BPPV - BENIGN PAROXYSMAL POSITIONAL VERTIGO.

BPPV can sometimes occur following a bout of viral Labyrinthitis, which is exactly what Isla experienced. 

Signs and symptoms...

Usually BPPV is characterised by short and very intense bursts of vertigo that are related to certain positions. Quite often people will experience vertigo when they lie down, turn over in bed, rise from bed, lean forward or look up.

Generally the vertigo is brief - lasting under a minute and is often accompanied by nausea and a classic nystagmus (eye movements).

What is BPPV...?

Benign paroxysmal positional vertigo (BPPV) is a peripheral vestibular (inner ear) disorder in which patients typically report attacks of vertigo with position changes.

The exact cause of BPPV is still not completely understood.

Although some controversy exists, the most widely excepted theory is that BPPV is caused by otoconia (calcium particles) that are shed from the utricular macula (which responds to linear motion) migrating to the posterior semi-circular canal (which responds to rotational motion).

When the otoconia particles have dislodged, they either may settle into the sensory organ cupula of the posterior semi-circular canal (cupulolithiasis) or they may continue to free float within the endolymph of the posterior canal itself (canalithiasis). In either case, their presence alters the dynamic response of the posterior semi-circular canal to head movement, causing vertigo.

This may occur for several reasons e.g. whiplash injury, falls, head injury, even high-impact exercises and sometimes as a consequence of viral Labyrinthitis. In certain cases people who have had prolonged periods of inactivity, such as confinement to a bed, may also develop BPPV because of the settling of the otoconia particles.

Getting BPPV diagnosed...

The diagnosis of BPPV is determined by a clinical history. Most people have a typical complaint of vertigo whenever leaning forward, getting up form bed and rolling over in bed.  The diagnosis is confirmed by a positive response on the Dix-Hallpike maneuver.

Treatment...

BPPV can have a very intermittent pattern with full resolution of symptoms for many months, even years at a time. For some, no treatment is required whilst others have more persistent symptoms that require treatment.

BPPV is generally treated by a physical maneuver called the Epley. The Epley is designed to reposition the particles away from the cupula into a less sensitive area of the inner ear.

This procedure takes around ten minutes and is always carried out in either a doctor’s surgery or hospital by a qualified practioner.

Some practioners may advocate a gentler approach to the Epley and may prescribe a course of home exercises that replicate the Epley but usually take longer to be effective.

Very rarely surgery is advocated when other treatments have failed and the patient is still highly symptomatic.

Isla’s experience with BPPV...

Isla did not experience classic spinning vertigo but rather constant false motion sensations and intense bursts of dizziness that lasted for less than a minute at a time. Isla had the Dix Hallpike test, which indicated BPPV, albeit no nystagmus was seen on the test.

As a result she had several Epley Manoeuvres performed.

During the Epley unsurprisingly Isla felt incredibly dizzy and saw lots of visual shifting of the room but not spinning. After about half and hour after the Epley she felt well enough to walk out and travel home.

During the first two weeks after the Epley Isla felt several types of symptoms. The most noticeable was that her eyes felt as though they were very hard to focus on any object, as if they were jerking and moving around all the time. Isla described her legs as feeling as if they were incorrectly connected to her body and odd lengths. When Isla walked it was very much like being at sea in a rough storm and very un-coordinated. This was interspersed with intense bouts of nausea.

Isla was told that these symptoms were due to the new set of signals being sent from the ear that the debris had been moved from. These symptoms were short lived (two weeks) after which Isla noticed a vast improvement in her overall sense of balance and in the constant sensations of false motion that she had been experiencing.

Whilst Isla’s ultimate diagnosis was that the underlying problem is uncompensated vestibular dysfunction and not BPPV it is accepted that she may have had a mild case of BPPV, hence the symptoms she experienced post Epley.

It is important to remember that not everybody who has BPPV feels exactly the same and again not everybody post Epley feels unwell. Some find the Epley an instant cure to their vertigo whilst others need to follow up with a course of VRT exercises.