Benign paroxysmal positional vertigo is a common cause of vertigo characterized by unsteadiness or loss of balance, nausea, dizziness, and vomiting. It occurs when small calcium crystals in the inner ear become dislodged and move into areas where they should not be. BPPV can hinder your everyday life, restricting your ability to perform even simple tasks. Suarez Physical Therapy, an experienced Las Vegas-based facility, can work with you to understand your treatment goal and develop the most effective treatment plans. Our physical therapy treatments are patient-centered and individualized, and you can receive optimal care during all your treatment sessions.

Defining Benign Paroxysmal Positional Vertigo (BPPV)

Benign paroxysmal positional vertigo is an inner ear condition. With the condition, head position changes, like sitting up in bed or tipping the head backwards, can result in sudden vertigo (feeling that the room is spinning).

BPPV does not indicate a severe challenge, but it subsides by itself within two to six weeks of its first episode. Nevertheless, its symptoms can be frightening and hazardous, particularly in senior citizens. Its unsteadiness can cause falls, which contribute to fractures.

BPPV is a common inner ear condition affecting individuals of different ages. Approximately 17% to 42% of patients presenting with vertigo are diagnosed with BPPV.

Signs and Symptoms

Signs and symptoms you are likely to experience include the following:

  • Feeling that you or your environment is moving or spinning (vertigo)

  • Unsteadiness or loss of balance

  • Nausea

  • Dizziness

  • Vomiting

These symptoms may come and go, typically lasting less than 60 seconds. BPPV episodes can subside for a while and then recur.

While activities that trigger these symptoms vary with patients, head position changes are the primary cause. Some patients also lose balance while walking or standing.

When to Seek Emergency Medical Attention

While it is an uncommon phenomenon for dizziness to indicate a severe ailment, you should seek immediate medical attention if you suffer vertigo or dizziness alongside any of the symptoms below:

  • A new, different, or severe headache

  • Fever

  • Loss of vision or double vision

  • Challenges speaking

  • Hearing loss

  • Arm or leg weakness

  • Challenges walking or falling

  • Tingling or numbness

  • Unconsciousness

What Causes BPPV?

Inside the ear is a little organ known as the vestibular labyrinth. It has three semicircular canals containing hairlike, fine sensors (cilia) and fluid that monitor the head’s rotation.

Otolith organs are other structures in the ear that monitor the head’s movements (left and right, down and up, to and fro), and the head’s position linked to gravity. These organs have crystals that make a person sensitive to gravity.

Benign paroxysmal positional vertigo develops if calcium carbonate crystals (particles) enter the semicircular canal and get trapped. The calcium carbonate particle can loosen due to age, injury, or infection. As the position of the head changes, the crystals roll about and press on cilia within the semicircular canals. Cilia transmit information regarding balance to the brain. Vertigo forms if the rolling crystals stimulate the cilia.

Diagnosing BPPV

The diagnosis consists of taking a comprehensive history of your health. Your physician verifies the diagnosis by observing nystagmus (jerking of your eyes that comes with the vertigo due to head position changes). It is achieved through a diagnostic test known as the Dix-Hallpike maneuver.

Your doctor will first ask you to sit and turn your head approximately 45 degrees to one side. Next, they will ask you to lie down on your back with your head on the edge of the examination table. The move will bring on the vertigo, and your physician will observe to verify whether your eyes have the nystagmus jerking pattern. Positive responses mean you have BPPV. Typically, diagnostic brain imaging is unnecessary.

Your physician’s BPPV diagnosis can be reassuring, particularly when you realize that medical assistance is available to alleviate your symptoms.

Can You Prevent BPPV?

There is no known way to prevent benign paroxysmal positional vertigo. After treatment, your signs and symptoms can recur if new crystals break off and enter your ear’s semicircular canal. BPPV can also recur if it stemmed from head trauma.

While the condition can recur, you can recognize the signs and symptoms and keep yourself safe until you get medical assistance. Your physical therapist can teach you exercises that can end or reduce the symptoms and improve your balance.

Treating BPPV

Physical therapists treat BPPV using simple exercises. The specialists recommend using a range of positional maneuvers tailored to move the crystals from your inner ear’s semicircular canal to a region that does not stimulate the wrong messages to be transmitted by your balance system.

Sometimes you might require another treatment. Your physician can perform the treatment in their office or recommend exercises to perform at home.

If your physical therapist recommends exercises and maneuvers, it is wise to persist with them; the treatment is a non-invasive and simple BPPV treatment option.

