What is Vertigo or BPPV?

By Lisa Chekanowsky, MS, ATC, LAT, PES

What is Benign Paroxysmal Positional Vertigo or BPPV?

Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo, or the false feeling that you are spinning or swaying without actual body movement. BPPV is caused by a mechanical problem within the inner ear disorders – and causes mild to severe dizziness.

Benign: not life-threatening

Paroxysmal: occurs in intermittent, brief episodes

Positional: episodes triggered by head positioning/movements

Vertigo: false sense of movement (spinning, swaying, falling, etc).

Illustration of Benign Paroxysmal Positional Vertigo or BPPV in the human ear anatomy. JOI Rehab

Illustration of Benign Paroxysmal Positional Vertigo or BPPV

What can Cause Benign Paroxysmal Positional Vertigo?

BPPV occurs when there is a disturbance of structures within the inner ear, causing small calcium crystals to move from the gel of the otolith organs into the semicircular canals. Movement of these crystals result in increased sensitivity to head movements which normally would not trigger dizziness – resulting in false signals being sent to the brain. While fluid in the semicircular canal does not typically react to gravity, the crystals do – which causes the fluid to move when it would typically be unaffected. When the fluid in the canals move, it signals to the brain that the head is moving, although it remains still. This information contradicts signals from the other ear, eye perception, and body movements – resulting in vertigo. These episodes of dizziness last a short time, typically less than 1 minute, and frequently occur when laying down.

Human Ear Anatomy

The ear contains a vestibular labyrinth, which consists of three semicircular canals containing fluid and hairlike sensors that monitor your head’s rotation. Otolith organs are structures in the inner ear that monitor head movements related to gravity (up/down, side to side, etc).

Image of a woman in a white shirt experiencing Benign Paroxysmal Positional Vertigo or BPPV. JOI Rehab

Image of a Woman with BPPV

Symptoms of BPPV

  • Dizziness
  • Sensation of spinning (yourself or surroundings)
  • Nausea/Vomiting
  • Loss of balance

Risk Factors for BPPV

BPPV can affect adult individuals of any age, but is most commonly seen in those over 50. Children rarely develop this specific type of inner ear condition.

Activities that can trigger BPPV are head trauma/concussion, prolonged reclined head positioning, and high intensity physical activity (particularly activities which include forceful, repetitive bouncing)

Diagnosis of BPPV or Benign Paroxysmal Positional Vertigo

BPPV can be diagnosed by physical exam and a series of diagnostic testing. Indicators of BPPV include:

  1. Assessment: Of ear canal and eye movements
  2. Dizziness:  caused by eye or head movements
  3. Positive Special Test: The Dix-Hallpike Maneuver can result in dizziness and nystagmus, or rapid eye movements.
  4. Diagnostic imaging: such as MRI, CT Scan or Electronystagmography (ENG).

Treatments for BPPV or Benign Paroxysmal Positional Vertigo

While BPPV may resolve without intervention (a few weeks or months), you may benefit from assistance from a physician or physical therapist. If affected by BPPV, it is important to be aware of your surroundings and possible triggers to reduce vertigo episodes.

How do you fix Benign Paroxysmal Positional Vertigo?

A medical professional may be able to perform a canalith repositioning procedure known as the Epley Maneuver. This procedure involves a series of head movements that help to relocate calcium carbonate crystals from the semicircular canal. This maneuver tends to be highly effective and often offers some relief in as little as 1-2 treatment sessions.

Medications are not commonly used for treatment of BPPV, although nausea medication may be used if needed. In rare instances when conservative care fails, inner ear surgery may be required.

Written By: Lisa Chekanowsky, MS, ATC, LAT, PES

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