most common reasons for dizziness in older people (Oghalai et al., 2000).

Most common causes of BPPV include infection, head trauma, and advancing age. Head trauma can refer to whiplash or many other types of surgery, including dental work.  Common symptoms include vertigo with positional changes, nausea, disequilibrium, and nystagmus (involuntary eye movement).  This means that people can feel dizzy or feel “unstable” when standing up from the bed, changing positions suddenly or even when tipping their head back to look up.  These symptoms can resolve over time or they can stop and then come back again.

Physical therapists can help to diagnose and treat BPPV based on patient history and physical findings performed during an initial evaluation.  In most cases, we can help patients get rid of symptoms using a few methods in only a couple of sessions.  One maneuver that we perform is called the Dix-Hallpike, which allows us to diagnose BPPV and can indicate which of the three canals is affected.  For instance, if we observe a specific type of nystagmus, we can know which type of canal is affected.  Commonly, we see an upbeating nystagmus indicating that the crystals moved to the posterior canal meaning the posterior canal is affected.  To treat a posterior canal BPPV, we will perform the Eplyey maneuver, which is comprised of a series of 4 head positions while the patient goes from sitting, to lying down to rolling over and back to sitting.

To support the maneuvers we perform in the clinic, physical therapists also teach patients how to perform the Brandt-Daroff Exercise at home to help resolve the symptoms.  Additionally, we can work with patients to decrease dizziness and vertigo by performing gaze stability and balance exercises.  These are only a general overview of the types of treatments that physical therapists can offer patients with BPPV.  Overall, physical therapy can significantly help those suffering from BPPV and ensure that you or they get back on track to living their lives!

Posted in: Physical Therapy

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