Benign Paroxysmal Positional Vertigo, BPPV: What is it and how can it be treated?

BPPV is a non-life-threatening condition of the vestibular system, the organ of balance and equilibrium. It is characterised by dizziness, vertigo, loss of balance and sometimes nausea. These effects often appear out of the blue and for no obvious reason. They are bought on by innocuous, everyday movements of the head. Fortunately, the mechanism that causes these symptoms is well understood and the solution simple.

What causes the symptoms of BPPV?

To understand what is happening in BPPV we have to have a look at the anatomy. So here goes.

The vestibular system, the organ of balance and equilibrium, sits in the middle ear alongside the structures of hearing. It consists of three main components: the utricle; the saccule and the semi-circular canals. The latter have expanded termini called ampullae. Within the utricle, saccule and ampullae are cells with tiny hairs attached called hair cells. In the utricle and saccule these cells sit in a gelatinous substance, the surface of which is covered in small calcium structures called otoliths. Each hair cell is innervated by nerve fibres, branches of the vestibular nerve, which relays information about balance and equilibrium to the brain.

The utricle, saccule, semi-circular canals and ampullae are all full of fluid. When the head moves so does the fluid. This fluid movement bends the hairs on the hair cells and a nerve impulse is relayed to the brain. In normal circumstances this sequence of events is only initiated by movement of the head. In the case of BPPV it is a stray otolith. A dislodged otolith can make its way out of the utricle or saccule and into one of the semi-circular canals. Here it acts to increase the momentum of the fluid causing the feelings of dizziness, vertigo and loss of balance.

The solution?

Fortunately, this is not a serious condition and the solution is fairly straightforward. It involves taking the head through a set of prescribed movements in order to encourage the otolith back into the utricle or saccule. Movements are gentle, measured and safe. They may bring on the dizziness but this is part of the process. They vary depending on which semi-circular canal the otolith is sitting in. The Epley manoeuvres are used to return the otolith from the posterior semi-circular canal. They are the most well-known and an effective treatment for the most common form of BPPV, posterior canal BPPV. Others include the Gufoni and Deep Head Hanging manoeuvres.

Where can I get treatment?

As highly trained physical therapists professionals with a refined understanding of anatomy and physiology, osteopaths are in a good position to help. Personally, I studied the functional anatomy of the ear in great depth during my postgraduate paediatric training and have, since, undergone further studies in the application of the Epley, Gufoni and Deep Head Hanging manoeuvres. Consequently, as the Osteopath Clapham, I am very pleased to help those with BPPV.

For more information and to the find out how I, the Osteopath Clapham, can help please do get in touch.