Benign Paroxysmal Positional Vertigo (BPPV)

What causes BPPV?

The inner ear contains tiny calcium crystals (otoconia) that help sense gravity and movement. Sometimes these crystals break loose and drift into one of the balance canals of the inner ear. When you move your head, the loose crystals shift and send false signals to the brain that you are spinning.

BPPV can follow a head injury, an inner ear infection, or long periods of bed rest, but in many people it happens without a clear cause. It becomes more common with age.

Common symptoms

• Brief spinning spells, usually lasting less than a minute.
• Vertigo when rolling over in bed, lying down, or getting up.
• Dizziness when looking up or bending over.
• Nausea or feeling off-balance after an episode.

How BPPV is diagnosed

Our physicians and audiologists diagnose BPPV with a careful history and positional testing. During the test, we move your head into specific positions while watching your eyes for a telltale movement called nystagmus. Videonystagmography (VNG) goggles can help us see these eye movements clearly and identify which ear and canal are involved.

Treatment

Most BPPV is treated with a canalith repositioning maneuver, such as the Epley maneuver. This is a series of slow head and body movements that guides the loose crystals out of the balance canal and back to where they belong. It is done in the office, takes only a few minutes, and many patients feel better after one or two treatments.

Medications usually do not fix BPPV, though they may ease nausea for a short time. For the rare patient whose vertigo does not respond to repositioning, further testing and other treatment options are available.

When to seek care

See a specialist if you have repeated spells of positional vertigo. Seek emergency care right away if dizziness comes with a severe headache, trouble speaking, weakness, numbness, double vision, or difficulty walking, as these can be signs of a more serious problem.