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Vertigo and Vestibular Rehabilitation

Benign Paroxysmal Positional Vertigo (BPPV) dizziness is generally thought to be due to debris which has collected within a part of the inner ear. This debris can be thought of as "ear rocks", although the formal name is "otoconia". Ear rocks are small crystals of calcium carbonate derived from a structure in the ear called the "utricle". The utricle may have been damaged by head injury, infection, or other disorder of the inner ear, or may have degenerated because of advanced age.

BPPV is a common cause of dizziness. About 20% of all dizziness is due to BPPV. About 50% of all dizziness in older people is due to BPPV.

The symptoms of BPPV include dizziness or vertigo, light-headedness, imbalance, and nausea. Activities which bring on symptoms will vary among persons, but symptoms are almost always precipitated by a change of position of the head with respect to gravity. Getting out of bed or rolling over in bed are common "problem" motions. Women with BPPV may find that the use of shampoo bowls in beauty parlors brings on symptoms. Something as simple as a Yoga posture or Pilates maneuver are sometimes the trigger.

The most common cause of BPPV in people under age 50 is head injury (which can include non-direct injuries such as whiplash). There is also a strong association with migraine headaches. In older people, the most common cause is degeneration of the vestibular system of the inner ear. Viruses affecting the ear such as those causing vestibular neuritis and Meniere's disease can also be significant causes. Occasionally BPPV follows surgery, including dental work, where the cause is felt to be a combination of a prolonged period of supine positioning, or ear trauma when the surgery is to the inner ear. In half of all cases, BPPV is called "idiopathic," which means it occurs for no known reason.

Diagnosis of BPPV is made with a combination of history, physical assessment and vertigo specific testing.

If BPPV is diagnosed, it can be treated with particle reposition maneuver and manual therapy to the neck. Treatment is approximately 80% successful within 1-2 sessions.