Benign Paroxysmal Positional Vertigo (BPPV) is a non-life-threatening condition of the vestibular system, the organ of balance and equilibrium.
BPPV is characterised by dizziness, vertigo, loss of balance and sometimes nausea. These effects often appear unexpected 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.
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:
– Semi-Circular Canals. (The latter have expanded termini
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 jellylike 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 the movement of the head.
In the case of BPPV, it is a stray Otolith that causes BPPV. 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.
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 effective treatment for the most common form of BPPV, Posterior Canal BPPV. Others include the Gufoni and Deep Head Hanging manoeuvres.
For the treatment of BPPV, we recommend that you consult a highly skilled and experienced physical therapist with a refined understanding of anatomy and physiology. Osteopaths are in a good position to help.
For further advice, contact our Osteopath’s at Nordic Balance Abbeville Road, Clapham SW4.
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