Is BPPV related to Tinnitus?

What is Benign paroxysmal positional vertigo (BPPV)?

Benign paroxysmal positional vertigo (BPPV) is defined by repeated episodes of acute, short, paroxysmal vertigo, provoked by changes in head position relative to gravity.

BPPV is the most common type of vertigo that a physical therapist treats is peripheral vertigo. This type of vertigo usually has symptoms “room spinning” dizziness, or feeling “unsteady”.

What is tinnitus?

Tinnitus is defined as the perception of sound in the absence of external auditory stimulation .

Tinnitus is characterized either by:

• Objective (can be heard by both patient and examiner) or

• Subjective (only heard by the patient)

Subjective tinnitus is most commonly seen in a physical therapy clinic for treatment by vestibular rehabilitation or manual therapy to the neck and jaw. A type of subjective tinnitus is peripheral tinnitus.

How does tinnitus relate to BPPV?

Peripheral tinnitus correlates with the anatomical region of the ear affected, and in the case of BPPV, it is the inner ear.

Even though not very common, some kinds of tinnitus in patients are affected by recurrent BPPV can disappear with canalith repositioning maneuvers. These are usually Semont and Epley Maneuvers, which can be professionally performed by a specialty trained vestibular physical therapist.

Just like loudness or intensity of tinnitus can be changed by sensory or motor stimuli such as muscle contractions, mechanical pressure on myofascial trigger points, cutaneous stimulation or joint movements; connections between the vestibular and cochlea centers, as well as hydrodynamics in the ear, could be a correlation between BPPV & tinnitus.

We recommend consulting with your ENT and/or audiologist to rule out outer or middle ear dysfunctions. This can help, alongside a vestibular examination, to rule in other causes of your tinnitus, including BPPV and/or somatosensory reasons.

How do I know if my tinnitus is related to BPPV?

Firstly, it is not very common to have tinnitus from BPPV. However, in cases that have not responded to your typical medical approach to treat tinnitus, or if you are better with some medical treatment but not completely better, this could be another reason for ongoing symptoms.

Generally speaking, the ear affected by tinnitus corresponds in most cases to the side of BPPV. Your therapist can determine this through diagnostic testing. The usual test is called the Dix-Hallpike test but other tests are also used to determine if another canal is involved.

Barozzi et al in 2013 found:

19.3% of the patients affected by BPPV reported the appearance of tinnitus in association with the onset of positional vertigo.

Therefore, if you are noticing a correlation with your position vertigo and tinnitus, we would consider this part of our clinical criteria and a reason for tinnitus sensitization.

Contact us for more information and determine if you are a right candidate for a tinnitus evaluation.