PHYSIOTHERAPY AND BPPV

Bening paroxysmal positional vertigo or BPPV as it is commonly known contributes to around 40-50percent of the cause of vertigo- a sudden sensation of spinning inside the head.

Benign paroxysmal positional vertigo causes dizziness which is triggered by specific head positions and may last for few seconds. This usually occurs while turning in bed or getting in and out of the bed.

Role of ear in BPPV?
The human ear has a tiny organ called the labyrinth which has three semicircular canals. These canals roughly lie perpendicular to each other and contain fluid and hair like structures which act as sensors to head rotation.
The other structure called as the otholith organ which monitors head movements like up and down , left and right. It also senses the head position in relation to gravity. The otholith organ contains small calcium carbonate crystals.

For some reason the crystals become dislodged from the otholith organ and enters one or more of the semicircular canals. This makes the semicircular canals sensitive to head position changes which it wouldn't respond to in normal conditions. Thus causing spinning of head.

Symptoms of BPPV:

• Dizziness which lasts for less than a minute
• Sense of spinning of head or surroundings
• Loss of balance or unsteadiness
• Nausea 
• Nystagmus- abnormal eye movements 

Diagnosis:

Different tests are performed to rule out the cause of vertigo:

Video nystagmography, balance test.

Treatment:

Conservative:

• Canalith repositioning:

A certified vestibular therapist performs different manuevers depending on the canal affected. It has several simple manuevers for positioning the head. Each position is held for around 30 seconds.

• Vestibular rehabilitation:

Once the repositioning is done the person is adviced to perform vestibular exercises which comprises of:

1. Eye gazing exercises
2. Habituation exercises
3. Balance exercises
4. Neck exercises

The exercises to be performed are advised according to the patients condition.

Surgical :

In very rare cases surgery is required. The part of the inner ear which causes dizziness is plugged using a bone plug.

                                      Dr. Pranjal Kankariya