Benign Paroxysmal Positional Vertigo (BPPV) Overview

What Is BPPV?

Benign paroxysmal positional vertigo (BPPV) is an inner-ear disorder that is the most common cause of vertigo, a very specific kind of dizziness that makes you feel as if the room is spinning around you.

Each part of the name describes a key part of this condition:

  • Benign means it’s not very serious. Your life is not in danger.
  • Paroxysmal means that it hits suddenly, lasts a short time, and comes and goes.
  • Positional means you trigger the vertigo with certain postures or movements of your head.

BPPV is common and usually can be treated in a doctor’s office.

In rare cases, the problem can be serious if it makes you more likely to fall. If you get these attacks often, they could point to other medical conditions. But they’re often hard to diagnose.

BPPV Symptoms

They can happen any time you tilt or change the position of your head. You could lose your balance and fall. You might feel scared that something is seriously wrong. The most common symptoms may include:

  • A feeling that the room is spinning
  • Nausea
  • Vomiting
  • Unsteadiness
  • Lightheadedness

When to call your doctor. If you have dizziness off and on for more than a week, you should make an appointment with your doctor.

You may be able to figure out before your visit which ear is affected. Here’s how to do that:

  1. Sit on your bed so that your head will hang over the edge when you lie down.
  2. Turn your head to the right and lie down quickly.
  3. Wait 1 minute. If you feel dizzy, the right side is affected.
  4. If you don’t feel dizzy, sit up, wait a little bit, and repeat the test with your left side.
  5. If you feel dizzy when you repeat the test, your left side is affected.

Call your doctor at once if you’re dizzy or:

  • A new or severe headache sets in.
  • You have a fever.
  • You’re seeing double or not at all.
  • It’s hard to talk.
  • You’re falling down or you can’t walk.

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BPPV Causes

Inside your ear are tiny crystals of calcium carbonate. You might think of them as “ear rocks.” They’re also called otoconia.

Sometimes the crystals come loose from their normal spot in your ear and move to other areas, including the canals in your ears that sense your head’s rotation. Once there, they can clump together.

Because the clump is heavy compared with other things in your ear, it will sink to the lowest part of your inner ear.

When you turn or change position, the clump will cause the fluid in your inner ear to slosh around after you’ve stopped moving. That creates the sense that you’re moving even though you are still.

There are any number of ways you could trigger BPPV by moving your head in a certain way:

  • Rolling over in bed
  • Getting in and out of bed
  • Bending over for a yoga pose
  • Tipping your head back in a salon to get your hair washed
  • Quick head movements

Usually, you can expect to have rhythmic eye movements when you get BPPV. Your doctor might call this “nystagmus,” and it’s what they’ll likely look for if they think you have vertigo.

BPPV Risk Factors

BPPV can happen spontaneously, without reason. You’re more likely to get it if you’re older. That’s because parts of the inner ear start to show wear and tear. Women are more likely to get it than men are.

In people younger than 50, head trauma is the most common cause of BPPV. It can be something as minor as a sneeze or bumping your head, or as serious as a concussion or a vehicle collision.

Other causes include:

  • Having your head in the same position for a long time -- at the dentist’s office or the hairdresser, for instance
  • High-intensity aerobics
  • Riding a bike over rough trails
  • An inner-ear disorder such as Meniere’s disease
  • Being in the hospital or on bed rest at home for a long time
  • A certain type of migraine

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BPPV Diagnosis

Your doctor will ask questions about your general health and your symptoms.

Physical exam. Your doctor will look for the telltale eye movement of nystagmus. They may ask you to lie on your back on a table with your head tilted back off it. This is to show whether you can control your eye movements.

Your doctor also will look to see if symptoms of dizziness happen when your eyes or head moves in a certain direction, and if doing so makes you dizzy for less than a minute. They may use something called Frenzel goggles to detect involuntary eye movements.

Medical tests. Your doctor might also run tests, including:

Electronystagmography ( ENG) or videonystagmography ( VNG). These check your eye movements and how they react to things that might trigger your vertigo.

MRI. This and other imaging tests may help rule out other causes of your symptoms.

BPPV Treatments

This condition is episodic and often goes away on its own. Your doctor may be able to stop your BPPV with a treatment in the office that moves the loose crystals in your ear into a spot that will cause less trouble.

To do this, they most may use these techniques:

  • Epley maneuver. A physical therapist or an audiologist also can do the maneuver, or you can even do it at home yourself.
  • Semont maneuver. This is less common in the U.S. than the Epley. Each one takes about 15 minutes.
  • Canalith repositioning. You hold four positions for about 30 seconds, or until the symptoms go away.

You will have to rest in the office for about 10 minutes before you can go home to make sure you don’t have any quick episodes of vertigo as the crystals resettle.

You will need someone to drive you. Wear comfortable clothes so you can move easily.

Surgery. This is done less and less often, but rarely, you might need an operation to cure your BPPV. Your surgeon will plug a part of your inner ear to prevent the small calcium crystals from moving in your ear canal. Surgery carries a small chance of complications, including loss of hearing.

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What Can I Do at Home?

Even after successful treatment for your BPPV, it can come back. But you can come up with a plan at home to help keep future bouts at bay. You should:

  • Be aware of your chances of falling.
  • Sit down at once if you feel dizzy.
  • Use good lighting if you get up at night.

If your BPPV comes back, you can take steps to deal with your symptoms until you see a doctor. For instance, you can:

  • Avoid sleeping on the affected side.
  • Sleep with two or more pillows under your head.
  • When you wake in the morning, lift your head slowly and sit on the side of the bed for a moment before you stand up.
  • Avoid bending over to pick things up.

Your doctor may teach you a maneuver you can try at home to move the loose ear crystals back into a better place.

WebMD Medical Reference Reviewed by Brunilda Nazario, MD on September 08, 2020

Sources

SOURCES:

Mayo Clinic: “Diseases and Conditions -- Benign paroxysmal positional vertigo.”

Vestibular Disorders Association: “BPPV,” “Canalith repositioning procedure.”

American Hearing Research Foundation: “Benign Paroxysmal Positional Vertigo.”

Johns Hopkins Medicine: “Diseases and Conditions -- Benign paroxysmal positional vertigo.”

Cleveland Clinic: “Diseases and Conditions -- Benign Paroxysmal Positional Vertigo.”

National Organization for Rare Disorders: “Benign Paroxysmal Positional Vertigo.”

Cedars Sinai: “Benign Paroxysmal Positional Vertigo.”

Johns Hopkins Medicine: “Benign Paroxysmal Positional Vertigo (BPPV),” “Home Epley Maneuver.”

ENT Health: “Benign Paroxysmal Positional Vertigo (BPPV).”

American Family Physician: “Dizziness: Approach to Evaluation and Management.”

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