What is Benign Paroxysmal Positional Vertigo?
Benign Paroxysmal Positional Vertigo, also known as BPPV is a common and treatable vestibular disorder that affects the inner ear, leading to episodes of dizziness and vertigo. The condition is characterizsed by brief intense episodes of spinning or whirling sensations that occur when you change the position of your head.
Patho-mechanism
It is typically caused by the displacement of small calcium carbonate crystals called otoliths or canaliths within the inner ear’s semicircular canals. These crystals are normally embedded in a gel-like substance, but if they become dislodged and migrate into the semicircular canals, they can disrupt the normal flow of fluid in the canals. This disruption sends false signals to the brain about head position and movement, leading to dizziness and vertigo.
In short, the crystal in our ear’s balancing system moves around causing vertigo.
Symptoms
Vertigo is a spinning sensation, often described as feeling like you’re spinning around or that your surroundings are spinning. Nausea(vomitting) or Nystagmus(rapid involuntary eye movement) are also seen.
Diagnosis
If the medical practitioner suspects BPPV from patient’s complaint, he/she will do something called a Dix-Hallpike maneuver. Dix-Hallpike maneuver is the golden standard for the diagnosis of BPPV. (1)
Treatment
There are few treatment options. Epley Maneuver, Gans Maneuver, Semont maneuver are the 3 main benign paroxysmal positional vertigo treatments. Epley currently has a little more evidence for it’s effectiveness than the other 2 maneuvers. These maneuvers can be done by most chiropractors, physiotherapists, and most musculoskeletal alternative therapists. (2)
So can chiropractic fix Benign paroxysmal positional vertigo? As mentioned in another post about how chiropractic works It is not only the adjustments that we deliver. Chiropractors can also do Epley Maneuver, and other balance related rehabilitation to fix BPPV.
Resolution time
We consider resolution as negative Dix-Hallpike test. So if the medical practitioner does the Dix-Hallpike maneuver and there is no reproduction of symptoms such as vertigo or nystagmus, then we consider the patient’s condition has resolved.
For this, we must understand posterior canal BPPV(PC-BPPV) which is when the patients vertigo lasts less than 30 seconds, and HC-BPPV which is when the vertigo lasts longer than 30 seconds.(3)
PC-BPPV resolves within 39±47 days. HC-BPPV resolves within 16±19 days.(3)
These values are natural resolution without benign paroxysmal positional vertigo treatments.
Reference
1. Talmud JD, Coffey R, Hsu NM, et al. Dix-Hallpike Maneuver. [Updated 2023 Jul 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459307/
2. Hilton MP, Pinder DK. The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo. Cochrane Database of Systematic Reviews 2014, Issue 12. Art. No.: CD003162. DOI: 10.1002/14651858.CD003162.pub3. Accessed 08 September 2023.
3. Lee SH, Kim JS. Benign paroxysmal positional vertigo. J Clin Neurol. 2010 Jun;6(2):51-63. doi: 10.3988/jcn.2010.6.2.51. Epub 2010 Jun 30. PMID: 20607044; PMCID: PMC2895225.