Although the condition can subside with time, it is essential to seek medical attention early to prevent suffering from injuries or falls, especially if you are elderly.

In severe cases, doctors perform surgical procedures to block your affected semicircular canals without interfering with the rest of your vestibular system functionality.

Canalith Repositioning Procedure (Epley Maneuver)

The Epley maneuver is a widely used Canalith Repositioning Procedure (CRP). It entails a sequence of head movements designed to move the canaliths from the semicircular canals, relieving you of the BPPV symptoms.

Here is what your physical therapist will do during the procedure:

  • Tilt the head to the side, causing BPPV

  • Ask you to lie on your back with your head off the edge of the examination table in the same position (BPPV symptoms can worsen in this position).

  • Gradually turn your head to the other side.

  • Turn the body so it aligns with the head. Your physical therapists may require you to lie on one side for some time.

  • Request you to sit upright.

During the CRP, you should keep your head down without lifting it. The process takes approximately ten minutes.

You Can Do the CRP on Your Own

To perform the CRP independently, sit on the bed and follow the above mentioned steps. For optimal results, perform the CRP twice daily.

You can request your physical therapist to show you the correct technique for the procedure before trying it on your own. Remember to inquire from your physician which ear is causing your BPPV symptoms.

You can perform the CRP any time, but most patients prefer doing it before bed. That way, they can sleep through the symptoms after the treatment.

Ensure you consult your physical therapist before incorporating a new type of therapy into your schedule.

What Occurs After the CRP?

Most patients report relief of signs and symptoms immediately after the procedure. Nevertheless, sometimes patients might be required to redo the CRP to reduce their symptoms. Others have mild signs and symptoms for a few weeks. After the symptoms disappear, you do not need to continue with the CRP.

Your physical therapist can recommend avoiding specific positions for a while after your BPPV symptoms disappear. For example, they might require you to sleep on two pillows to prevent your neck from extending upright.

While you can return to your daily routine after the CRP, ensure your BPPV symptoms have disappeared before engaging in any dangerous activity, like driving.

If you have undergone the treatment but still experience signs and symptoms, consult your physical therapist for additional guidelines. The physician might perform tests to rule out other diseases, like migraines and ear infections. Sometimes, they can prescribe motion sickness or nausea medication to relieve you of the symptoms.

Risks and Complications

After treatment, some patients experience vomiting, intense vertigo, and nausea.

Generally, the Epley maneuver is safe, but notify your physical therapist if you suffer from specific diseases, including neck injuries, back injuries, vascular disease, or retinal detachment.

Please note that the Epley maneuver can result in adverse consequences like worsening your BPPV symptoms or neck injuries, if you perform it incorrectly. To lower the likelihood of these side effects, request your physician to show you the correct technique before you attempt it on your own.

Brandt-Daroff Exercises

Brandt-Daroff exercises are a series of simple movements that help stop the dizzy spells that BPPV patients experience.

To perform the Brandt-Daroff exercises, follow the steps below:

  • Begin by sitting down on the edge of a bed or couch

  • Lie down on your side and turn your head to look up. Do these movements for about two seconds. Keep the head elevated up at a 45-degree angle for thirty seconds.

  • Next, sit for thirty seconds.

  • Repeat the above steps on the right side.

  • Repeat these five times for all sides.

  • Finally, sit. You can feel light-headed or dizzy; it is normal. Wait for the feeling to subside before standing up.

Brandt-Daroff Exercises Efficacy, Success Rate, and Benefits

According to a study published in The Egyptian Journal of Otolaryngology on the efficacy of these exercises, the exercises worked for 80% of the subjects. However, approximately 30% had their signs recur.

That means these exercises are an effective BPPV symptom management option.

Risks Related to the Exercises

The exercises can lead to lightheadedness or dizziness, especially if it is your first time doing them. In that case, it is wise to have another individual with you.

After undergoing the Semont or Epley maneuver, it is advisable to wait for two days before attempting Brandt-Daroff exercises to allow for symptom stabilization.

How Brandt-Daroff Exercises Differ from Other Exercises

It is safe to do these exercises at home. On the other hand, your physical therapist should guide you on performing Semont and Epley maneuvers correctly before attempting them at home.

Additionally, your physical therapist can recommend against the CRP at home since it can cause vomiting and compress the arteries.

Most patients find Brandt-Daroff exercises easier to do independently than other exercises. Brandt-Daroff exercises involve rapid body and head movements which may not be suitable for patients with back or spine injuries.

