Among the peripheral vestibular disorders, benign paroxysmal positional vertigo (BPPV) is the most common.

The diagnosis of BPPV is clinical and is done mainly through thorough medical history taking and specific maneuvers that determine what type and canal BPPV is present.

Physical therapy is an effective, reliable and non-invasive therapeutic approach, which leads to consider it as an important treatment option for BPPV.

Causes

BPPV can occur via two mechanisms:

1. Canalithiasis, in which degenerative debris (otoconia fragments) of the utricle are circulating freely in the endolymph of the semicircular canals of the labyrinth.

2. Cupulolithiasis, proposes that these same degenerative debris are not circulating in the canals but adhered to the cupula, making it more sensitive to gravity.

Treatment

Treatment success depends on identifying and specifying the type of BPPV and canal involved. In fact, an accurate diagnosis and choice of appropriate maneuver are crucial to the success of the treatment. At PhysioFit of North Carolina, Dr. Danielle Vaughan, our vestibular specialist, uses goggles in her diagnostic and treatment procedures for further clarification and better results with her patients.

Canal Repositioning Manuevers

Your vestibular specialized physical therapist will determine which canal is involved and then proceed with the most appropriate canal repositioning manuever. The most common canal is the posterior semicircular canal, but in some instances (not as frequent), the anterior or lateral canal can be involved. These procedures, if performed correctly, can be very effective treatment.

Articles reporting the effects of the Epley maneuver on the posterior canal in the short term stated that 91% of participants felt improvement of symptoms with one to three therapy maneuvers. For the horizontal canal, the intervention with the Gufoni and Barbecue maneuvers proved highly effective, with 92 and 93% treatment success rates, respectively.

Vestibular Rehabilitation

In some cases, a progressive form of vestibular exercise is called vestibular rehabilitation or vestibular therapy is also indicated. It involves addressing the three balance systems (vision, vestibular system and proprioceptive information from feet and neck) and how they communicate together and how the body responds to that information to improve balance, sensation of stability, and reduce dizziness.

Your vestibular specialized physical therapist will determine if you are having any balance disturbances, and provide with you specific exercises, customized to your needs to reduce symptoms.

Maintenance Therapies

BPPV can have a high recurrence rate, ranging from 7 to 55% of the cases long term, especially in the elderly. Therefore, it is wise to have a vestibular therapist that you trust and can contact when needed as symptoms arise. See our other blog post on this concept!