Positional Vertigo (BPPV)
Benign paroxysmal positional vertigo (BPPV) is the most common cause of inner ear dizziness. It is due
to damage to one of the balance canals (semicircular canals) of the
BPPV is a benign disorder because it is not life-threatening;
a paroxysmal disorder
since the symptoms occur sporadically; a positional disorder since
it is produced by movement of the head or body; and it is a balance disorder
since it causes vertigo, which is a sensation of spinning.
BPPV causes a sudden, sometimes violent, dizziness after movement
or a change in head position. This sensation usually lasts only
seconds. This form of imbalance may be noticed when trying to lie
down, arise or turn over in bed. It may even awaken a person from
sleep. BPPV can also occur when looking up, downward to the side,
or, for instance, when lying back to have one's hair washed.
As a rule, BPPV does not cause hearing loss, ear fullness or head
noise (tinnitus). If these symptoms are present, it is likely that
a second inner ear problem exists.
BPPV is due to damage to the vestibular system. The damage may have occurred
from trauma to the head, whiplash injury, infection, circulatory changes,
degeneration of the inner ear due to aging, or from an unknown cause.
In the majority of cases, the cause of BPPV is unknown. Specifically, BPPV occurs when calcium crystals become dislodged in
the inner ear. These crystals interfere with the normal function of
the semicircular canals.
BPPV is diagnosed on the basis of a history of typical symptoms, findings
on the physical exam, and the results of balance tests. Frequently, the
doctor will try to see the patient during or around the time of the dizzy
spell to confirm the diagnosis.
Typically, BPPV will go into complete remission with appropriate treatment.
Remission means that the dizziness will eventually go away but it may return
several months or years later. Treatment may include specific exercises
for BPPV, medication, or surgery. Complete remission is achieved in over
98% of cases using nonsurgical treatment.
One of the most effective treatments for BPPV is physical therapy. Physical
therapy helps to place the dislodged calcium crystals back into their proper
position in the inner ear. One of the most successful types of physical
therapy is a form of head manipulation performed in the doctor's office.
This treatment has various names, such as the Epley Maneuver, the Canalith Repositioning Procedure, and the Semont Maneuver. The
treatment takes approximately 15 minutes. Sometimes the treatment is repeated
in one to two weeks if dizziness is still present. Other forms of physical
therapy include exercises performed at home. These exercises are known
as the Brandt-Daroff exercises.
In a very small number of cases, physical therapy or medications may not
control the dizziness. In these instances, surgery may be necessary. Please
talk to your doctor about the different types of surgery for benign positional