Is BPPV related to Tinnitus?

Is BPPV related to tinnitus is a common question we get as neck and vestibular health experts.

While BPPV and tinnitus are separate conditions, they may share common risk factors or coexist due to the complex nature of ear-related disorders.

What is BPPV?

Repeating episodes of acute, short, paroxysmal vertigo, provoked by changes in head position relative to gravity, define Benign Paroxysmal Positional Vertigo (BPPV).

BPPV is the most common type of vertigo that a physical therapist treats is peripheral vertigo. This type of vertigo usually has symptoms “room spinning” dizziness, or feeling “unsteady”.

What is tinnitus?

The definition of tinnitus is the perception of sound in the absence of external auditory stimulation.

Tinnitus is characterized either by:

• Objective (can be heard by both patient and examiner) or

• Subjective (only heard by the patient)

In a physical therapy clinic, vestibular rehabilitation or manual therapy to the neck and jaw most commonly treats subjective tinnitus. A type of subjective tinnitus is peripheral tinnitus.

How does tinnitus relate to BPPV?

Peripheral tinnitus correlates with the anatomical region of the ear affected, and in the case of BPPV, it is the inner ear.

Even though not very common, some patients with recurrent BPPV can experience the disappearance of certain types of tinnitus through canalith repositioning maneuvers. Specialty trained vestibular physical therapists typically perform these maneuvers, which usually include Semont and Epley Maneuvers.

Just like loudness or intensity of tinnitus can be changed by sensory or motor stimuli such as muscle contractions, mechanical pressure on myofascial trigger points, cutaneous stimulation or joint movements; connections between the vestibular and cochlea centers, as well as hydrodynamics in the ear, could be a correlation between BPPV & tinnitus.

We recommend consulting with your ENT and/or audiologist to rule out outer or middle ear dysfunctions. This can help, alongside a vestibular examination, to rule in other causes of your tinnitus, including BPPV and/or somatosensory reasons.

How do I know if my tinnitus is related to BPPV?

Firstly, it is rare to have tinnitus from BPPV. However, in cases that have not responded to your typical medical approach to treat tinnitus, or if you are better with some medical treatment but not completely better, this could be another reason for ongoing symptoms.

Generally speaking, the ear affected by tinnitus corresponds in most cases to the side of BPPV. Your therapist can determine this through diagnostic testing. The usual test is called the Dix-Hallpike test but other tests are also used to determine if another canal is involved.

Barozzi et al in 2013 found:

19.3% of the patients affected by BPPV reported the appearance of tinnitus in association with the onset of positional vertigo.

Therefore, if you are noticing a correlation with your position vertigo and tinnitus, we would consider this part of our clinical criteria and a reason for tinnitus sensitization.

Contact us for more information and determine if you are a right candidate for a tinnitus evaluation.