BPPV (Benign Proximal Positional Vertigo)

Introduction
BPPV (Benign Proximal Positional Vertigo) is the most common disorder associated with the vestibular system which plays a pivotal role in balance (Timothy & Hain, 2009). Parnes & Nabi (2009) defined BPPV as: “A peripheral vestibular disorder that manifests as sudden short-lived episodes of vertigo precipitated by certain head movements” (p. 287). This definition can be supplemented by Timothy & Hain, 2009) who described BPPV as sudden vertigo that is positional and paroxysmal. According to Parnes, Agrawal & Atlas (2003), benign means that the pathology is not cancerous or due to a serious cause. The word proximal refers to a recurring sudden episode of symptoms. Positional refers to the triggering of symptoms being dependent on a certain position or movement and vertigo is the sensation of the surroundings spinning around relative to the person and vice versa. The two major pathophysiological BPPV mechanisms that will be discussed include canalithiasis and cupulithiasis (Parnes & Nabi, 2009). These are distinguished by the pathophysiology involved.

Anatomy and physiology
Parnes & Nabi (2009) mentioned in their article that the vestibular system allows for vertebrates to detect spatial position as well as motion. Timothy & Hain (2009) further elaborated that rotational movement is detected by the semi-circular canals. The vestibular system can be subdivided into the otolith organs and the semi-circular canals (SCC) (Parnes & Nabi, 2009). The otolith organs can be further divided into the utricle and saccule (Timothy & Hain, 2009). All of these canals have a pivotal role in the maintenance of balance (Fife, 2009). The SCC which contains endolymph is situated at right angles to each other and detects rotational hea...

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...pation diving can cause disorientation under water due to acute vertigo. Due to the occupational consequences of BPPV, a person may be forced to take large periods of sick leave or eventually leave work. Due to fear of an episode and associated symptoms, socialising and engaging in recreational activities may be restricted. Some people may tend to avoid driving due to fear of a vertigo episode which could cause them to lose concentration and becoming disorientated and lose control. Also, people who do drive may not turn their head to check for blind-spots due to a possible positional trigger of vertigo. This puts one at risk of causing an accident. In severe cases, the adverse effects and abovementioned consequences can lead to depression. It is important to note any psychological consequences of a BPPV and make the necessary referral to a psychologist (Tusa, 2010).