Semont Maneuver

The Semont maneuver is another procedure that involves repositioning the canalith to eliminate BPPV symptoms. It entails your physical therapist moving you from lying on one side to lying on the opposite side. A PT performs it after determining which vestibular system (left or right) BPPV is affecting. Here is what to expect during the process:

  • Your physical therapist will ask you to sit on the examination table’s edge with your legs hanging over the side

  • Next, they will turn the head approximately 45 degrees from the side where BPPV is affecting

  • Then they will ask you to lie on your affected side and look up. If you feel dizzy, you will remain in that position until it disappears.

  • After the dizziness subsides, your physical therapist will ask you to sit, move you to the other side, and look at the floor. If you suffer from vertigo, your PT will ask you to remain in that position until it disappears.

  • After the vertigo disappears, your PT will ask you to sit.

The procedure takes around 15 minutes.

If your PT performed the procedure correctly, the vertigo and dizziness should disappear in two days. If not, your physical therapist will repeat the Semont maneuver or attempt CRP.

After your treatment, you might experience brief vertigo episodes as canaliths reposition themselves. Therefore, you should wait for ten minutes before going home. You should have a person to drive you home after your treatment.

Other post-treatment recommendations include the following:

  • Sleep on your back with additional pillows to maintain a 45-degree angle

  • Avoid turning your head towards your affected side.

  • Avoid exercises that require head movements, like toe touches, freestyle swimming, and sit-ups.

  • Do not visit your hairdresser or dentist.

A week after the procedure, put yourself in a position that makes you experience vertigo and report the outcome to your physical therapist.

Cawthorne-Cooksey Exercises

Cawthorne-Cooksey exercises are vestibular training activities that physical therapists use to assist patients with balance disorders.

The exercises last up to eight weeks, several times daily, depending on your response to treatment and the seriousness of your symptoms. These exercises aim to build up tolerance mechanisms, and the more regularly and diligently you perform them, the sooner your symptoms will subside.

For optimal benefit, perform your exercises for about 10 minutes. Avoid overdoing the exercises, and take a break if your symptoms worsen. You should start with the first exercise, which you should perform thrice a day in three sets of five. Remember to grade the seriousness of your signs and symptoms as you do the exercise, using the scale below:

  • Symptom free — 0

  • Mild discomfort — 1

  • Discomfort — 2

  • Severe — 3

You should proceed to the next exercise once your symptoms disappear or after two weeks.

If your doctor had prescribed medication to relieve your symptoms, you should continue taking it while on the Cawthorne-Cooksey exercises program.

These exercises include the following:

Sitting Down

  • Make eye movements up and down, and then side to side

  • Next, make head movements, bending forward and backward, and then turn from one side to the opposite side

  • Circle the shoulders

  • Next, bend forward to pick up anything lying on the ground

  • Finally, bend from one side to the other and pick up anything lying on the ground

Standing Up

  • Make the same head and eye movements highlighted above.

  • Stand up with your eyes open and repeat with your eyes closed.

  • Throw a ball from one hand to the other under the knees and above your eye level.

Move Around

  • Make steps while throwing and catching a ball.

Gufoni Maneuver

Physical therapists use the Gufoni maneuver to treat horizontal (lateral) canal BPPV.

People with past or current spine or neck injuries do not qualify for the treatment.

Your physical therapist should stop the treatment and refer you for neurological evaluation if you experience neurological symptoms like blurred vision, confusion, and numbness.

The procedure involves your PT:

  • Asking you to sit on the edge of their examination table, facing them

  • Guiding you to lie on the unaffected side

  • While in that position, quickly turn your head to a 45-degree angle

  • Allowing you to remain in that position for three minutes before asking you to sit down.

Contact a Compassionate Physical Therapist Near Me

BPPV is a balance disorder with signs and symptoms like feeling dizzy or unsteady. Even while sitting, lying, or standing still, you, the patient, will feel like you are floating, moving, or spinning. Medical practitioners use physical therapy to restore mobility, reduce pain, and manage symptoms without long-term medication or surgery. Physical therapy aims to make everyday tasks easier, improving your quality of life. Suarez Physical Therapy can conduct a comprehensive medical history and physical exam to ensure we offer an individualized treatment plan. Your treatment plan can integrate balance and coordination exercises, condition-specific methods, physical therapy, and education while improving your functionality and symptoms. Please contact our Las Vegas office at 702-368-6778 and start the journey of getting back on your feet.