Have you ever felt dizzy or off balance, especially when you move your head in certain ways?
If so, you might have a condition called BPPV.
BPPV, which stands for benign paroxysmal positional vertigo, is a common type of vestibular disorder that affects the inner ear, also known as the vestibular system.
In our first blog on BPPV we highlighted some of its anatomy, how it’s diagnosed, and treated.
Here, we will spend some time discussing how to know if you have BPPV.
BPPV is actually very common.
BPPV is the most common vestibular disorder, accounting for approximately 20% of all cases.
BPPV is more common in women than in men.
BPPV is more prevalent in older adults, with peak ages between 50 and 70 years old, although it can occur at any age.
BPPV affects approximately 2-3% of the population at some point in their lives.
BPPV recurrence rates vary, with some studies reporting recurrence rates as low as 15% and others reporting rates as high as 50-60%.
What causes BPPV?
1. Age-related changes
No one likes hearing this one. But it’s honestly the truth.
Aging is a common cause of BPPV.
As we get older, the otoconia, or little calcium crystals, can become less firmly attached to the utricle, the part of the inner ear where they belong, and may break off more easily and move into the semicircular canals, the area they don't belong.
Just like the rest of our body deals with structure and functional changes when we age, the structure and function changes that occur in your inner ear and may also contribute to BPPV.
2. Head Trauma
Trauma to the head, such as a blow to the head or whiplash, can dislodge the crystals (or otoconia) from the utricle and cause them to migrate into the semicircular canals.
Head trauma can also cause damage to the inner ear, leading to inflammation or other changes that contribute to BPPV.
I remember treating my first patient who had BPPV due to head trauma.
My patient, Patty, had finished her physical therapy treatments with me after a total knee replacement she had a few months earlier. During the time, I had told her that I specialize in dizziness and concussions.
Well it was a good thing she remembered, because a few months later Patty slipped down the stairs (whoops!). Unfortunately, she hit her face, broke her nose, and a few teeth and was diagnosed with a concussion.
I took her through a vestibular assessment including an in depth assessment of her concussion symptoms.
She passed the concussion tests with flying colors, but when I assessed her for BPPV, it was positive!
Patty actually had bilateral canal BPPV, meaning both inner ears were involved.
This was likely due to the impact of smacking her face and head on the ground, which dislodged the crystals and pushed them into the posterior semicircular canals.
After 3 sessions her vertigo completely resolved and in a few additional sessions, to address her strength and mobility, she was completely back to normal.
3. Inner ear infections
Infections of the inner ear, such as labyrinthitis or vestibular neuritis, can cause inflammation and swelling that may dislodge the otoconia (crystals) from the utricle.
Inner ear infections can also cause damage to the inner ear that can lead to BPPV.
4. Meniere's disease
Meniere's disease is a disorder of the inner ear that causes episodes of vertigo, hearing loss, and ringing in the ears.
While the exact cause of Meniere's disease is not fully understood, it is thought to be related to changes in fluid pressure within the inner ear.
Meniere's disease can also cause the otoconia to become dislodged and migrate into the semicircular canals, leading to BPPV.
5. Prolonged bed rest or inactivity
Being bedridden or inactive for a prolonged period of time can cause the otoconia to shift out of place.
This especially happens after you've had an illness or a surgery in which you are stuck in bed for long periods of time.
This is because the inner ear relies on movement to help keep the otoconia in their proper position.
I know I saw this frequently at the height of the Covid-19 pandemic. In general, people who were use to being active couldn't be as mobile, whether that was because of illness, quarantine, or shelter in place.
When there is less movement, the otoconia may become dislodged and migrate into the semicircular canals and cause BPPV.
6. Genetic predisposition
Some studies have suggested that there may be a genetic component to the condition.
Researchers have identified several genetic variants that may be associated with an increased risk of BPPV.
I have patients tell me,
“Oh my mom use to get vertigo, but I never understood it until I went through it myself”.
7. Low Vitamin D
Vitamin D can be obtained through your exposure to sunlight, as well as through certain foods and supplements.
It is a nutrient that helps your body absorb calcium, which is important for maintaining strong bones and proper muscle function.
Low Vitamin D is also common among individuals with osteoporosis and osteopenia. However, vitamin D may also play a role in the inner ear and the balance system as well.
Research suggests that low levels of vitamin D may be associated with an increased risk of developing BPPV. In a study published in the journal Neurology, researchers found that individuals with BPPV had significantly lower levels of vitamin D compared to individuals without BPPV.
It is thought that vitamin D may play a role in the calcium metabolism of the inner ear, that is, how the calcium crystals are getting absorbed in the inner ear.
Vitamin D may also help to reduce inflammation and oxidative stress, which can contribute to the development of BPPV.
Before starting any medication or supplementation, it’s important to talk to your healthcare provider.
If you have diabetes, you are at an increased risk for BPPV. One study published found that individuals with type 2 diabetes had a higher prevalence of BPPV compared to individuals without diabetes.
Other studies have also suggested a link between diabetes and an increased risk of BPPV in older adults.
It's thought that diabetes may contribute to the development of BPPV by causing damage to the inner ear or the vestibular system (which controls balance and spatial orientation).
Diabetes can effect the blood vessels and your vascular system, commonly the smallest blood vessels first. There are lots of small blood vessels that help supply the inner ear/vestibular system with the nutrients it needs to maintain its full health and function.
Diabetes can also lead to nerve damage (neuropathy), which may affect the function of the inner ear as well.
It's important to note that having diabetes does not necessarily mean that you will develop BPPV.
However, if you have diabetes and are experiencing symptoms of dizziness or vertigo, it's important to talk to your healthcare provider and/or a vestibular therapist to determine the underlying cause and develop an appropriate treatment plan.
Migraines are a type of headache that are typically accompanied by other symptoms such as nausea, sensitivity to light and sound, and visual disturbances.
BPPV, on the other hand, is a disorder of the inner ear that causes episodes of vertigo (a spinning sensation) that are triggered by changes in head position.
Studies have suggested that individuals with a history of migraines may be at an increased risk of developing BPPV. It's been cited, that individuals with migraines were more likely to have BPPV compared to individuals without migraines.
It's thought that the link between migraines and BPPV may be related to changes in blood flow to the inner ear or to the brain.
Migraines can also cause changes in the vestibular system (which controls balance and spatial orientation), which may contribute to the development of BPPV.
One study published found that 14% of individuals with migraines also had BPPV.
Overall, BPPV can be scary.
Feeling like the whole world is spinning around can leave you feeling out of control and scared to move because you never know when the next episode is going to happen.
Ignoring symptoms and movement can actually make your vestibular system worse, since it thrives and functions on movement for it to maintain its health.
Connecting with a skilled vestibular specialist is recommended to review your causes and risk factors and develop an individualized treatment plan that is best suited for you.