Do you have trouble with feeling like you’re spinning or off-balance when you do certain everything things? Getting in/out of bed, rolling in bed, looking up, bending forward, or fast head movements can all cause false sensations of spinning and imbalance and are common symptoms of benign paroxysmal positional vertigo, or BPPV, a very common cause of dizziness. The symptoms typically last for seconds to minutes, although some may feel disoriented between the episodes of spinning. Often the very first episode is the worst one, with the following episodes not quite as severe.
What exactly does BPPV mean?
- Benign, meaning not life threatening
- Paroxysmal, occurring in sudden, short spells
- Positional, triggered by certain head positions or movements
- Vertigo, producing a sensation of spinning of the self or the surrounding environment
What causes BPPV?
BPPV is a problem involving the peripheral vestibular system, which is located in the inner ear. To maintain standing balance, the vestibular system contains sensors that provide information to the brain about movement of the head in space. Calcium carbonate crystals are normally present in a specific part of the vestibular system. If calcium crystals dislodge and move to a different part of the vestibular system, the sensors then provide incorrect information about head movement to the brain. This produces the symptoms of BPPV—spinning and imbalance. It is also common to experience nausea and vomiting.
How is BPPV diagnosed and treated?
BPPV is diagnosed by placing the head in specific positions to cause movement of the calcium crystals, which produces specific eye movements that the care provider can see.
Treatment of BPPV is usually straightforward and involves moving the head in a specific series of positions to shift the crystals back to where they belong in the vestibular system of the inner ear. Most people only need 1 – 3 treatment sessions to achieve complete relief from the spinning. A longer course of treatment may be required if the calcium crystals are out of place in more than one area of the vestibular system or if certain other medical conditions are also present. Following treatment for BPPV, some people feel better immediately. Some people feel a sense of disorientation and imbalance that lingers for a few days to a few weeks.
Who can evaluate and treat BPPV?
Physical therapists with specialized training in vestibular rehabilitation can evaluate and treat BPPV. Valley Medical Center’s Outpatient Rehabilitation Services Department has physical therapists who have achieved competency certification in vestibular rehabilitation though Emory University and the American Physical Therapy Association (i.e. Herdman certification).
How can I be diagnosed and treated?
A referral from a physician or approved healthcare provider is required for outpatient physical therapy evaluation and treatment. For information, or to schedule an evaluation, call Rehabilitation Services – Physical Therapy, Vestibular Rehabilitation Service at 425.251.5165. Referrals may be faxed to 425.656.4028.
Find additional information about vestibular services at Valley’s Rehabilitation Services here.
Bhattacharyya N, Gubbels SP, et al. Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update). Otolaryngology – Head and Neck Surgery 2017, Vol. 156 (3S) S1 – S47.
By Vicky Lerner, PT, MSPT