If you have dizziness, you should see your doctor. This page is not intended to substitute for medical advice.
Benign Proximal Positional Vertigo is the most common type of peripheral vertigo, can be seen following head injury, vestibular neuritis, stapes surgery, Meniere’s disease, or can present alone. BPPV sometimes may result from a head injury or just from getting older.
According to the National Institute of Health in the United States, untreated BPPV has been reported to double the incidence of falls and depression in older adults and reduce their activities of daily living by one half.
What are the symptoms of a balance disorder?
If your balance is impaired, you may feel as if the room is spinning. You may stagger when you try to walk or teeter or fall when you try to stand up.
Some of the symptoms you might experience are:
- Dizziness or vertigo (a spinning sensation)
- Falling or feeling as if you are going to fall
- Light-headedness, faintness, or a floating sensation
- Blurred vision
- Confusion or disorientation
Other symptoms are nausea and vomiting, diarrhoea, changes in heart rate and blood pressure, and fear, anxiety, or panic. Some people also feel tired, depressed, or unable to concentrate. Symptoms may come and go over short time periods or last for longer periods of time.
What are the causes of a balance disorder?
Warning: Technical explanation below
BPPV is caused when otoconia tumble from the utricle into one of the semi-circular canals and weigh on the cupula. The cupula can't tilt properly and sends conflicting messages to the brain about the position of the head, causing vertigo. Hydration also plays a role. If you are not getting enough fluids, these sacs may shrink causing the otoconia to fall into the semi-circular canals. The loss of some otoconia is normal. Movement of the head acts to clean out the semi-circular canals. If there is not as much movement, you can also get a build up of the otoconia.Our vestibular system works with other sensorimotor systems in the body, such as our visual system (eyes) and skeletal system (bones and joints), to check and maintain the position of our body at rest or in motion. It also helps us maintain a steady focus on objects even though the position of our body changes. The vestibular system does this by detecting mechanical forces, including gravity, that act upon our vestibular organs when we move. Two sections of the labyrinth help us accomplish these tasks: the semi-circular canals and the otolithic organs.
The semi-circular canals are three fluid-filled loops arranged roughly at right angles to each other. They tell the brain when our head moves in a rotating or circular way, such as when we nod our head up and down or look from right to left.
Each semi-circular canal has a plump base, which contains a raindrop-shaped structure filled with a gel-like substance. This structure, called the cupula, sits on top of a cluster of sensory cells, called hair cells. The hair cells have long threadlike extensions, called stereocilia, that extend into the gel. When the head moves, fluid inside the semi-circular canal moves. This motion causes the cupula to bend and the stereocilia within it to tilt to one side. The tilting action creates a signal that travels to the brain to tell it the movement and position of your head.
Between the semi-circular canals and the cochlea lie the otolithic organs, which are two fluid-filled pouches called the utricle and the saccule. These organs tell the brain when our body is moving in a straight line, such as when we stand up or ride in a car or on a bike. They also tell the brain the position of our head with respect to gravity, such as whether we are sitting up, leaning back, or lying down.
Like the semi-circular canals, the utricle and the saccule have sensory hair cells. These hair cells line the bottom of each pouch, and their stereocilia extend into an overlying gel-like layer. On top of the gel are tiny grains made of calcium carbonate called otoconia. When you tilt your head, gravity pulls on the grains, which then move the stereocilia. As with the semi-circular canals, this movement creates a signal that tells the brain the head's position.
Our visual system works with our vestibular system to keep objects from blurring when our head moves and to keep us aware of our position when we walk or when we ride in a vehicle. Sensory receptors in our joints and muscles also help us maintain our balance when we stand still or walk. The brain receives, interprets, and processes the information from these systems to control our Balance.
What are the treatments of BPPV?
The loss of some otoconia is normal. Movement of the head acts to clean out the semi-circular canals. If there is not as much movement, you can also get a build up of the otoconia. There is the new method and the old method.
Most commonly people are given heavy sedatives to suppress the balance system. The main side affect is that you feel like you are walking through Golden Syrup.
The old fashioned method that has been used since the 1940’s is Vestibular Retraining therapy. These are a series of exercises that you can do at home. If you do have BPPV; the exercises should fix the problem. If you do not, you will not do any farther damage. The only cost is your time.Cawthorne Cooksey Exercises
- In bed or sitting
- Eye movements -- at first slow, then quick
- up and down
- from side to side
- focusing on finger moving from 3 feet to 1 foot away from face
- Head movements at first slow, then quick, later with eyes closed
- bending forward and backward
- turning from side to side
- Eye movements and head movements as above
- Shoulder shrugging and circling
- Bending forward and picking up objects from the ground
- Eye, head and shoulder movements as before
- Changing form sitting to standing position with eyes open and shut
- Throwing a small ball from hand to hand (above eye level)
- Throwing a ball from hand to hand under knee
- Changing from sitting to standing and turning around in between
- Moving about (in class)
- Circle around centre person who will throw a large ball and to whom it will be returned
- Walk across room with eyes open and then closed
- Walk up and down slope with eyes open and then closed
- Walk up and down steps with eyes open and then closed
- Any game involving stooping and stretching and aiming such as bowling and basketball
Diligence and perseverance are required but the earlier and more regularly the exercise regimen is carried out, the faster and more complete will be the return to normal activity. Individuals should be accompanied by a friend or relative who also learns the exercises to ensure safety and to make sure you are doing them correctly. Remember that you may get dizzy doing these exercises so first and fore most, make sure you are not going to fall.Positional exercises of Brandt and Daroff
The Brandt-Daroff Exercises are a home method of treating BPPV, usually used when the side of BPPV is unclear. They succeed in 95% of cases but may take longer than the other maneuvers. In approximately 30 percent of patients, BPPV will recur within one year.
Sit on the edge of the bed near the middle, with legs hanging down. (position 1)
- Turn head 45° to right side.
- Quickly lie down on left side, with head still turned (angled upwards), and touch the bed with portion of the head behind the ear. (Position 2)
- Maintain this position and every subsequent position for about 30 seconds or till the dizziness disappears.
- Sit up again. (Position 3) stay for 30 seconds
- Quickly lie down to right side after turning head 45° toward the left side. (Position 4)
- Sit up again.
- Do 6-10 repetitions, 3 times per day for 2 weeks
The Brandt-Daroff Exercises are a home method of treating BPPV, usually used when the side of BPPV is unclear. They succeed in 95% of cases but may take longer than the other maneuvers. In approximately 30 percent of patients, BPPV will recur within one year.Home Epley Left
The Epley and/or Semont maneuvers may be done at home every night for a week.
The method (for the left side) is performed as shown on the figure. One stays in each of the lying down positions for 30 seconds, and in the sitting upright position (top) for 1 minute. Thus, once cycle takes 2 1/2 minutes. Typically 3 cycles are performed.
Maintaining Good Balance
- Drink an adequate amount of fluids
- Walk 20 minutes a day
- Start each day with a gentle head roll to give the semi-circular canals a good clean out.