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08.01.2016
It is important to know that BPPV will NOT give you constant dizziness that is unaffected by movement or a change in position. BPPV is fairly common, with an estimated incidence of 107 per 100,000 per year2 and a lifetime prevalence of 2.4 percent3.
Your family doctor may suspect BPPV from the symptoms you are describing, since it is very commonly triggered by things like rolling over in bed, getting in and out of bed, tipping the head to look upward, bending over, and quick head movements.
The relationship between the inner ears and the eye muscles are what normally allow us to stay focused on our environment while the head is moving.
The nystagmus will have different characteristics that allow a trained practitioner to identify which ear the displaced crystals are in, and which canal(s) they have moved into. There are two types of BPPV: one where the loose crystals can move freely in the fluid of the canal (canalithiasis), and, more rarely, one where the crystals are thought to be ‘hung up’ on the bundle of nerves that sense the fluid movement (cupulolithiasis).
Though many people are given medication for BPPV, there is no evidence to support its use in treatment of this condition6. One maneuver that is used for the most common location and type of BPPV is called the Epley maneuver. Many studies have been done into the effectiveness of treatment maneuvers for BPPV, with results showing rates of resolution well into the 90% range by 1-3 treatments7 (the more rare cupulolithiasis or ‘hung-up’ variant can be a little more stubborn, as can BPPV that is the result of trauma). Unfortunately, BPPV is a condition that can re-occur periodically with long-term recurrence rates as high as 50% within 5 years9, especially in those whose BPPV is related to trauma.
Click here to download a copy of the "Benign Paroxysmal Positional Vertigo BPPV" publication.
For more in depth information about BPPV, you may wish to purchase VEDA's book, "BPPV - What You Need To Know" from our online store. Visit VEDA's Resource Library to get more information about your vestibular disorder and download one of VEDA's many short publications.
Please help VEDA continue to provide resources that help vestibular patients cope and find help. Common sense says that it is a good idea to learn to adapt to conditions that you can't fix.
The goal is to find the relevant areas in this space which are not working well and practice them. It occurs when some of the calcium carbonate crystals (otoconia) that are normally embedded in gel in the utricle become dislodged and migrate into one or more of the 3 fluid-filled semicircular canals, where they are not supposed to be.
Otoconia migrate from the utricle, most commonly settling in the posterior semicircular canal (shown), or more rarely in the anterior or horizontal semicircular canals.
However, the crystals do move with gravity, thereby moving the fluid when it normally would be still. It will NOT affect your hearing or produce fainting, headache or neurological symptoms such as numbness, “pins and needles,” trouble speaking or trouble coordinating your movements. It is thought to be extremely rare in children but can affect adults of any age, especially seniors.


However, they may or may not be familiar with the testing or treatment of BPPV, or may only be familiar with management of the most common form of BPPV but not the rarer variants.
Since the dislodged crystals make the brain think a person is moving when they’re not, it mistakenly causes the eyes to move, which makes it look like the room is spinning.
Tests like the Dix-Hallpike or Roll Tests involve moving the head into specific orientations, which allow gravity to move the dislodged crystals and trigger the vertigo while the practitioner watches for the tell-tale eye movements, or nystagmus. With canalithiasis, it takes less than a minute for the crystals to stop moving after a particular change in head position has triggered a spin. The patient is moved from a seated to a supine position with her head turned 45 degrees to the right and held for 30 seconds. It is possible to have more than one canal involved, especially after trauma, in which case your vestibular therapist would typically have to correct them one at a time. If it seems to always reoccur in the same canal and if deemed safe, your therapist may teach you to perform a specific treatment maneuver on yourself.
The impact can range from a mild annoyance to a highly debilitating condition, and can affect function, safety and fall risk. Benign positional vertigo: incidence and prognosis in a population-based study in Olmsted County, Minnesota. These are exercises aimed at improving vision while the head is moving, generally while viewing an earth stationary object.
Studies have particularly shown that it is helpful in bilateral vestibular loss (Herdman et al, 2007), and it is our opinion that gaze stabilization is clearly indicated in bilateral loss. A vestibular physical therapist can be very helpful in selecting the appropriate variation. We usually recommend doing them for at least 30 minutes (which may be split over several sessions).
This may not be the most important dimension unless you spend a lot of time with your head off-center.
This is not the most important dimension unless you need to have good balance in odd positions. This is where things can get really hard, when combined with some of the other activities above. When enough of these particles accumulate in one of the canals they interfere with the normal fluid movement that these canals use to sense head motion, causing the inner ear to send false signals to the brain. The detached otoconia shift when the head moves, stimulating the cupula to send false signals to the brain that create a sensation of vertigo. When the fluid moves, nerve endings in the canal are excited and send a message to the brain that the head is moving, even though it isn’t. The vast majority of cases occur for no apparent reason, with many people describing that they simply went to get out of bed one morning and the room started to spin.
General practitioners typically refer patients to a medical professional specifically trained to deal with vestibular disorders, most commonly a vestibular rehabilitation therapist (typically a specially trained physical therapist, but occasionally an occupational therapist or audiologist) or an ENT (ear, nose & throat specialist) who focuses on vestibular disorders.


