The purpose of our vestibular system is to help us maintain balance, spatial orientation, and stability during movement. It’s a sensory system located in the inner ear, specifically in the vestibular organs known as the utricle, saccule, and three semicircular canals. The key functions and purposes of the vestibular system include:

1. Balance Maintenance

The vestibular system plays a crucial role in detecting changes in head position and movement, which helps us stay upright and maintain balance. This includes activities such as walking, standing, and changing body positions.

2. Spatial Orientation

By providing information about the position of the head in relation to gravity and the environment, the vestibular system contributes to our sense of spatial orientation. This helps us understand our body’s position in space and adjust our movements accordingly.

3. Eye Movement Control

The vestibular system is closely connected to the ocular motor system, which controls eye movements. It helps coordinate eye movements with head movements to maintain stable vision during activities like walking or turning the head.

4. Postural Stability

The information processed by the vestibular system is integrated with input from other sensory systems, such as vision and proprioception (sensation of body position), to help regulate posture and prevent falls.

5. Motion Sensation

The vestibular system is sensitive to linear acceleration (movement in a straight line) and angular acceleration (rotational movement). This sensitivity allows us to perceive and respond to changes in motion, such as riding in a car or turning our head quickly.

BPPV is the most common cause of vertigo arising from a peripheral vestibular disorder. It accounts for 20-30% of all patients with a history of vertigo, and it is more commonly seen in the elderly. More specifically, it is a biomechanical problem in which one or more of the semicircular canals are inappropriately excited, resulting in vertigo, nystagmus and frequent nausea. The mechanism of the problem involves otoconia that have become displaced from the utricle and float to one or more of the 3 semicircular canals.

Potential causes of BPPV

• Head trauma
• Surgical trauma to the inner ear
• Vascular problems to the inner ear
• Vitamin D deficiency and calcium metabolism issues

Symptoms of BPPV

Typically, the symptoms of BPPV are triggered by looking up, lying down quickly, bending forward and rolling in bed. The symptoms of BPPV will come and go with periods of remission between episodes.

• Vertigo: a sudden sensation of spinning in the environment
• Nystagmus: involuntary eye movements
• Dizziness: feeling of unsteadiness
• Imbalance: feeling unstable, needing to hold on to objects when standing or walking during an episode of vertigo
• Nausea

The different types of BPPV

1. Cupulolithiasis

The dislodged otoconia (crystals) from the utricles adhere to the cupula of the affected semicircular canal. This causes the cupula to be gravity-sensitive with head changes.

2. Canalithiasis

The dislodged otoconia (crystals) from the utricles are free-floating in the endolymph (fluid) within the semicircular canals. When the head is moved, the otoconia moves in the endolymph causing an abnormal pressure within the inner ear.

Assessment of BPPV

1. Anterior and posterior semicircular canals

• Dix-hallpike
• Side-lying test

2. Horizontal canals

• Roll test

Treatment of BPPV

1. Anterior and posterior semicircular canals

• Epley maneuver (canalithiasis)
• Liberatory/Semont maneuver (cupulollithiasis)

2. Horizontal canals

• Barbecue roll (canalithiasis)
• Modified Semont maneuver (cupulollithiasis)