BPPV

What is BPPV?

Benign paroxysmal positional vertigo (BPPV) is the most common of the vestibular disorders and is easily treated. This condition can affect people of all ages, but is most common in people over the age of 60. BPPV symptoms include episodes of vertigo when your head is moved in a certain way (typically tilted up or back, or when you are turning over in bed or maneuvering out of bed). Nausea is also common.

  • Benign – it is not life-threatening
  • Paroxysmal – it comes in sudden, brief spells
  • Positional – it gets triggered by certain head positions or movements
  • Vertigo – a false sense of rotational movement

BPPV is a mechanical problem in the inner ear. It occurs when some of the calcium deposits (crystals or “ear rocks”) that are normally embedded in a part of our balance system known as the utricle, become dislodged and migrate into one or more of the 3 fluid-filled semicircular canals of our balance system, where they are not supposed to be. Fluid in these canals does not normally react to gravity. However, the crystals do move with gravity, thereby moving the fluid when it normally would be still. When you move your head, these crystals roll around the semicircular canal. This irritates the nerve endings in the canal, which then transmit misleading information that doesn’t match up with the other sensory information. This mismatched information is perceived by the brain as a spinning sensation, or vertigo.

If someone has BPPV they suddenly feel very dizzy when they stand up or move their head. Even turning over in bed can make them feel dizzy. This does not usually last longer than a minute.  Between vertigo spells some people feel symptom-free, while others feel a mild sense of imbalance or disequilibrium.

How is BPPV Diagnosed?

BPPV is usually easy to diagnose based on the symptoms and your recent medical history, and is easily differentiated from other types of vertigo.

The Dix-Hallpike test (performed during the VNG test at our office) can be used to confirm that it is BPPV: The test involves moving your head and torso quickly in a specific order. This kind of “provocation” maneuver can trigger an episode of dizziness. The doctor watches closely to see whether you have involuntary eye movements (nystagmus), which occur during an episode of vertigo.  The eye movement is the clue that something must be happening mechanically to move the fluid in the inner ear canals when it shouldn’t be.  You may have to wear special goggles during the test. This makes it easier for us to see any eye movements during the test. The nystagmus eye movements will have different characteristics that allow a trained practitioner to identify which ear the displaced crystals are in, and which canal(s) they have moved into.

It is important to know that BPPV will NOT give you constant dizziness that is unaffected by movement or a change in position. It will NOT affect your hearing or produce fainting, headache or neurological symptoms such as numbness, “pins and needles,” trouble speaking or trouble coordinating your movements. If you have any of these additional symptoms, tell your healthcare provider immediately.

How is BPPV Treated?

BPPV can resolve on its own in a few weeks or months if not treated but the discomfort and risk of falls is unnecessary as treatment is typically simple.

“Repositioning” procedures or maneuvers are commonly used to treat BPPV. They involve moving the patient into specific lying or sitting positions following a certain sequence, with specific positions of the head. The sequence of movements is designed to help move the tiny crystals out of the semicircular canal and into areas of the vestibular system where they can no longer disturb the sensory hair cells.

The Epley maneuver and the Semont maneuver are two very simple and effective repositioning procedures for the treatment of BPPV caused by crystals in the posterior semicircular canal. These maneuvers are typically done several times with the help of a healthcare provider. There are also slightly modified repositioning procedures that can be done at home in addition to these maneuvers.

In some persons, the positional vertigo can be eliminated, but imbalance persists. In these persons it may be reasonable to undertake a course of generic vestibular rehabilitation.

Will BPPV Come Back?

Unfortunately, BPPV is a condition that can re-occur periodically with long-term recurrence rates as high as 50% within 5 years, especially in those whose BPPV is related to trauma. If BPPV recurs, we repeat treatment.  Home exercises may also be recommended.

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