Vertigo & BPPV (Benign Paroxysmal Positional Vertigo)

BPPV happens when tiny calcium-carbonate crystals (otoconia) that normally sit in the utricle of the inner ear dislodge and fall into one of the semicircular canals, usually the posterior canal. When the head moves into a triggering position, the crystals shift, the canal signals 'spinning' to the brain, and a short intense vertigo episode follows. It is almost always one-ear-only, often after a period of bed rest, a head bump, a heavy Ramadan fasting day combined with driving, or simply age-related changes in the inner ear. The cohorts we see repeatedly: Port Dickson retirees whose mornings start with a roll-over spin, daily Seremban–KL commuters hit the moment they lie down at night after nine hours driving, Seremban Chinatown seniors with a gradual balance decline and now a near-fall, Bandar Sri Sendayan young families where a postnatal mother has her first positional spinning episode. A trained physio confirms the diagnosis with the Dix-Hallpike test (for posterior canal) or supine-roll test (for horizontal canal) and then performs an Epley or Semont manoeuvre to move the crystals back to the utricle. If the physio finds signs that do not match a peripheral pattern — sustained vertigo, limb signs, vision changes — the handoff is to HTJ or an ENT consultant at KPJ Seremban Specialist Hospital, not a second Epley attempt.

First session 45–60 minutes, RM 100–180 in a Seremban or Nilai private clinic. Expect: detailed history (duration of each spin, triggering positions, hearing changes, headache, any neurological symptoms), blood-pressure and heart-rate lying-to-standing (to screen for orthostatic drop as a separate cause of dizziness), head-impulse test, gaze and smooth-pursuit screen, HINTS assessment to rule out central causes, and the Dix-Hallpike or supine-roll test. If classic BPPV is confirmed, the physio performs the Epley (posterior canal) or Semont (alternative/lateral canal) manoeuvre in the same session — most people feel a brief worsening of spin during the manoeuvre, then relief within minutes. Post-manoeuvre advice: keep the head relatively upright for 24 hours, sleep propped up the first night, avoid the trigger position for 48 hours, and expect a lingering mild light-headedness for a few days. A single follow-up at one week confirms resolution; if residual balance issues remain, habituation exercises (Brandt-Daroff) and gaze-stabilisation drills run 4–6 weeks to rebuild confident head movement. Fall-risk framing — particularly for Port Dickson retirees — includes lighting review, night-bathroom path check, and balance-reactive training.

Classic posterior-canal BPPV is one of the fastest-resolving conditions in physiotherapy. A single correctly performed Epley manoeuvre clears symptoms for around 80% of cases; a second manoeuvre a week later handles most of the rest. Within 7–10 days, roughly 90% of uncomplicated BPPV is either resolved or markedly improved. Horizontal-canal BPPV takes slightly longer and often uses the barbecue-roll or Gufoni manoeuvre. Residual light-headedness without true spinning is common for 1–2 weeks — this is not failure of treatment, it's the central balance system re-calibrating, and it responds well to Brandt-Daroff home exercises done 2–3 times daily. Recurrence is the main limitation: about 15–30% of people have another episode within a year, especially Port Dickson retirees with generalised balance decline. For those, a 6-week habituation and balance-training programme reduces fall risk meaningfully. BPPV that does not resolve after two manoeuvres, or where spin is constant rather than positional, is not really BPPV and needs ENT review at KPJ Seremban Specialist Hospital or HTJ — Ménière's disease, vestibular neuritis, vestibular migraine, or central causes are the differential.

The priority sort is central-vs-peripheral, because central vertigo can be stroke. Go straight to HTJ A&E / 急诊 if the dizziness is sustained rather than position-triggered, or if it comes with any of: new severe headache (the worst of your life), face droop, arm or leg weakness, slurred speech, double vision, difficulty walking in a straight line, or sudden hearing loss with spinning. These are central patterns and need a same-hour CT or MRI — not a physio clinic. Go to a physio clinic or home visit when the pattern is classic BPPV: brief spinning (seconds to a minute) triggered by specific head positions, no hearing loss, no headache, no neurological signs. That is the Epley/Semont territory. Go to ENT review at KPJ Seremban Specialist Hospital, HTJ ENT clinic, or Columbia Asia Seremban when BPPV fails to resolve after two manoeuvres, when there is fluctuating hearing or tinnitus (Ménière's), when vertigo lasts hours to days at a time (vestibular neuritis or vestibular migraine), or when headache and light-sensitivity dominate. Physio and ENT often co-manage the recovery phase once the diagnosis is clear.