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What is Benign Paroxysmal Positional Vertigo?

What is Benign Paroxysmal Positional Vertigo?

Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause of vertigo, or a false sensation of movement, usually reported as a spinning sensation. This condition is caused when calcium carbonate crystals in the inner ears, called otoconia, become dislodged and migrate into one of the three semicircular, fluid filled ear canals.



The sensation of spinning can feel as scary as the condition's name sounds - but it's actually harmless, and, with a professional, it's usually a quick fix.


Breaking down the tongue twister of a name:

Benign - the condition is not life threatening

Paroxysmal - the condition comes in sudden, brief spells, the dizziness is not constant

Positional - the spells are triggered by certain head positions or movements

Vertigo - a false sense of movement, usually described as spinning, but can also be felt as a swaying, rocking, or falling.


In other words, BPPV is when the otoconia has moved into the semicircular canals and specific head movements or positions cause a spinning or swaying sensation.


Why does BPPV occur?

The utricle is a small gelatinous sac in the inner ear that holds the otoconia, which brush against the tiny hairs in the ear, and this informs our balance. These calcium crystals can become dislodged or fragmented with an injury like a concussion, blow to the head, or whiplash, or due to degeneration of the utricle with age or illness.


These dislodged or fragmented crystals in and of themselves are not an issue and do not typically produce vertigo symptoms. However, when these out-of-place otoconia move into one or more of the semicircular canals, the sensations of dizziness, swaying, rocking, or falling can occur.


Who can suffer from BPPV? Anyone can suffer from BPPV! Because aging can cause degeneration of the utricle, it becomes more common as you get older. Approximately 3% of the population will suffer from BPPV at some point in their lives, with women having a higher incidence rate than men.


How is BPPV diagnosed?

BPPV is diagnosed by a professional (physician, physical therapist, or otolaryngologist/ENT), who will perform a maneuver called the Dix-Hallpike maneuver. This involves movement of the head and body to reproduce the symptoms, including nystagmus, the involuntary beating of the eyes that is a hallmark of BPPV.


Some doctors and physical therapists will use a special set of goggles in a darkened room to film eye movements and analyze the movements, but it is not a necessary part of diagnosis.


How is BPPV treated?

Some people "treat" BPPV with a "wait-it-out" method. Because it is paroxysmal - in short bursts - people may live with BPPV for years without it affecting their daily life. Still others may find that the BPPV resolves with no special treatment.


The "wait-it-out" method isn't recommended. More than 50% of people who have BPPV once will have recurrences in the coming weeks or months, and living with the condition can habituate your vestibular system into being off-balance. This can cause what should have been a relatively easy fix to become a much longer, more involved process.


A physician may prescribe a medication if the symptoms are frequent and overwhelming, but the medication does not solve the issue itself and only treats the issues, primarily the nausea that is associated with BPPV.


A trained professional who has additional certifications in treating vestibular disorders will perform the Dix-Hallpike maneuver to determine if the otoconia is displaced in the right ear or left ear, or both, and in which of the three semicircular canals they are now present. This information will allow the professional to perform the appropriate maneuvers (there are several types, but the most common is the Eply maneuver) to remove the crystals from the canals and back to the utricle.


It is not recommended to somersault or otherwise perform maneuvers without consulting with a professional. An incorrect maneuver can make BPPV worse.


If you or a loved one suffers from dizziness or imbalance, call FlexPlus Physical Therapy to set up your initial evaluation. FlexPlus Physical Therapy has Level 3 Vestibular Certified therapists on staff to provide the best treatments possible. Call our Natick location today at 508-650-0060.


FlexPlus Physical Therapy is a proud member of the Vestibular Disorders Association, who wrote the majority of this article, which can be found on the VeDA website.

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