Is your world spinning?
Vertigo is a sensation of spinning dizziness, as though the room/environment is spinning in circles around the person. It is a symptom and can be caused by various conditions involving the brain (central) or inner ear (peripheral). Alongside headache, dizziness and vertigo is one of the most common symptoms presented to doctors, with a lifetime prevalence of around 20% to 30%.
The term dizziness can take on many meanings to different people, so it is important we take a thorough history to ensure that it is vertigo you’re experiencing and not other forms of dizziness such as lightheaded, foggy/faint. These may indicate other issues for example, blood pressure, heart/vascular issues and neck tension/headaches. Once we have determined it is in fact vertigo, a thorough subjective and objective assessment will help us to determine the cause of your vertigo and whether physiotherapy treatment is appropriate.
How do I know if I have vertigo?
Vertigo is a symptom but can be accompanied by other symptoms such as:
- balance problems
- sense of motion sickness
- nausea and vomiting
- ringing in the ear, called tinnitus
- a feeling of fullness in the ear
- Nystagmus, in which the eyes move uncontrollably, usually from side to side
What is BPPV?
Benign paroxysmal positional vertigo (BPPV) is the most common peripheral cause of vertigo with a lifetime prevalence of 2.4% and can be easily treated by physiotherapists. More than 90% of cases are for an unknown reason with the remaining mostly due to head trauma, infections/inflammation of the ear or fluid build up such as in Menière’s disease. BPPV can also arise after prolonged bed rest necessitated by other diseases, or after surgery especially dental. It can resolve spontaneously within a few weeks or months, however it can also last for years. If left untreated, it persists in about 30% of patients.
Common signs of BPPV?
- Sudden brief attacks of violent rotational vertigo
- Eyes may flick uncontrollably called nystagmus( rapid eye movements)
- The attacks are precipitated by movement of your head eg rolling over in bed, looking
up or moving quickly.
- It typically occurs several seconds after head movement and lasts a total of 30 to 60
- Dizziness and/or nausea
What causes the symptoms of BPPV?
The inner ear has two primary structures, the cochlea for hearing and the vestibular apparatus responsible for balance. The vestibular part has 3 semicircular fluid filled canals that detect movement of the head and two otolithic organs, the utricle and saccule, which detect motion such as going up an elevator or taking off in a plane from the movement of calcium carbonate rocks called octonia (ear rocks).
BPPV is thought to arise due to the displacement of these crystal ear rocks from the maculae of the utricle and saccule of the inner ear into the fluid-filled semicircular canals. With this displacement, these delicate feedback loops relay conflicting signals to the brain that can result in any symptom related to BPPV.
How to test for BPPV?
If your vertigo doesn’t match the above characteristics of BPPV, with episodes lasting hours to persistent and occur at rest it may indicate another inner ear issue such as an infection or fluid buildup. Alongside medical advice and/or medication, physiotherapy can assist with providing exercise and balance retraining. Once other conditions have been excluded and the subjective history fits the criteria, we would use a series of head maneuvers to diagnose the BPPV and determine which ear and semicircular canal is affected.
How to treat BPPV?
BPPV is treated with rapid positioning maneuvers into a particular direction to move the ear rocks out of the semicircular canals and back to the inner ear, to prevent the conflicting messages being sent to the brain. Two techniques have been proven to be equally effective, and the cure rate is more than 95% within a few days of the first treatment, as shown by multiple controlled studies. We will also give you some advice on what to avoid and what to do after treatment as well as exercises to complete at home to resolve any ongoing symptoms.
The rate of recurrence of BPPV is about 15% to 30% per year but if that happens just book in again and our trained physiotherapists will be able to help.
If you think you have dizziness or vertigo, we will be able to complete a thorough exam to determine whether or not you have BPPV, another form of vertigo or whether your dizziness is coming from your cervical spine which is a common area to cause feelings of vertigo. Cervicogenic vertigo can also be treated easily by physiotherapists through joint mobilisations, deep tissue massage, dry needling, stretches and specific strengthening exercises and postural corrections.
To make an appointment with Physiotherapist Kayla Malone, click here to book online or call (08) 6389 2947.