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BPPV

What is BPPV?

Benign Paroxysmal Positional Vertigo (BPPV) is one of the most common causes of vertigo, characterized by brief episodes of dizziness or a spinning sensation triggered by specific changes in head position. It occurs when tiny calcium carbonate crystals, called otoconia, become dislodged from their usual location in the utricle of the inner ear and move into the semicircular canals. These misplaced crystals interfere with the normal movement of fluid within the canals, sending false signals to the brain about the body’s position and balance. This leads to a sensation of spinning or imbalance, especially when turning over in bed, looking up, or bending down. Although BPPV can be alarming, it is typically not serious and can often be effectively treated with simple repositioning maneuvers. BPPV treatment usually focuses on these repositioning exercises to guide the crystals back to their correct location.

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Causes

In many patients, the spinning starts suddenly without any apparent cause. This is called Primary BPPV. However, some conditions can increase the risk of BPPV like:

  • Head injury
  • Prolonged bed rest
  • Ear infections
  • After surgery
  • Migraine

The incidence of BPPV increases with advancing age. A deficiency of Vitamin D also increases the risk of getting BPPV.

A vector image of women suffering from bppv
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Symptoms

  •  Dizziness or spinning usually brought on by a change of position like turning in bed or bending down
  •  Unsteadiness or Imbalance
  •  Nausea or vomiting

Though the episodes of spinning usually last for less than a minute, patients may feel unsteady or heavy headed.

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Diagnosis

Certain positional tests like the Dix-Hallpike and Supine Roll tests are performed, preferably under the guidance of VNG, to diagnose BPPV and identify the position of the displaced crystal. BPPV treatment typically follows the confirmation of diagnosis through these positional tests. BPPV may co-exist with other vestibular problems which cause dizziness like Vestibular neuritis, Meniere’s disease, Vestibular migraine, etc. Hence, a thorough vestibular evaluation is advised to ensure appropriate BPPV treatment is provided and to rule out other possible causes.

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Treatment of BPPV

Repositioning Maneuvers:
BPPV is a mechanical disorder of the inner ear caused by displacement of calcium carbonate crystals. The BPPV treatment involves a repositioning of these crystals back to their original position in the utricle. Various repositioning maneuvers have been described for BPPV treatment. A few common maneuvers are highly effective in managing BPPV:

  • Epley’s Maneuver
  • Semont’s Maneuver
  • Barbeque Maneuver
  • Zuma Maneuver
  • Gufoni Maneuver

A correctly done maneuver can provide relief to most patients of BPPV.

Post Treatment Care

After the repositioning maneuver, the patient is asked to come for a follow-up visit to make sure that all displaced crystals have been repositioned. Some patients may require additional maneuvers. Some patients experience dizziness after the treatment of BPPV which can be treated with Vestibular Rehabilitation.

Book your appointment at your nearest Vertigo treatment clinic now.

Prevention & Lifestyle Tips

While BPPV cannot always be fully prevented, certain lifestyle changes and precautions may help reduce the risk of recurrence and improve overall balance health.

 

Tips to Prevent Recurrence:

    1. Maintain Healthy Vitamin D Levels:
      Research has linked Vitamin D deficiency with a higher risk of BPPV recurrence. Ensuring adequate levels through safe sun exposure, a balanced diet rich in Vitamin D (e.g., fatty fish, eggs, fortified foods), or supplementation as advised by your doctor may help prevent relapses.

    2. Be Mindful of Head Movements:
      After undergoing repositioning therapy, it is advisable to avoid sudden or jerky head movements and rapid changes in position, particularly when getting out of bed or bending over. While not a guaranteed preventive measure, cautious movement may reduce the chances of symptom recurrence.

  • Sleep Modifications (Post-Treatment Considerations):
  • Elevate Your Head: Sleeping with an extra pillow to keep the head slightly raised for a few days after treatment may help prevent the crystals from shifting again.

  • Avoid Sleeping on the Affected Side: Temporarily refraining from lying on the side that previously triggered symptoms may also be beneficial, especially during the initial recovery period.

  1. Vestibular Rehabilitation and Balance Training:
    Incorporating gentle balance exercises such as gaze stabilization, habituation exercises, or guided Vestibular Rehabilitation Therapy (VRT) may strengthen the vestibular system and help reduce sensitivity to head movements. These should be undertaken under professional supervision if symptoms persist.

  2. Stay Physically Active:
    Prolonged bed rest or physical inactivity can predispose individuals to recurrent episodes of BPPV. Engaging in regular, safe physical activity such as walking or light aerobic exercises supports general balance and vestibular function.

Manage Underlying Health Conditions:
Certain conditions like osteoporosis, migraine disorders, or chronic ear infections have been associated with an increased risk of BPPV. Addressing and managing these underlying factors can potentially reduce the chances of recurrence.

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