Benign Paroxysmal Positional Vertigo

What is Benign Paroxysmal Positional Vertigo (BPPV)?

Vertigo is the sensation of motion or spinning that is often described as dizziness. One of the most common forms of vertigo is Benign Paroxysmal Positional Vertigo (BPPV); about 20% of people who are evaluated for dizziness will be diagnosed with BPPV.

BPPV is a condition of the inner ear and it causes brief episodes of dizziness, which can be mild to intense and are usually triggered by specific changes in the head’s position.

While BPPV can affect anyone, it is most common in older adults.

What are the Symptoms of BPPV?

Symptoms include:

  • Vertigo (sense that you or your surroundings are spinning/moving)
  • Dizziness
  • Lightheadedness
  • Nausea
  • Unsteadiness or loss of balance
  • Vomiting
  • Nystagmus (rapid, involuntary eye movements)

Symptoms often come and go, and commonly last under a minute. Episodes can disappear for a period of time and then recur. While the activities that trigger BPPV can vary for everyone, symptoms are normally brought on by a change in head position.

In rare cases, symptoms can last for years. However, in most cases, without treatment, there will be a lessening of symptoms over a few days to weeks, with the condition sometimes spontaneously resolving itself.

What Causes BPPV?

In BPPV, tiny calcium crystals (otoconia) dislodge from their normal location in the inner ear. When the crystals become detached, they can flow in the fluid-filled spaces of the inner ear, including the semicircular canals, which sense the rotation of the head. The otoconia will cause problems when a person changes his or her head position (e.g., when looking up or down or when going from lying to seated). When the otoconia then move to the lowest part of the canal, the balance (eight cranial) nerve will be stimulated, leading to vertigo and nystagmus.

In many cases there is no known underlying cause for BPPV, which is called idiopathic BPPV.

In other causes, BPPV can be associated with:

  • A minor to severe blow to the head
  • Disorders of the inner ear
  • Damage that occurs during ear surgery
  • Long periods of keeping the head in the same position (for example, during strict bed rest or when in a dentist chair)
  • Certain strenuous activities (such as biking over rough terrain or participating in high intensity aerobics)
  • Migraines

How is BPPV Diagnosed?

Generally, a doctor will do a series of tests to look for the cause of vertigo, usually by having the patient do a series of eye and head movements. Additional testing, such as electronystagmography (ENG), videonystagmography (VNG), and MRIs may be used to look for causes of vertigo.

What is the Treatment for BPPV?

One treatment is canalith repositioning. The goal of the procedure is to move particles from the fluid-filled semicircular canals of the inner ear into the vestibule that houses one of the otolith organs, where the particles don’t cause trouble and are reabsorbed. This procedure normally works after one to two treatments.

If canalith repositioning doesn’t work, a surgery procedure may be used. During surgery, a bone plug is used to block a portion of the inner ear that is causing the vertigo. This bone plug prevents the semicircular canal from being able to respond to particle movements, or head movements generally. The success rate for this type of surgery is about 90%.

Other techniques that can be utilized to cope with the dizziness associated with BPPV include:

  • Taking caution and being aware of the risk of losing balance
  • Avoiding movements (e.g., looking up) that trigger symptoms
  • Walking with a cane when at risk of falling

BPPV can recur even with successful treatment, which is the case for about half the people who experience it. While it isn’t typically considered a serious condition, it can increase the chance of serious falls.

These posts are for informative purposes only and should not be used as a substitute for consultation with and diagnosis by a medical professional. If you are experiencing any of the symptoms described above and have yet to consult with a doctor, do not use this resource to self-diagnose. Please contact your doctor immediately and schedule an appointment to be evaluated for your symptoms.


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