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BPPV Physiotherapy & Vestibular Rehabilitation Toronto

Benign Paroxysmal Positional Vertigo (BPPV) in Toronto

Inner ear disorder causing dizzinessBPPV or Benign paroxysmal positional vertigo refers to episodes of sudden and severe dizziness associated with head movement. Vertigo & dizziness symptoms commonly can be triggered by rolling over in bed, getting out of bed, and lifting head to look up.

A person affected by vertigo symptoms may have attacks of vertigo for a few days or weeks, then a period of time with no dizziness symptoms at all. The symptoms can come and go with no apparent reason.

BPPV is caused when the particles within the vestibular system are misplaced and it usually affects only one ear, however, occasionally it can occur in both ears at the same time.

What are the Symptoms of BPPV?

The symptoms of BPPV can include:

  • Sudden episodes of violent vertigo (spinning)
  • Dizziness and/or nausea
  • Movements of your head trigger the vertigo
  • Your vertigo may last half a minute or more
  • Your eyes may drift and flick uncontrollably (nystagmus)

What Causes BPPV?

Inside the inner ear, there are three semicircular canals filled with fluid. These canals are oriented at different angles. With each head movement, the fluids inside these channels are moved to create signals to inform the brain stem of the direction, speed, and quality of movement.

BPPV & VertigoBPPV is caused by the displacement of little calcium carbonate crystals or otoconia within the vestibular canals. The treatment for BPPV is re-positioning maneuvers which essentially is finding which one of the canals, the particles are floating, position the head in a way that the gravity moves the particles to where they belong. These maneuvers, if done properly, are usually very effective and patients have immediate relief of dizzy symptoms.

Occasionally conservative BPPV treatments such as physiotherapy and medication fail. If despite treatments, the symptoms continue for more than 12 months, an operation may be needed.

Who Performs BPPV Treatment?

These crystals are held in special reservoirs within other structures of the inner ear (Saccule and Utricle). These crystals can be dislodged and displaced due to injury or degeneration of the Utricle and move into the balance organ and interfere with your vestibular system. The vestibular physiotherapy is to relocate these crystals to their original location.

The following factors cause or allow crystals to migrate into vestibular canals include:

  • Head or ear injuries such as concussion or whiplash
  • Ear surgery or acute or chronic ear infection
  • Degeneration of the inner ear structures
  • Vestibular neuritis (viral infection of the inner ear)
  • Meniere’s disease
  • Some types of minor strokes
  • Idiopathic (no cause can be found

BPPV should only be treated by physiotherapists or other healthcare practitioners who have undertaken specific training to diagnose and successfully treat. Our Vestibular trained physiotherapists are registered with the College of Physiotherapists of Ontario. Vestibular physiotherapy is covered by most insurance plans.

How is BPPV Diagnosed?

Not every dizzy patient is suffering from a vestibular condition. A wide range of medical conditions can cause dizziness and vertigo. Therefore, it is important to find the exact cause of these symptoms. Vestibular physiotherapy is effective in managing dizziness and vertigo when the cause is in the vestibular system. The rehabilitation protocols can help patients manage the balance disorders related to the vestibular system involvement.

What is the Treatment for BPPV?

What Is Epley Maneuver and Is It Effective For Vertigo?

After the assessment and the confirmation of BPPV diagnosis, your vestibular trained physiotherapist will apply specific techniques to relocate the displace Otolithic derbies to an area in the inner ear that doesn’t stimulate the feelings of dizziness or vertigo.

Is BPPV treatment successful?

When BPPV treatment techniques are performed correctly, reduction of vertigo, dizziness and other symptoms of BPPV is immediate in 80% or more of cases. In most cases (90%+), quality BPPV practitioners have high success rate within three applications of the maneuvers.

In addition, doctors may prescribe some medication to diminish your sensitivity to movement and manage nausea and vomiting. These medications are mainly management and are not considered to be treating the cause of vertigo and may just mask BPPV symptoms.

Summary

Benign Paroxysmal Positional Vertigo (BPPV) is determined when a person suffers from a series of episodes of unexpected and severe vertigo and dizziness. People suffering from BPPV may suffer from vertigo for a few days or weeks. Sometimes the symptoms disappear for a while and then return.

BPPV occurs when particles or the calcium carbonate crystals dislodge from the position, enter the fluid filling the vestibular canals forming the balance organ in the inner ear, and interfere with the vestibular system, causing the person to feel dizzy and imbalanced. Some symptoms of BPPV include:

  • Unexpected episodes of severe spinning
  • Nausea, dizziness, or both
  • Eyes drift and flick open and close uncontrollably
  • Vertigo lasts for thirty seconds or more
  • A loss of balance
  • Falls

To treat BPPV, physiotherapists determine which one of the three canals of the inner ear are the particles floating in and then applies a re-positioning maneuver specific to that canal to return the crystals to their original position. The most common type is loose crystals moving freely in the ear’s fluid canal and the second type is crystals clinging on the bundle of nerves responsible for fluid movement. Usually, one or two treatments are enough. If the episodes of vertigo go on for a long period of time then some imbalance in the vestibular system may occur and based on the diagnosis, the physiotherapists recommend a series of specific exercises called vestibular rehabilitation.

Common Treatment Options

  • Repositioning maneuvers, such as Epley and Semont
  • Vestibular rehabilitation
  • Balance exercises
  • Gaze stabilization exercises
  • Education
  • Return to work program

Physiotherapists treat BPPV or Vertigo

At Physiomobility, we have a team of qualified professionals who offer specialized treatment for various musculoskeletal conditions. Whether you have a chronic medical condition, such as arthritis, or you have experienced a sports injury, or suffer from dizziness and vertigo our experienced physiotherapists will provide you a personalized treatment, offering you relief from pain and discomfort and enabling you to get back to your usual activities quickly.

Dizziness or vertigo is a sensation that you, or the objects around you, are spinning or moving. It is important to understand that vertigo or dizziness is not a disorder in itself. Instead, it is a symptom of an underlying condition.

While dizziness can be caused by a number of diseases, most commonly it occurs due to a vestibular (inner ear) disorder known as Benign Paroxysmal Positional Vertigo (BPPV). It is caused due to displaced crystals in the inner ear and can be easily managed with vestibular physiotherapy. Usually, the physiotherapist or other trained professionals apply re-positioning maneuvers and educate patients to manage symptoms. The vestibular rehabilitation program designed by Physiomobility is aimed at making a patient symptom free and to feel more confident and decrease their risk for trips and falls by treating dizziness and improving their gait, balance, and coordination.

Common Treatment Options

  • Re-positioning maneuvers, such as Epley Maneuver
  • Vestibular rehabilitation (VRT)
  • Falls prevention

Read more:

Dizziness & Balance

By: Gita Mikal, Registered Physiotherapist certified in Vestibular Rehabilitation

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