The Most Common Cause of Vertigo is also the Most Treatable

Chris Hupf, PT, DPT, CSCS

Do you ever feel a sense that you or your surroundings are spinning or moving? Do you experience bouts of sudden unsteadiness or dizziness? Vertigo is a type of dizziness defined as an illusory sensation of motion of either the self or the surroundings in the absence of true motion.1 According to the National Institute on Deafness and Other Communication Disorders, it’s estimated that close to 40% of the population will experience dizziness or balance problems over the course of their lifetime.2 

One of the most common causes of vertigo is a condition called benign paroxysmal positional vertigo (BPPV). In fact, of the 5 million people in the United States who seek care for complaints of dizziness every year, between 17% and 42% end up receiving a diagnosis of BPPV.1 

BPPV is a type of positional vertigo caused by a disorder of the inner ear. Those who have it experience repeated “spinning” sensations or unsteadiness when they move their head in a certain direction. This could occur when rolling over or getting out of bed or tipping the head back to look up. A feeling of lightheadedness and nausea can occur as well. 

It’s widely understood that BPPV is caused by small calcium carbonate crystals that become dislodged from their normal resting place and end up free-floating within one of three semicircular canals used by the inner ear to sense movement. With changes in head position, these crystals migrate within the fluid-filled canal, causing movement of fluid and subsequent pressure changes that result in an abnormal sensation of rotation or spinning.

In the clinic, a physical therapist can assist in diagnosing BPPV through physical examination and understanding your history. This includes observation of involuntary eye movements that occur when the patient is placed in specific positions that provoke their dizziness. Depending on the canal affected, treatment involves a sequence of specific maneuvers designed to clear these crystals from the canal. These maneuvers are highly effective, with studies showing a complete resolution of symptoms 74-95% of the time in as little as one visit.3-6 

Almost 90% of people with BPPV will experience some interruption to their daily lives, including anxiety, depression, an increased risk for falls and impaired performance at home or at work.1,7 And, because most people who seek treatment are unaware that physical therapists can help, many ultimately end up undergoing expensive and unnecessary diagnostic testing and treatment first.7 

BPPV is quickly and easily treated by physical therapists. Many of our therapists have undergone additional training to diagnose and treat BPPV, so please don’t hesitate to reach out and schedule an appointment. It could be your next and final step in ending this debilitating condition, allowing you to live life uninterrupted once again.

References: 

1. Bhattacharyya, N., Gubbels, S. P., Schwartz, S. R., Edlow, J. A., El-Kashlan, H., Fife, T., ... & Seidman, M. D. (2017). Clinical practice guideline: benign paroxysmal positional vertigo (update). Otolaryngology–Head and Neck Surgery, 156(3_suppl), S1-S47. 

2. National Institute on Deafness and Other Communication Disorders. (2005). Strategic plan (FY 2006-2008). Retrieved from http://www.nidcd.nih.gov/StaticResources/about/plans/strategic/strategic06-08.pdf [PDF]. 

3. Wang, Y. H., Chan, C. Y., & Liu, Q. H. (2019). Benign paroxsymal positional vertigo–recommendations for treatment in primary care. Therapeutics and clinical risk management, 15, 719. 

4. Fyrmpas, G., Barkoulas, E., Haidich, A. B., & Tsalighopoulos, M. (2013). Vertigo during the Epley maneuver and success rate in patients with BPPV. European archives of oto-rhino-laryngology, 270(10), 2621-2625. 

5. Helminski, J. O. (2014). Effectiveness of the canalith repositioning procedure in the treatment of benign paroxysmal positional vertigo. Physical therapy, 94(10), 1373-1382. 

6. Bruintjes, T. D., Companjen, J., van der Zaag‐Loonen, H. J., & van Benthem, P. P. G. (2014). A randomised sham‐controlled trial to assess the long‐term effect of the Epley manoeuvre for treatment of posterior canal benign paroxysmal positional vertigo. Clinical Otolaryngology, 39(1), 39-44. 

7. BPPV: Experts Update Best Practices for Diagnosis and Treatment. (2017, March 1). Retrieved from https://www.entnet.org/content/bppv-experts-update-best-practices-diagnosis-and-treatment

Image of Inner Ear: Blausen.com staff (2014). "Medical gallery of Blausen Medical 2014". WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436. - Own work.