Vertigo or dizziness may be described as a feeling of spinning when you are standing still, or of standing still in a spinning room.

Types of Vertigo or Dizziness:

The main areas that can cause this problem are: central (the brain); or peripheral (the balance organs of the ear or associated nerves).  Central causes can include reduced blood supply or damage to some parts of the brain or central nervous system associated with balance

The most common peripheral cause is Benign paroxysmal positional vertigo (BPPV). Some of the other peripheral causes can include neck injury such as whiplash, nerve damage from the inner ears, or reduced local blood circulation..

Treatment of vertigo must be specific to the particular cause of the vertigo. For some causes of vertigo, such as BPPV in particular, treatment can be realistically directed to eliminating the vertigo itself (described below). For other causes of vertigo treatment may be directed at reducing some of the symptoms using medications, as well as improving the persons strategies for improving balance, and day to day function.

Occasionally the cause of vertigo or dizziness is a combination of 2 or more causes, and therefore treatment or management may involve a combination of different strategies.

Here we can test whether the condition is central or peripheral with reasonable accuracy, and are able to offer treatment procedures for BPPV (to eliminate or reduce the vertigo) if indicated. We can also offer balance training, if the vertigo can not be eliminated.

Benign paroxysmal positional vertigo (BPPV)

BPPV is a condition characterised by episodes of sudden and severe vertigo when moving the head. These episodes can occur getting up from sitting, rolling in bed or when getting out of bed, or just turning to look. The diagnosis (and treatment if the diagnosis is positive) involves a procedure which can be performed in a single treatment session (by a specially trained physiotherapist or doctor). Treatment may result in complete remission of vertigo.

BPPV is believed to be caused by debris or small dislodged particles (called otochondria) in the fluid of one or more of the Semilunar Canals of the balance organ in the inner ear.  When the otochondia are moving freely around in the canals and as such bumping the sensory balance organs after change in head position for a short period of time, this is called Canalithiasis.  When the otochondria attach themselves to the hair like balance organs in the canals and respond to changes in head position for sustained periods, this type of BPPV is called Cupulolithiasis.

 There are a variety of possible causes of BPPV:

Head of ear trauma, ear infection; degenerative changes to the inner ear; viral infections of the inner ear; Meniere’s disease (disorder of the inner ear); or possibly stroke can be involved.
BPPV causes are often not known.
Diagnosis is by medical history and physical examination using a variety of non invasive tests to determine the specific triggers of the vertigo, and in particular examining the particular trigger, type, direction of nystagmus (involuntary eye movements). Diagnoses should be able to determine which side is affected, and which canals.

Treatment options of BPPV used here are:

The Epley manoeuvre is used when the posterior (the most commonly involved) semilunar canal is involved, and the mechanism is Canalithiasis.  The proceedure involves the patient’s head (and body) being moved into different specific angles and held in each postural position for about a minute; For Cupulolithiasis of the posterior canal, the Liberatory Technique in which the patient is put quickly into sidelying, then quickly rolled from one side to the other.

When Horizontal Canal BPPV is found then a different manoevre may be used such as the BBQ Roll, or the Appiani Manoevre, or for cupulolithiasis the Casani Manoevre is indicated.

All of these proceedures are specific to the particular type (Canalithiasis or Cupulolithiasis), and side of BPPV (left or right), or which specific (most commonly the posterior, or less so the lateral semilunar canal) the patient presents with, and uses gravity, and / or sudden change of directional movement, to move (and / or un attach then move) the particles into an area where they no longer disturb the sensory areas of the particular canal of the balance organs.

Often, reduction of the vertigo and other symptoms of BPPV is immediate, when correctly diagnosed and treated.  Sometimes when the diagnosis is not as clearly obvious, a test treatment may be performed to see if symptoms resolve, there by confirming a specific diagnosis retrospectively.

As can be seen above there are many variables of BPPV pathology, and specificity of treatment is most important.  This explains why often the very simplistic self treatment strategies for BPPV found on the internet don’t work.