Vestibular Dysfunction & BPPV post-MVA

Understanding Vestibular Dysfunction & BPPV post-MVA

Also known as: Post-Traumatic BPPV, Benign Paroxysmal Positional Vertigo, Post-Accident Vertigo, Inner Ear Dizziness After Car Crash BPPV is one of the most rewarding conditions to treat because it often resolves in one to three visits when handled correctly — and it is extraordinarily common after motor vehicle accidents. The condition is caused by tiny calcium carbonate crystals (otoconia) that normally sit in the utricle of the inner ear becoming dislodged into one of the semicircular canals. The rapid head acceleration of an MVA shakes them loose. Once misplaced, they create abnormal fluid movement when you change head position, producing brief but intense spinning.

Brief, intense spinning — usually less than 60 seconds — triggered by rolling over in bed, lying down, getting up, tipping your head back, or bending forward is the hallmark. Between episodes you may feel fine or mildly unsteady. Because the episodes are so brief, patients often learn to avoid the triggering positions rather than timing them accurately — which inadvertently prolongs the problem, because the brain needs the input to recalibrate. Post-traumatic BPPV is more often bilateral or multi-canal than the idiopathic form, which requires careful diagnosis.

We diagnose with the Dix-Hallpike maneuver and the supine roll test, carefully identifying which canal in which ear is affected before treating. Treatment uses canalith repositioning maneuvers — Epley for posterior canal, BBQ/Lempert roll for horizontal canal — followed by habituation exercises, gaze stabilization, and balance retraining. We document findings carefully and coordinate with ENT or a vestibular specialist if symptoms don't respond as expected. We may recommend: vestibular rehabilitation, cervicovestibular therapy, VOMS-guided protocol, Activator, corrective exercise, postural rehab, myofascial release Seek immediate care if: You experience sudden hearing loss, constant spinning lasting hours, double vision, severe headache, slurred speech, or weakness on one side — these suggest central (brain) causes of vertigo requiring emergency evaluation.