Benign paroxysmal positional vertigo (BPPV) is the most common cause of dizziness and vertigo. (1-4) The condition is characterized by brief episodes of dizziness, nausea, and/or nystagmus triggered by head movement. (5) Over seven percent of the population will experience BPPV at some point in their lifetime and 80% of those patients will require entail medical consultation and/or sick leave. (95,96) The condition is predictably resolved via canalith repositioning maneuvers; however, recurrence is possible. (7)
BPPV can affect any age group but commonly presents during the fourth and fifth decade with increasing incidence over time. The condition is quite prevalent in elderly populations; however, seniors often fail to report dizziness and vertigo. (3,4,7-13) BPPV is slightly more common in females. (7,10,12,16,17) The condition affects the right labyrinth more frequently. (7) There is a significant correlation between the habitual sleep side and the affected ear. (18-23) Additional risk factors for the development and recurrence of BPPV include a sedentary lifestyle, diabetes mellitus, hyperinsulinemia, and hyperglycemia, hypertension, hyperlipidemia, osteoporosis, and nutritional deficiencies, particularly vitamin D deficiency. (24,25,99)
A brief review of inner ear anatomy is essential to understanding BPPV. The bony labyrinth houses three semicircular canals, each filled with a viscous fluid called endolymph. With head movement, the endolymph bends small cilia that line the interior of the semicircular canals. This stimulation is transmitted to the brain, which correlates the data along with input from the eyes and cervical proprioceptors to determine balance.
Each semicircular canal is oriented in a divergent plane to help detect particular head movements. The superior (aka anterior) semicircular canal is positioned to sense nodding head motion; i.e., nodding “yes.” The horizontal (aka lateral) semicircular canal perceives right and left head rotation; i.e., shaking “no.” The posterior semicircular canal detects movement in a coronal plane, i.e., touching your head toward your shoulder or performing a cartwheel.
The ampulla is a dilated sac at the end of each semicircular canal that contains sensory organs called crista ampullaris that sense angular acceleration and deceleration. The ampulla connects to a large common reservoir called the utricle. BPPV develops when calcium carbonate particles (statoconia) from the utricle dislodge and migrate into one of the three semicircular canals. (2,5) This unwelcome debris may either adhere to a canal cupula (cupulolithiasis) or, more commonly, float freely within a semicircular duct (canalithiasis). (5,26-29)
The majority of BPPV cases have an idiopathic origin. (24,30) The remainder can be attributed to one or more diseases from a lengthy list of possibilities, including cranial trauma, prior otological surgery, infection/otitis media, vestibular neuritis, middle ear disease, Meniere’s, ovarian hormonal dysfunction, ototoxicity, endolymphatic hydrops, syphilis, psychological disorders, vestibular system degeneration, metabolic disorders, cardiovascular disease, and vertebrobasilar insufficiency. (15,31-34) Notably, elderly patients with BPPV demonstrate higher incidences of concurrent vertebral artery stenosis (21.2%) and tortuosity (24%). These vascular abnormalities may contribute to the patient’s BPPV symptoms. (35)
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What we do in our office to help this condition:
1. Perform a detailed exam, assessing the alignment of the spine. Due to the fact that the nerves exiting the spine in the cervical region (neck) branch off and go to the head, face, neck, shoulders, and arms, improper alignment in any of these areas may be detrimentally affecting the structures in the head. This can compromise proper function and lead to potential symptoms.
2. As indicated, adjust areas of spinal subluxations (misalignments), restoring proper nerve system function which facilitates healing.
3. Perform laser therapy which penetrates to the cellular level of the soft tissues surrounding the head and neck. This promotes better oxygen and nutrients to these tissues, which can relieve pain and facilitate the healing process.
4. Prescribe stretches and exercises in conjunction with chiropractic care to help reset any of the potential causes of the BPPV.