Dizziness and vertigo are balance disorders that health professionals encounter regularly. Two conditions often confused due to overlapping symptoms are Benign Paroxysmal Positional Vertigo (BPPV) and Cervical Vertigo.
This blog will explain the differences between these common causes of vertigo and offer balance professionals valuable insights to enhance their diagnostic and therapeutic approaches.
BPPV is a prevalent vestibular disorder characterized by brief episodes of intense vertigo triggered by specific head movements.
In 1969, Schuknecht proposed a mechanism for BPPV, suggesting that particles, likely otolith organ otoconia or tiny crystals, stick to the cupula of the posterior semicircular canal, making it gravity -sensitive. Although this type of BPPV, known as cupulolithiasis, exists, it is rare.
The more widely accepted explanation for BPPV involves canaliths, free-floating particles within the semicircular canal. This type is called canalithiasis.
While BPPV is commonly associated with otoconia, the predominant type involves canaliths—particles that freely float within the semicircular canals.
Symptoms of BPPV include sudden onset vertigo, nausea, and nystagmus (involuntary eye movements). Patients often report these symptoms when changing positions, such as rolling over in bed or tilting their head back.
Physical therapy and audiologists play a crucial role in diagnosing and treating BPPV. The Dix-Hallpike and Epley maneuvers are common methods to diagnose and treat BPPV.
During the Dix-Hallpike maneuver, the therapist quickly moves the patient from a sitting to a supine position with their head turned to one side, triggering vertigo if BPPV is present.
Once diagnosed, the Epley maneuver involves a series of head and body movements designed to reposition the displaced crystals within the inner ear, relieving symptoms. Balance professionals can guide patients through these maneuvers and educate them on home exercises to manage recurrent BPPV episodes.
While traditional BPPV diagnosis maneuvers are frequently used, recent innovations, including the TRV chair and Video Frenzel goggles (infrared video goggles), present distinct advantages over manual techniques.
The TRV Chair is designed to effectively diagnose and treat BPPV with distinct advantages. The TRV Chair:
The TRV Chair facilitates the diagnosis and treatment of all types of BPPV.
Video Frenzel goggles can be used alone or alongside the TRV Chair to improve diagnosis and treatment.
Cervical Vertigo is a condition where dizziness is associated with neck movements or positions. Unlike BPPV, cervical vertigo is not rooted in the inner ear but originates from dysfunction in the cervical spine (neck). Common causes include cervical spondylosis, whiplash injuries, or cervical disc disorders.
Patients with cervical vertigo may experience dizziness, unsteadiness, and disorientation, often triggered by activities such as turning the head or maintaining a specific neck position for an extended period. It is crucial to distinguish cervical vertigo from other vestibular disorders, as treatment approaches differ significantly.
The diagnostic process for cervical vertigo involves a thorough examination of the patient’s medical history, a comprehensive physical examination, and sometimes imaging studies such as X-rays or MRI to assess the cervical spine. Physical therapists can play a vital role in identifying cervical vertigo by evaluating the neck’s range of motion, muscle strength, and any signs of joint dysfunction.
Cervical vertigo arises from dysfunction in the cervical spine (neck).
Treatment strategies for cervical vertigo focus on addressing the underlying cervical spine issues. Physical therapists may incorporate manual therapy, exercises to improve neck mobility and strength, and postural training to alleviate symptoms. Patient education on proper ergonomics and neck care is also crucial for managing and preventing recurrent episodes of cervical vertigo.
While BPPV and cervical vertigo share symptoms like dizziness and unsteadiness, distinct features help differentiate between the two conditions.
Understanding these disorders’ subtle yet critical differences is essential for accurate diagnosis and effective vestibular rehabilitation.
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