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BPPV and Treatment

Physical Treatment for Benign paroxysmal positioning vertigo

Benign paroxysmal positioning vertigo (BPPV) was initially described in 1921 and is a common medical cause of a brief intermittent spinning sensation.  The name of the condition is self explanatory, benign (not serious), paroxysmal (episodic), positioning (consistently related to a change in position), vertigo (dizziness, a sense of movement and commonly spinning).  In BPPV vertigo is precipitated by certain head movements. This commonly occurs when getting into, out of, or rolling over in bed, bending and standing, or with neck extension on getting something out of a high cupboard.  Such dizziness usually occurs within a few seconds of the movement, though it may sometimes not occur for up to 20 seconds.  The actual vertigo usually subsides within 10 to 20 seconds, though more vague symptoms sometimes may last for up to a minute.  Symptoms always abate, even when maintaining the position in which the dizziness was brought on.  Sometimes the dizziness may recur when returning from the lying down to the upright position.  Dizziness in this reverse situation usually lasts for a shorter period.  On lying down again, if this is what precipitates your symptoms, you will find that the intensity of the dizziness is less and neither does the dizziness last as long.  Repeatedly lying down and sitting up also results also in ever lessening symptoms.

The cause of this condition relates to small particles of material within the inner ear detaching from one compartment and falling into a small semicircular canal that is sensitive to movement.  Dizziness in BPPV may follow a head injury with damage to the inner ear apparatus, infections in the ear (e.g. viruses) or ageing.  In most cases, however, no cause is found.

The natural history of this condition is for a spontaneous improvement in weeks or months, but in some patients the condition persists unless treated.  Drug therapy is not helpful.  Treatment with physical exercises is aimed at moving the small particles of material within the inner ear out of the canal and into a chamber that is not sensitive to movement.  This involves repeatedly putting your head into a position which will induce the symptoms, as illustrated in the Epley or Semont manoeuvres (see this page for Dizziness)