Benign Paroxysmal Positional Vertigo Treatment (BPPV)

Common Causes

Some common known causes of Benign Paroxysmal Positional Vertigo (BPPV) include head injury, complications following ear surgery, age-related deterioration of the vestibular system, and general inner ear issues such as severe inner ear infections, an inner ear disorder or inner ear disease like vestibular neuritis. These conditions can displace calcium carbonate crystals inside the inner ear canals resulting in episodes of vertigo. BPPV manifests in various forms depending on the affected semicircular canal: anterior canal BPPV is induced by tilting the head forward, while posterior canal BPPV is elicited by movements that alter head position, such as rolling over in bed with the head turned towards the side of the affected ear. Recognising the triggers of vertigo episodes, their underlying causes, and specific types is essential for precise diagnosis and management of BPPV.

BPPV Theory

There are two main theories about the cause of BPPV. These theories both speak about abnormal detections which trigger vertigo symptoms, regarding changes in the endolymph that flows in the semicircular canals of the otolith organs. These two theories are as follows:

The ‘Cupulolithiasis Model’

This model suggests that loose matter in the endolymph becomes stuck in the cupula, or the sensory organs that are located in the otolith. 

The ‘Canalithiasis Model’

This theory suggests that the cupula detects free-flowing particles in the endolymph.

There are two physical tests that can be used to accurately diagnose BPPV and determine which is the affected canal. The Dix-Hallpike Test can be used to detect dysfunction in the posterior semicircular canal of the otolith, while the supine roll test can be used to assess the horizontal canal. In positive tests; the patient will experience their symptoms of vertigo, and the therapist will observe for signs of nystagmus, or rapid beating of the pupils. In the rare case that the superior semicircular canal is affected, the Dix -Hallpike test would be positive and the therapist will observe nystagmus.