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Benign Paroxysmal Positional Vertigo (BPPV)

What is BPPV?

BPPV is characterised by the sudden onset of vertigo episodes, that are triggered by head movements. Vertigo is a subjective, external experience of rotational movement. This happens regardless of any input from the environment. It is estimated that vertigo patients are diagnosed with BPPV 17-42% of the time and a yearly prevalence of 11-64 people per 100,000 per year [1]. BPPV is most commonly diagnosed with physical tests and on its subjective history, rarely requiring further examination [2, 1].

BPPV is a dysfunction of the inner area, specifically the otolith organs, which detect the gravitational and acceleration forces of our head during movement. Impairment to these organs can cause an abnormal response to head movement, sparking symptoms of vertigo and even nausea and vomiting. Because of the low threshold for attacks of vertigo and the severe nature of the symptoms, BPPV can be very debilitating for its sufferers [1].

What are the symptoms of BPPV?

  • Vertigo
  • Dizziness
  • Nausea
  • Vomiting
  • Nystagmus (rapid, unidirectional beating of the eyes, unnoticed by the patient)

What Causes BPPV?

There are two main theories regarding the cause of BPPV; both are regarding the endo-lymph flowing through the semi-circular canals of the otolith organs. The ‘cupulolithiasis model’ suggests that matter within the endo-lymph becomes attached to the capula, or the sensory organs located in the semi-circular canals. The ‘canalithiasis model’ suggests that there are free floating particles within the endo-lymph that are detected by the capuli, this abnormal detection is registered and vertigo is experienced as a result [1].

The Dix-Hallpike test and the supine-roll test has been developed to detect faults in the posterior and horizontal semi-circular canals respectively.  These tests are designed to created a change the fluid -dynamics and the detection of the endo-lymph in the otolith organs. Vertigo is experienced in a positive test and the therapist will observe for the presence and direction of nystagmus, or rapid beating of the eyes. It is very rare that the superior semi-circular canal is at fault during BPPV, however if it were to be, the Dix-Hallpike test would again be positive, and the therapist would observe upwards beating nystagmus in the patient [2, 1].

In a lot of the patients that we see, they experience all of the symptoms of BPPV, but the results are often unclear when they undergo testing or they do not respond effectively to the standard treatment of BPPV. In these patients, it is likely that sensitivity in the central nervous system, specifically the brainstem, is the true cause. The afferent vestibular nerve sends normal information that reaches the sensitised brainstem, this information is wrongly interpreted as a threat and vertigo is experienced.

I’ve tried it all, is there anything else that can help my BPPV?

The standard treatment for Posterior Canal BPPV, the most common type, is the Epley Manoeuvre [1]. This involves a series of position changes that are designed to shift any matter in the semi-circular canals so that they no longer trigger symptoms. This manoeuvre is easy to perform at home once taught by a health professional. However, it doesn’t seem to always be effective.

Our patients have had mixed results with the Epley manoeuvre, some have tried medications, some have even had surgeries, like neurotomies, in attempts to reduce their symptoms. Some of these methods have had some affect, though they have mostly been minimal or short-lived. This is likely because, in these cases, they haven’t been properly assessed to determine if a sensitised brainstem is the true cause of their symptoms.

In cases where we have assessed and found that a sensitized brainstem and dysfunction in your upper cervical spine are the cause of your BPPV then we are able to treat this using our world-leading, modern techniques. If this is the case, we can start treatment immediately, and we usually see rapid results, within the first 6 sessions, as we do with 85-90% of our patients.

The best part is that our treatment is safe, gentle, medication-free and non-invasive.

 

Watch the video to understand more about BPPV

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Phase 1

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Phase 2

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The Difference

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The Assessment

Phase 1

Accurately diagnose your condition for effective treatment

The Treatment

Phase 2

Experience the latest treatment methods that are evidence-based

The Results

Phase 3

A life free from migraines or headaches is now proven possible

The Difference

Phase 4

A medication-free solution that treats the cause not the symptons

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