However, when someone with BPPV has their head moved into a position that makes the dislodged crystals to move within a canal, the error signals cause the eyes to move in a very specific pattern, called “nystagmus”. Once the crystals stop moving, the fluid movement settles and the nystagmus and vertigo stop.
Often people have tried the Epley maneuver themselves or had it performed on them without success. However, it can be challenging to perform the maneuver on one’s self, so many people prefer to return to their vestibular therapist to confirm that they are experiencing the same problem, and if so, determine which maneuver is indicated and provide the appropriate treatment. Fortunately, symptoms tend to decline over time as the brain slowly adjusts to the abnormal signals it is receiving, or because the condition spontaneously resolves.
They consist of daily practice of exercises such as shown above, with many variants described below. This false information does not match with what the other ear is sensing, with what the eyes are seeing, or with what the muscles and joints are doing, and this mismatched information is perceived by the brain as a spinning sensation, or vertigo, which normally lasts less than one minute. However associations have been made with trauma, migraine, inner ear infection or disease, diabetes, osteoporosis, intubation (presumably due to prolonged time lying in bed) and reduced blood flow. Sadly, some doctors are not aware that highly effective treatment is available and tell patients that they just have to live with the condition and hope that it reduces or resolves on its own, which is not in line with best practice5. With cupulolithiasis, the crystals stuck on the bundle of sensory nerves will make the nystagmus and vertigo last longer, until the head is moved out of the offending position. Once your healthcare provider knows which canal(s) the crystals are in, and whether it is canalithiasis or cupulolithiasis, then they can take you through the appropriate treatment maneuver.
Later assessment reveals that it is actually a different maneuver that should have been used, or that it is not BPPV at all.
However, current research suggests that post-maneuver restrictions do not significantly affect outcomes8.
However, with a health care professional who is appropriately trained in the assessment and treatment of BPPV, most patients are pleased that their problem can be easily corrected so their world can stop spinning.
By alerting your healthcare provider to symptoms you are experiencing in addition to vertigo they can re-evaluate your condition and consider whether you may have another type of disorder, either instead of or in addition to BPPV.
The maneuvers make use of gravity to guide the crystals back to the chamber where they are supposed to be via a very specific series of head movements called Canalith Repositioning Maneuvers. This is why caution should be used with self-treatment or with being treated by someone who is not fully trained in identifying the many different variants of BPPV and respective treatment maneuvers.
In the case of cupulolithiasis, they would utilize rapid head movement in the plane of the affected canal to try to dislodge the ‘hung-up’ crystals first, called a Liberatory Maneuver, and then guide them out as described above.
Additionally, before testing or treating for BPPV, the healthcare provider should perform a careful neurological scan, evaluation of the neck, and other safety-related investigations to determine if certain elements of the procedure need to be modified or avoided.



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