Vertigo can be debilitating, but there are a few ways to approach BPPV treatment.
What is BPPV?
BPPV, or benign paroxysmal positional vertigo, is a special type of benign vertigo that is actually the most common of the vestibular disorders. The inner ear helps to maintain balance with its vestibular system. Vertigo is the feeling that there is spinning, and BPPV causes that sensation suddenly with a change in head position, hence the terms “paroxysmal and positional”. The semicircular canals, which are part of the vestibular organs, contain fluid. Sometimes there are “tiny crystals of calcium carbonate” called otoconia that detach and collect in that fluid. They shift upon movement, and this helps to send false signals to the brain to produce vertigo and involuntary eye movements called nystagmus. The BPPV subtypes include canalisthiasis (otoconia floating in the canal), and cupulothiasis (otoconia attached to the cupula). The cupula is the “sensory receptor at the base of the canal” that sends signals to the brain. Most cases of BPPV are unilateral, but some people have both ears affected. Symptoms of this disorder include dizziness, imbalance, nausea, and difficulty concentrating. It is hard for patients to look up or roll over to get out of bed at times. It can be short-lived, or the disorder can recur over a lifetime. There is a risk of falling, and BPPV can also impact work and relationships.1
Diagnosis and BPPV Treatment Methods
The Dix-Hallpike Maneuver is a diagnostic method for BPPV. With it, a patient lies down on their back and the “head is turned 45 degrees” while the body is positioned to allow the “head (to be) extended about 20 to 30 degrees”. Nystagmus eye twitching will be present in patients with this disorder. The maneuver is then repeated for the other side.2 After a positive posterior canal BPPV diagnosis, patients can be treated with the Epley Maneuver. The body and head are positioned as with the Dix-Hallpike Maneuver. After 30 seconds or a minute, “the head is turned at 90 degrees to the opposite side”, and it is held there for the same amount of time. Another rotation of 90 degrees occurs as the patient turns to lie on their side and again holds that position. The “the head should be turned 45 degrees from the horizontal”. Then the patient may sit up. By engaging in these movements, the crystal is made to fall toward the canal opening. The head positions must angle correctly and be held long enough (but not too long).3 For lateral canal BPPV, the Lempert Maneuver may be used. This is also known as the BBQ maneuver. The head is turned 90 degrees while the patient lies on their back. After 30-60 seconds, the patient turns to the stomach and faces the head down for about another minute. The head is rotated 90 degrees again so the patient lies on the side. After that minute, the patient returns to their back and can then sit up.4 Chiropractors can perform these maneuvers.5
Find out more about chiropractic treatment for vertigo.