Why does BPPV happen?
Before we explain why BPPV happens, it is important to first understand the anatomy and physiology of the vestibular system.
The vestibular system contains two structures within the bony labyrinth of the inner ear:
1. The vestibule – this contains two membranous sacs, the utricle and saccule (also known as the ‘otolith organs’).
2. The semicircular canals – the superior, horizontal and posterior canals.
Otolith organs: The otolith organs contain receptors that respond to gravitational forces, linear acceleration and tilting of the head. The hair bundles at the top of these organs are of graded lengths, with a single long and motile kinocilium that rises from the cell membrane at one side of the cuticular plate. The hair cells become stimulated when they are deflected (e.g. when you tilt your head), which alters the rate of nerve impulses that get sent to the brainstem. It is also important to note that the surface of the membrane contains tiny, floating calcium-carbonate crystals, called statoconia. It is these crystals that respond to the inertial drag of the endolymph (fluid) inside the otolithic membrane.
Semicircular canals: The semicircular canals are responsible for sensing rotation or angular acceleration. Each canal has an expanded end, called the ampulla, which opens into the vestibule. Hence, the vestibule completes the circle of each of the semicircular canals. When you move your head around, these fluid-filled tubes slosh around and move the tiny hairs that line each canal.
In the case of BPPV, the calcium carbonate crystals detach from the utricle, landing in the semicircular canals. This causes misfiring of nerve signals (particularly when the crystals move around). This confuses the brain and leads to BPPV.
Symptoms of BPPV
What is BPPV? While the main characteristic of BPPV is associated with changes in head position, many people will still feel a mild degree of unsteadiness between their recurrent attacks of positional vertigo. BPPV can impact people of all ages but is most common in people over 60. The onset of this condition can be very abrupt with many people thinking they are seriously ill due to severe nausea and vomiting. However, there are risks that do come with BPPV, one being that the person is at a higher risk of having a fall.
For most people, the exact cause of BPPV is unknown. However, it may be triggered by:
- Previous head trauma
- Keeping your head in the same position for a long period of time
- Bike riding or rough trails
- High intensity sports
- Other inner ear diseases (e.g. infections or other otologic conditions)
What to do if you think you have bPPV
BPPV is usually diagnosed using:
1. ENG (electronystagmography) – electrodes that test your eye movements in response to stimuli that may cause your vertigo.
2. VNG (videonystagmography) – similar to ENG but it uses cameras instead.
3. Imaging tests – such as MRI to rule out any underlying neurological causes.
Treatment will vary depending on several factors. Treatment considerations include:
1. The first port of call is usually to see a physiotherapist that specialises in vestibular rehabilitation. They will often give you a series of head and neck movements. One common and effective exercise for BPPV is the Epley Maneuver.
2. Medicine often isn’t given for BPPV, as many people find this doesn’t help. Rather, medications may be used to help the short-term side effects such as anti-nausea pills.
3. In rare cases, your healthcare provider might recommend surgery that involves plugging the posterior canal. In rare cases, surgery can result in hearing loss.
4. Other times, your health provider might also take a ‘wait-and-see’ approach to see if it goes away, monitoring the symptoms in the meantime. In certain cases, they may recommend preventative measures such as: using 2 pillows to raise your head, not sleeping on your affected side or rising slowly out of bed.
When it comes to BPPV, we also find that general release of neck tension through remedial massage can help with this condition. Our on-site Audiologist is also very knowledgeable in this area and can help you rule out other causes for vertigo such as Meniere’s Disease.
If you do have concerns about your vertigo, don’t hesitate to book in to see us. Give us a call on (07) 3310 4494. We are more than happy to point you in the right direction, depending on your individual circumstances.