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Physical Therapy Guide on the Recovery of Benign Paroxysmal Positional Vertigo


Vertigo is a common problem that is experienced by millions of people around the globe. In vertigo, patients feel a sensation that everything in their surroundings is spinning. This spinning sensation causes an imbalance which can increase the risk of falling. It affects a large number of adults worldwide.

About 9 out of 100 adults are affected by it, which makes it the most common form of episodic vertigo. But the great news is that BPPV can be treated. A physical therapist can diagnose and confirm vertigo with various tests and prescribe special exercise and treatment plans to overcome this problem.

What Do You Know About BPPV?

Benign paroxysmal positional vertigo (BPPV) is a common problem among people that affects the inner ear, which is responsible for maintaining the balance of the body. Patients with BPPV can experience dizziness, imbalance, or spinning sensation when their head is moved in certain positions.
Inner ear diagram

Benign in BPPV means that this disease is not a threat to life and commonly is not increasing. Paroxysmal refers to that spinning sensation (vertigo) that happens suddenly. Positional means that this disease is related to the position. It is set off with the change in head position, generally when looking up, lying down, or changing position in bed. Vertigo is the name of a spinning sensation.

When the patient moves his head in a specific position, the crystal moves towards the inner canal of the ear, which triggers the endings of the nerve, due to which the patient feels dizziness. The exact cause of BPPV is unknown, but the crystals may form due to any infections, aging, medical conditions like Meniere’s disease, or trauma to the head. Generally, BPPV is more common in women, and it can be due to any family history.

How Does It Feel?

Benign paroxysmal positional vertigo commonly arises due to change in positions like looking up, changing position in bed, lying down, and bending. Before patients start feeling symptoms, there is a small pause more often of 15 seconds after a change in position.

The dizzy sensation can be brief or intense depending on the patient and usually lasts for 15 to 45 seconds. The symptoms of BPPV may last up to 2 minutes if crystals stay longer in the inner ear. The patient may experience vertigo constantly for weeks to months. During this period, the patient may experience room spinning around him, imbalance, dizziness, or light-headedness.

Factors That Can Trigger Vertigo:

Vertigo may happen as a side effect of many other diseases like:

  • Head injury
  • Migraine
  • Head trauma
  • Surgery
  • Heart Stoke
  • A hole inside the inner ear
  • Any mental disorder
  • Shingles inside or outside of the ear
  • Acoustic neuroma (an abnormal growth that develops on a nerve inside the inner ear)
  • Otosclerosis (irregular bone growth in the middle ear)
  • Multiple Sclerosis disorder

Vertigo is also reported in pregnant women; it may occur as a result of hormonal changes in the body. It is important to see a doctor and get a comprehensive, thorough check-up to determine what is the cause of vertigo in your case and to check the intensity of vertigo as each patient is different.

Signs and Symptoms of BPPV:

Normally the symptoms and signs of BPPV last for less than one minute. But in some cases, it can last for 2 minutes as each patient is different. The signs and symptoms can appear or disappear for some time, and after some time, they can reoccur. Changes in head position and certain head movements cause most of the symptoms and signs of BPPV. These may include:

  • Dizziness
  • Vomiting
  • Vertigo (A sensation of you and everything around you is spinning)
  • Nausea
  • Imbalance or unsteadiness

How Is It Diagnosed?

Commonly, the diagnosis of BPPV is based on whether you experience vertigo when you move your head or whether you have any specific involuntary eye movement known as nystagmus. Your doctor or physical therapist performs some tests to observe vertigo and involuntary eye movement results by moving your head in different positions. These entire tests will help your doctor to determine the exact cause of your dizziness and whether to refer you to your physician for some more testing.

These entire tests are carried out to recreate BPPV signs and symptoms. Your physical therapist determines the appropriate repositioning maneuver to treat and eliminate vertigo by repositioning your head in different positions and checking your involuntary eye movement.

Different people describe different symptoms and causes of dizziness and BPPV, which make this disease and its causes more challenging to determine. Make sure to be specific and clear while talking to your physical therapist about the causes of BPPV. It will help them to diagnose it type more accurately.

