Posted: March 24th, 2023

Chiropractic and Benign Paroxysmal Positional Vertigo (BPPV)

Many older adults experience dizziness and balance difficulties at a very high rate. The general prevalence rate of the problem is between 5% and 10% and even more than 30% among the elderly (Ndetan, Hawk, Sekhon, & Chiusano, 2016). Dizziness and balance problems are a major risk factor for falls, which have become a public health problem, especially among the elderly. Within this population, falls account for two-thirds of all unintentional injuries, which are, in turn, the fifth main factor behind deaths. Benign Paroxysmal Positional Vertigo (BPPV) is one of the problems related to balance and movement challenges among the affected individuals.

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Benign Paroxysmal Positional Vertigo is one of the common movement disorders in the United States. The condition is defined as a hallucination or illusion of movement (Server, Edizer, Yigit, Yasak, & Erdim, 2018). It is commonly experienced in the emergency department as well as in clinical practice. Benign Paroxysmal Positional Vertigo is the leading cause of vertigo and its main characteristic is brief episodes of spinning sensation. Clinical researchers estimate that BPPV accounts for 17-30% of vertigo cases that patients present in vestibular clinics (van der Velde, 1999). Vertigo manifests vestibular disease, though in a subjective manner because patients report the feeling of movement or spinning. However, besides the subjective vertigo (the sensation of spinning), it can also be objective vertigo (the sensation of the spinning of the world around the person). Patients report feeling “dizziness,” which is a description of various symptoms, such as unsteadiness, dysequilibrium, light-headedness, giddiness, and vertigo.

Various factors are implicated in causing Benign Paroxysmal Positional Vertigo. As a result, it becomes hard to diagnose the underlying etiology that causes the condition. Many patients suffering from the condition remain undiagnosed due to the challenge in determining the fundamental causation. Besides, suitable diagnostic tests and tools are yet to be established, which is another challenge in the diagnosis of vertigo regardless of high incidences (Bracher, Almeida, Almeida, Duprat, & Bracher, 2000). However, in most cases, physicians conduct differential diagnoses to establish the possibility of Benign Paroxysmal Positional Vertigo, including “cervicogenie vertigo, inner ear disease, central or psychogenic vertigo, medical or chemical causes of vertigo, and vestibular nerve disorders” (Nerregaard, Lauridsen, & Harivigsen, 2009, p. 387). The high prevalence of the disease requires effective treatment.

Regardless of the various types of treatment for Benign Paroxysmal Positional Vertigo the condition remains a major challenge, especially for older adults. Clinicians use various approaches in the treatment of the disorder. Examples of treatment methods include canalith repositioning maneuvers (such as Epiey inaneuver) and Brandt-Daroff exercises. Medical professionals also recommend surgical procedures or medications for the treatment of Benign Paroxysmal Positional Vertigo. Epiey inaneuver is a commonly used treatment because of the canalolithiasis theory (Nerregaard, Lauridsen, & Harivigsen, 2009). There is disagreement in research regarding the efficacy of the maneuver treatments of the condition and the frequency of the treatment to achieve positive outcomes. Therefore, it would be beneficial to research on the use of potentially effective interventions to prevent the limiting effects of the disease, such as Chiropractic.

Methods

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The study is a review of previous literature on the topic of Benign Paroxysmal Positional Vertigo and its treatment. The database used to obtain the articles for the study included PubMed and Galileo. The sources from the databases were selected using the following criteria: recent scholarly articles from peer reviewed journals and their relevance to the topic of study. The keywords used in the search were: “vertigo and chiropractic,” “Benign Paroxysmal Positional Vertigo (BPPV),” “Chiropractic” and “Epley Maneuver.” The search was conducted using various combinations of keywords, such as vertigo AND chiropractic, and chiropractic AND Benign Paroxysmal Positional Vertigo. The first combination provided 21 results, while the second one had only 4 results. Sources were selected after reading the abstract to determine their relevance to the topic under study. The selected articles included relevant symptoms, diagnosis, and treatment of Benign Paroxysmal Positional Vertigo. They proposed the efficacy of the Epley Maneuver in chiropractic care and the effect of the treatment using real cases.

Results

The research study used 141 citations out of which 71 were relevant. A few of the studies, 2 related to the Epley Maneuver technique. The majority of the studies, 36 were related to chiropractic because of the general nature of the search. The search using the keyword would provide many possible articles. For vertigo and vestibular dysfunction, the study revealed 85 articles. However, the study has to narrow down to 5 sources that were relevant to both vertigo and chiropractic care.

