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BPPV – Vertigo

Have you ever rolled over in bed and had the sensation that the room is spinning? And not because you’ve had too much to drink?! Well, some people experience a condition called Benign Paroxysmal Positional Vertigo (BPPV).

BPPV is a benign condition, that while harmless, can cause people to feel terribly unwell, can affect their ability to work and function, and can be very distressing while experiencing symptoms. BPPV is a condition that is common, but a lot of people are unaware it can be resolved quickly by an osteopathic practitioner.

The signs and symptoms of BPPV usually include the sensation of vertigo, or spinning, caused by changes in the position of the head. Commonly people experience it when rolling over in bed, or sitting upright from lying down. Along with the sensation of spinning, people often feel nauseous, off balance and light headed. Each episode typically lasts from 30 seconds to a couple of minutes, and then settles until a certain head movement sets symptoms off again. The symptoms of BPPV can be short lived and self-resolve or may last for days and even weeks. Often if a person has experienced symptoms of BPPV, they are more likely to have other episodes in the future.

Middle ear diagram

To understand BPPV it is important to understand the balance centre in our middle ear. We have three canals sitting on different planes, called the semi-circular canals, filled with a viscous fluid in each middle ear, left and right. When we change the position of our head, the fluid within the canals move setting off tiny neural impulses to our brain which are interpreted to let our body know where we are in space and how fast and how far we have moved.

With BPPV, tiny particles present in a particular part of the middle ear called the utricle, break off within the middle ear system and find their way into the fluid filled canals. It is thought that normal degenerative changes, an injury or blow to the head or a middle ear disorder can cause these crystals to break off. Often these tiny crystals are reabsorbed in the utricle and don’t cause any symptoms but in some instances the crystals escape into the adjacent fluid filled canals. When the head is moved, these crystals move in the viscous fluid within one of the canals and keep the fluid moving after the head has stopped. The nerve receptors within the canal interpret this as movement and sends the signal to the brain that the head is still moving, when it fact it is not.

How can osteopathy help?

It is important that a thorough history be taken and an examination carried out. Firstly to ensure that you have BPPV. There are other conditions that can affect our brain and balance systems that can mimic the symptoms of BPPV. There are some rare and serious conditions that vertigo is a symptom of and it is very important that these are ruled out. An experienced practitioner is able to do this by some diagnostic eye and balance tests. Secondly, the practitioner needs to determine which ear is affected and which canal the crystals are sitting in. The symptoms of BPPV can be resolved by the osteopathic practitioner positioning the patients head in a particular series of positions. These manoeuvres are gentle and simply move the head through a particular set of positions with the aim to move and slide the crystals in the canal back into the middle portion of the inner ear, the utricle, where they can be reabsorbed. Determining the correct ear and the correct canal determines which direction the crystals have to be moved. Once the practitioner has correctly moved the crystals the client’s symptoms should resolve.

Ear diagram courtesy of VEDA (Vestibular Disorders Association)