For example, explain how long your BPPV symptoms last and what is the intensity of these symptoms.  Also describe, if you feel nausea or feel everything spinning around you. Also, tell your doctor by which movement or position your experience more dizziness and by which movement you feel better and easier.

PRO TIP: While talking to your physician or doctor, ensure to discuss any past injury or surgery, hormonal imbalance, immunity problems, medication for headaches, etc. All these things can be important for your therapist to determine and diagnose your problem and refer you for further testing if needed.

Methods to Diagnose BPPV:

If your private care specialist can’t find out the reason for your signs and issues related to BPPV, then the person might arrange extra diagnoses process include:

Electronystagmography Test:
Electronystagmography Test

The reason for these tests is to distinguish unusual eye development. ENG (which utilizes anodes) or VNG (which utilizes little cameras) can help decide whether discombobulation is because of internal ear illness by estimating compulsory eye developments while your head is set in various positions or your offset organs are animated with water or air.

Magnetic Reverberation Imaging:

The test utilizes an attractive field and radio waves to make cross-sectional pictures of your head and body. Your PCP can utilize these pictures to recognize and analyze the scope of conditions. An X-ray might be performed to preclude other potential reasons for dizziness.

Surgical Options to Treat BPPV:

In uncommon circumstances, when the Image repositioning technique doesn’t work, your private healthcare specialist might suggest surgery. In this test, a bone attachment is utilized to impede the segment of your internal ear that is causing dizziness.

The attachment can prevent the crescent waterway in your ear. It helps the patient to get the option to react to molecule developments or head developments overall. The achievement rate for trench stopping a medical procedure is about 90%.

Effective Home Remedy and Lifestyle Changing Treatment:

If you experience dizziness related to BPPV, think about these tips:

  • Know about the chance of losing your equilibrium, which can prompt fall and genuine injury.
  • Keep away from developments, for example, looking into, that welcome on the manifestations.
  • You need to sit down promptly when you feel lightheaded.
  • You need to use great lighting in the event that you get up around evening time.
  • The patient should need to walk with a stick for steadiness in case you’re in danger of falling.
  • Work intimately with your primary care physician to deal with your BPPV issues and signs successfully.

As per the research, BPPV might repeat even if you go through with the advanced treatment. In every case, the condition can be dealt with exercise-based recuperation and home medicines.

How Can a Physical Therapist Help?

Benign paroxysmal positional vertigo (BPPV) is a common disease, but fortunately, it is treatable. It can be treated with a simple and effective head and neck maneuver technique done by the physical therapist. Your physical therapist will reposition your head or neck in 3-4 positions.

You have to hold each position for 30 seconds to 2 minutes according to the instructions of your physical therapist. This specific repositioning treatment is designed to set back crystals to their appropriate position in the utricle (inner ear) from the semicircular canal.

Another special repositioning treatment called the Epley maneuver is used for positioning of posterior canal BPPV, which is the most commonly involved canal for BPPV. Medications are not found effective for BPPV treatment. Even in some cases, the medication causes more harm than cure.

Frequently Asked Questions (FAQs):

1. Can we get help from physical therapy to cure BPPV?
The most effective and safe treatment of BPPV is physical therapy. The problem of BPPV is normally completely solved in one to two visits. The physical therapist uses Epley Maneuver treatment which is a non-invasive technique with very effective outcomes for BPPV.

2. How does a physical therapist treat vertigo?
Physical therapists focus on improving your balance and treating vertigo at the same time. The treatment may include specific head and neck movements and exercises that physical therapists gently perform and teach you to do at home. Treatment also includes special exercises to address signs and symptoms of vertigo.

3. How are many physical therapy sessions required to completely treat vertigo?
Physical therapists use Epley and Semont exercises for the treatment of BPPV. All these techniques are performed by expert physical therapists. Usually, one to two sessions of 10-15 minutes are required to treat benign paroxysmal positional vertigo (BPPV).

4. How can we treat vertigo permanently?
Special techniques Epley maneuver, which is also known as Vertigo repositioning, is used to cure benign paroxysmal positional vertigo (BPPV). It is found to be a more effective and safe treatment of BPPV rather than any medication. These treatments are performed by an expert audiologist, physical therapist, or physician.

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