BPPV - BENIGN PAROXYSMAL POSITIONAL VERTIGO.
BPPV
can sometimes occur following a bout of viral Labyrinthitis, which is
exactly what Isla experienced.
Signs and symptoms...
Usually
BPPV is characterised by short and very intense bursts of vertigo that
are related to certain positions. Quite often people will experience vertigo
when they lie down, turn over in bed, rise from bed, lean forward or look
up.
Generally
the vertigo is brief - lasting under a minute and is often accompanied
by nausea and a classic nystagmus (eye movements).
What is BPPV...?
Benign
paroxysmal positional vertigo (BPPV) is a peripheral vestibular (inner
ear) disorder in which patients typically report attacks of vertigo with
position changes.
The
exact cause of BPPV is still not completely understood.
Although
some controversy exists, the most widely excepted theory is that BPPV
is caused by otoconia (calcium particles) that are shed from the utricular
macula (which responds to linear motion) migrating to the posterior semi-circular
canal (which responds to rotational motion).
When the otoconia
particles have dislodged, they either may settle into the sensory organ
cupula of the posterior semi-circular canal (cupulolithiasis) or they
may continue to free float within the endolymph of the posterior canal
itself (canalithiasis). In either case, their presence alters the dynamic
response of the posterior semi-circular canal to head movement, causing
vertigo.
This
may occur for several reasons e.g. whiplash injury, falls, head injury,
even high-impact exercises and sometimes as a consequence of viral Labyrinthitis.
In certain cases people who have had prolonged periods of inactivity,
such as confinement to a bed, may also develop BPPV because of the settling
of the otoconia particles.
Getting BPPV diagnosed...
The
diagnosis of BPPV is determined by a clinical history. Most people have
a typical complaint of vertigo whenever leaning forward, getting up form
bed and rolling over in bed. The diagnosis is confirmed by a positive
response on the Dix-Hallpike maneuver.
Treatment...
BPPV can have a very intermittent pattern with full resolution
of symptoms for many months, even years at a time. For some, no treatment
is required whilst others have more persistent symptoms that require treatment.
BPPV is generally treated by a physical maneuver called
the Epley. The Epley is designed to reposition the particles away from
the cupula into a less sensitive area of the inner ear.
This procedure takes around ten minutes and is always carried
out in either a doctor’s surgery or hospital by a qualified practioner.
Some practioners may advocate a gentler approach to the
Epley and may prescribe a course of home exercises that replicate the
Epley but usually take longer to be effective.
Very rarely surgery is advocated when other treatments
have failed and the patient is still highly symptomatic.
Isla’s experience with BPPV...
Isla
did not experience classic spinning vertigo but rather constant false
motion sensations and intense bursts of dizziness that lasted for less
than a minute at a time. Isla had the Dix Hallpike test, which indicated
BPPV, albeit no nystagmus was seen on the test.
As
a result she had several Epley Manoeuvres performed.
During
the Epley unsurprisingly Isla felt incredibly dizzy and saw lots of visual
shifting of the room but not spinning. After about half and hour after
the Epley she felt well enough to walk out and travel home.
During
the first two weeks after the Epley Isla felt several types of symptoms.
The most noticeable was that her eyes felt as though they were very hard
to focus on any object, as if they were jerking and moving around all
the time. Isla described her legs as feeling as if they were incorrectly
connected to her body and odd lengths. When Isla walked it was very much
like being at sea in a rough storm and very un-coordinated. This was interspersed
with intense bouts of nausea.
Isla
was told that these symptoms were due to the new set of signals being
sent from the ear that the debris had been moved from. These symptoms
were short lived (two weeks) after which Isla noticed a vast improvement
in her overall sense of balance and in the constant sensations of false
motion that she had been experiencing.
Whilst Isla’s
ultimate diagnosis was that the underlying problem is uncompensated vestibular
dysfunction and not BPPV it is accepted that she may have had a mild case
of BPPV, hence the symptoms she experienced post Epley.
It is important
to remember that not everybody who has BPPV feels exactly the same and
again not everybody post Epley feels unwell. Some find the Epley an instant
cure to their vertigo whilst others need to follow up with a course of
VRT exercises.