Benign Paroxysmal Positional Vertigo (BPPV)

By Wendy Innes. May 7th 2016

Everyone from time to time experiences some form of dizziness, especially if they stand up too quickly. This is commonly related to a condition called vertigo. While there are different types of vertigo, benign paroxysmal positional vertigo (BPPV) is one of the most common forms. While it isn’t life threatening, at its most severe it can cause problems in day-to-day life. Here’s everything anyone would need to know about BPPV.


Benign paroxysmal positional vertigo (BPPV), also known as benign positional vertigo, is a feeling of spinning inside a person’s head. The problem is rarely serious although it can increase the risk of falling when standing. It accounts for up to 90 percent of vertigo cases.

BPPV is actually a problem of the inner ear. The symptoms of the vertigo are caused by debris in the inner part of the ear. The debris is called otoconia, and it is made of small crystals of calcium carbonate, known colloquially as “ear rocks”. The vertigo occurs when the position of the head changes, causing the ear rocks to shift and send false signals to the brain about the body’s position in the surrounding space, resulting in feelings of dizziness.


Inside the ear is something called the vestibular labyrinth. It is made up of three semicircular shaped canals that contain fluid and sensors that provide input to the brain about the body’s position in space. Other structures in the ear, called the otolith organs, assist in this function.  They contain the crystals of calcium carbonate that make people sensitive to movement. When these crystals become dislodged, they can cause feelings associated with vertigo.

  • The cause of the calcium carbonate crystals becoming dislodged is often a mystery. In some cases, a blow to the head, even a minor one, can cause the crystals to break loose causing the vertigo.
  • There are no known risk factors associated with BPPV, although it is thought to run in families. A prior head injury or an inner ear infection called labyrinthitis is also thought to play a role.
  • Though it is rare, crystals can become dislodged during ear surgery or in those who have spent a prolonged period of time on their back.


The most common symptom associated with BPPV is dizziness. A person may feel as if the inside of his or her head is spinning or as if the surrounding area is spinning. This usually occurs after a change in head position such as changing sleeping positions or looking up quickly. The symptoms typically don’t last more than a minute or two and they usually come and go.

Other symptoms include:

  • Nausea
  • Vomiting
  • Loss of hearing
  • Loss of balance

Abnormal rhythmic eye movement, called nystagmus, usually occurs in conjunction with BPPV.

Though it is rare, bilateral BPPV is possible. This means that the vertigo occurs in both ears.


There are a number of tests used to diagnose BPPV including:

  • CT Scan
  • MRI
  • EEG
  • Electronystamography
  • Hearing test
  • Magnetic Resonance Angiography


There are a number of treatment options available to treat benign paroxysmal positional vertigo.

  • The most common treatment used to treat BPPV is particle-repositioning maneuvers. This includes the Epley Maneuver and the Semont-Liberatory maneuver. These treatments use specific abrupt movements to move the calcium crystals out of the semicircle channels so that the vertigo stops. These procedures can be done in a doctor’s office in about 15 minutes. Typically only one treatment is required, though some people do require multiple treatments.
  • In addition to the repositioning maneuvers, a doctor may prescribe vestibular rehabilitation therapy. This treatment is specific to each patient in which a therapist will design a therapy plan that will re-train the way that the brain responds to the vestibular input it receives.
  • Another treatment option is something called Brandt-Daroff maneuver. This is similar to the other particle repositioning maneuvers but it is used in the case of atypical BPPV, meaning that the vertigo doesn’t exactly fit the normal pattern of BPPV, or if the other maneuvers are unsuccessful. This is a series of exercises that is repeated several times with the goal of moving the calcium crystals out of the semicircular channels. If this treatment is unsuccessful, surgery may be needed.
  • Though surgical intervention is rarely used, it is more than 90 percent effective at treating the vertigo. The surgery blocks the affected canal to prevent the crystals from causing problems. The surgery can result in some hearing loss that is usually temporary as well as some residual balance problems, though this is usually temporary as well, as the brain re-learns how to function without the channel that has been blocked.
  • Occasionally medications are used to relieve symptoms but they are often not very effective.
  • The best way to prevent vertigo is to avoid the positions that cause it.

While BPPV can be problematic, it is very simple to treat and rarely has any long term implications. With simple treatment people can return to their normal lives in no time.


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