BPPV and Vertigo Treatment

In the ear, there is the vestibular organ responsible for our sense of balance. Inside it, there are otoliths, which are small biomineral crystals. These otoliths detect changes in head movement and transmit signals.

If these otoliths become dislodged from their proper position, they can float around within the vestibular organ, causing disturbances in the sense of balance and inducing dizziness. Based on its symptoms, this condition is referred to as Benign Paroxysmal Positional Vertigo (BPPV).

Other conditions that need to be differentiated from BPPV include Meniere's disease, vestibular neuritis, migraine-associated vertigo, cervical vertigo, and orthostatic hypotension. In the case of Meniere's disease, symptoms such as hearing loss and tinnitus may accompany dizziness.

Diagnosis and Treatment of BPPV

Typically, a diagnosis of BPPV involves a positive reaction to the Dix-Hallpike test, and the possibility of other conditions is excluded through differential diagnosis. Furthermore, the therapeutic response to canalith repositioning maneuvers can serve as a post-hoc diagnostic criterion for BPPV. In cases of recurrent dizziness, we frequently see patients seeking dizziness treatment at Korean medicine clinics.

Causes of BPPV

There are two main theories regarding the cause of BPPV. It can be seen as either dislodged otoliths adhering to the cupula itself, causing sensory disturbance, or free-floating otoliths transmitting inaccurate sensory signals. For a sensor to work properly, it needs to be well-calibrated. Due to displaced otoliths, this "sensor" malfunctions, leading to dizziness.

Canalith Repositioning Maneuvers

To correct the position of the otoliths, canalith repositioning maneuvers are performed. The Dix-Hallpike test, which is performed before the repositioning maneuver, is utilized to diagnose BPPV. While seated, the patient's head is turned 45 degrees to one side, then they are suddenly laid back into a supine position with the neck hyperextended. If nystagmus, a rhythmic eye movement, occurs at this point, it can be considered a positive reaction.

Please check the videos below for the examination methods.

• Dix-Hallpike Test Method 1
• Dix-Hallpike Test Method 2
• Canalith Repositioning Maneuver 1
• Canalith Repositioning Maneuver 2

The repositioning maneuver demonstrates the movement of the otoliths. This method involves returning the otoliths to their proper position through changes in head and body posture. While symptoms may resolve through canalith repositioning maneuvers, in cases where symptoms are not well-controlled, consistently recur, or are accompanied by other symptoms such as tinnitus or hearing loss, Korean medicine treatment may be considered.

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