Benign Paroxysmal Positional Vertigo or BPPV is the most common cause of vertigo. This is when tiny crystals (called otoconia) get displaced from the utricle (see diagram below) and can become either free-floating in the canals or at the end of each canal in your inner ear. Each canal has a specific test to determine whether the otoconia are located in it and from there your treatment plan can be decided.
The most commonly affected canal is the posterior canal and to test this the Hallpike Dix Test is performed. If positive, the eyes will move in a certain direction and the vertigo symptoms will be reproduced. From that position we can go straight into treatment which involves moving the head in certain directions to move the otoconia out of the canal and back into the utricle. This manoeuvre can be done a few times in one treatment but generally it resolves symptoms immediately. It's important you don't lie down for a couple of hours afterwards as this could undo all of the good work and allow those otoconia to get back into the canal!
A recent Cochrane review by Hilton & Pinder (2014) found that these re-positioning manoeuvres (as described above) are effective in completely resolving your vertigo in 56% of cases. There is unfortunately a recurrence rate of 36% which is why McDonnell & Hillier (2015) recommend a combination of vestibular rehabilitation and these manoeuvres to keep your vertigo at bay. Research in vestibular rehabilitation is certainly a growing area and there are currently several studies being carried on other forms of re-positioning manoeuvres.
- http://vestibular.org/understanding-vestibular-disorders/types-vestibular-disorders/benign-paroxysmal-positional-vertigo (Accessed on 21/11/2016)
- Hilton MP, Pinder DK. The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo. Cochrane Database of Systematic Reviews 2014, Issue 12. Art. No.: CD003162. DOI: 10.1002/14651858.CD003162.pub3.
- Hunt WT, Zimmermann EF, Hilton MP. Modifications of the Epley (canalith repositioning) manoeuvre for posterior canal benign paroxysmal positional vertigo (BPPV). Cochrane Database of Systematic Reviews 2012, Issue 4. Art. No.: CD008675. DOI: 10.1002/14651858.CD008675.pub2.
- McDonnell MN, Hillier SL. Vestibular rehabilitation for unilateral peripheral vestibular dysfunction. Cochrane Database of Systematic Reviews 2015, Issue 1. Art. No.: CD005397. DOI: 10.1002/14651858.CD005397.pub4.