Discussion

Research focused on the symptoms, examination, and treatment regimens of people suffering from different types of vertigo. Some of the reviewed studies used actual cases of patients with symptoms of vertigo (Côté, Mior, & Fitz-Ritson, 1991). Besides patients with the condition, Server, Edizer, Yigit, Yasak, and Erdim (2018) also engaged health volunteers to participate in the study as a control group. The study used doppler ultrasonography examination to determine the type of vertigo for the current diagnosis and eventual treatment. Similarly, Bracher, Almeida, Almeida, Duprat, and Bracher (2000) used fifteen subjects with cervical vertigo recruited from among individuals presenting the symptoms of vertigo, especially dizziness. The recruitment of the subjects was conducted at an otorhinolaringology medical office. Sato, Sekine, Matsuda, and Takeda (2013) conducted their study using a total of 157 patients diagnosed with benign paroxy small positional vertigo. It is the only study that used two types of vertigo because they also included 40 individuals with secondary P-BPPV.

Some of the reviewed articles, such as the study by Nerregaard, Lauridsen, and Harivigsen (2009) explored the usefulness of chiropractic treatment in vertigo. The studies applied cases involving the treatment. For instance, Nerregaard, Lauridsen, and Harivigsen (2009) used a case of severe vertigo to explore its response to the treatment. The case revealed immediate response to a simple repositioning maneuver conducted by a chiropractor. Bracher, Almeida, Almeida, Duprat, and Bracher (2000) also included a similar treatment regimen for the treatment of cervical vertigo, especially spinal manipulation and manual therapy. The study indicated a particular treatment approach under chiropractic treatment, such as manipulation of the affected muscles, labyrinth sedation, surface electromyography biofeedback, analgesic electrotherapy, and exercises. The study indicated the need for specialized use of the treatment procedure to achieve successful treatment of the target type of vertigo.

Other studies explored the actual impact of chiropractic in treating diseases presented through dizziness and balance. Although Ndetan, Hawk, Sekhon, and Chiusano (2016) did not explicitly indicate that it was focused on the treatment of vertigo, the presented symptoms reveal the condition. The study proved the effectiveness of chiropractic in the treatment of dizziness or balance diseases, such as vertigo. However, the study used the 2008 National Health Interview Survey instead of primary quantitative study, like most of the other authors. Another article that differed in terms of the research method was conducted by van der Velde (1999a). The research was a review of theories related to the etiology and pathophysiology of benign paroxysmal positional vertigo (BPPV). The review was conducted from 35 studies chosen based on their relevance to the topic. van der Velde (1999b) conducted a follow-up study that revealed the role of many pathophysiological theories for BPPV, cupulolithiasis, and canalithiasis in the development of treatment procedures for the treatment of Benign Paroxysmal Positional Vertigo. Epley’s canalith repositioning procedure is one of the proven treatments for the condition.

Research provided evidence of success in the treatment of vertigo secondary to Benign Paroxysmal Positional Vertigo as being within the role of chiropractors. However, most of the studies indicated that the impact of treatment depends on the correct diagnosis of the condition (Côté, Mior, & Fitz-Ritson, 1991; Nerregaard, Lauridsen, & Harivigsen, 2009). The role of effective testing and diagnosis of vertigo is based on the aspect that the condition presents itself in various types. Chiropractic treatments differ in their application to the different kinds of Vertigo, which further explains the need for proper diagnosis. Chiropractic treatment through spinal manipulation is shown to be effective in the treatment of cervicogenic vertigo (Nerregaard, Lauridsen, & Harivigsen, 2009). The studies reveal the efficacy of well-implemented spinal manipulation in the treatment of vertigo.

Studies indicate that the most suitable diagnosis of the type of vertigo should pay attention to the patient history to implement successful treatment. For Benign Paroxysmal Positional Vertigo, the focus should be on the symptoms, including nausea and tatigable rotatory nystagmus towards the lower part of the ear (Nerregaard, Lauridsen, & Harivigsen, 2009). Following the successful identification of the specific type of vertigo, the chiropractor can use the Dix-Hallpike maneuver. Sato, Sekine, Matsuda, and Takeda (2013) investigated the effectiveness of a single Epley maneuver in individuals with idiopathic benign paroxy small positional vertigo and secondary PBPPV. Similar to the findings from the study by Nerregaard, Lauridsen, and Harivigsen (2009), Sato et al. (2013) established that the impact of a treatment depends on the kind of vertigo and the presented symptoms. Their study revealed that in individuals with posterior semicircular canal (PSCC) benign paroxy small positional vertigo (P-BPPV), prolonged bedrest and head trauma reduce the efficacy of the Epley maneuver treatment.

Conclusion

The review of literature explores the efficacy of chiropractic in the treatment of Benign Paroxysmal Positional Vertigo. The studies revealed a positive outcome from effectively implemented treatment procedures on patients suffering from Benign Paroxysmal Positional Vertigo. According to most of the studies, the efficacy of treatment depends on the type of vertigo under treatment. Therefore, it is important for chiropractors to correctly diagnose the condition using the patient history and presented symptoms before implementing the treatment regimen. Mainly, the articles concluded that chiropractic is effective among patients experiencing dizziness through spinal and other types of manipulative interventions. Some of the studies used actual cases of patients receiving the treatment and the efficacy of the maneuvers to restore the functioning of the body following the disorder.

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