Benign Paroxysmal Positional Vertigo (BPPV)

Overview

What is Benign Paroxysmal Positional Vertigo (BPPV)?

Benign Paroxysmal Positional Vertigo (BPPV) is one of the most common causes of vertigo, a sensation that you are spinning, or the surroundings are spinning. It occurs due to a problem in the inner ear, specifically the vestibular system, which is responsible for maintaining balance. BPPV can affect people of all ages, but it’s most common in adults over the age of 50. While not life-threatening, BPPV can significantly affect a person’s quality of life. Understanding its signs, causes, and treatments is crucial for those affected by this condition. 

Signs and Symptoms

What are the Signs and Symptoms of BPPV?

The hallmark symptom of BPPV is brief episodes of vertigo triggered by certain head movements. This might occur when you tip your head up or down, when you lie down, or when you turn over or sit up in bed from the lying down position. These episodes may be intense and sudden, often subsiding within a minute or two. Other common signs and symptoms include: 

  • Vertigo and/or dizziness, usually triggered by specific movements such as rolling over in bed, tilting the head back, or looking up which lasts for less than a minute or two. 
  • Nausea or vomiting, especially during episodes of vertigo. 
  • Imbalance or unsteadiness, even between episodes of vertigo. 
  • Nystagmus, which is involuntary rapid eye movements, typically accompanying vertigo episodes. 
Causes

Causes of BPPV

BPPV occurs when tiny calcium carbonate crystals called otoconia are dislodged from their usual position in the inner ear and enter the semicircular canals. These canals are fluid-filled structures responsible for detecting head movements and transmitting signals to the brain about the body’s position. When otoconia moves inside the semicircular canals (along with the fluid), they disrupt the normal flow of fluid, leading to erroneous signals being sent to the brain about head movements, resulting in vertigo. 

The exact cause of why otoconia become dislodged is often unknown, but factors such as head injuries, inner ear infections, or conditions affecting the inner ear’s structure may contribute to their displacement. 

Diagnosis

Tests to Diagnose BPPV

Diagnosing BPPV typically involves a thorough medical history review and physical examination, focusing on eliciting characteristic vertigo symptoms and observing eye movements that occur during positional changes. As there are three semicircular canals in each ear, it is very important to determine the affected side and canal for successful treatment.

Vestibular Specialists perform specific diagnostic tests to identify the semicircular canals involved ans based on the canal involved the diagnosis can be of either one of the three or rarely a combination these.

Possible diagnosis could be:

  • Posterior Canal BPPV
  • Lateral Canal BPPV
  • Anterior Canal BPPV

Tests used to diagnose BPPV are:

  • Dix-Hallpike test for Posterior Canal BPPV
  • Supine head roll test for Lateral Canal BPPV
  • Deep Headhanging Test for Anterior Canal BPPV.
Treatment

Treatment for BPPV

Fortunately, BPPV is highly treatable, and various strategies aim to alleviate symptoms by repositioning displaced calcium carbonate crystals (otoconia) within the within the inner ear’s semicircular canals (canalith repositioning). 

In some cases, medications may be prescribed to manage symptoms such as nausea or dizziness, although they do not address the underlying cause of BPPV. 

Canalith Repositioning Maneuvers

The procedure is typically performed by trained vestibular specialists and healthcare professionals and can provide rapid relief for individuals suffering from BPPV. The goal of the procedure is to move otoconia from the fluid-filled semicircular canals in your inner ear into their original position by a series of carefully guided head and body movements. A single particle repositioning procedure session is effective in treating about 80% to 90% of cases of BPPV. Additional sessions may be needed if symptoms continue. 

 

After identifying the specific affected semicircular canal and ear side is crucial for the successful treatment of BPPV. This ensures that the canalith repositioning maneuver is precisely tailored to address the displacement of calcium carbonate crystals within the appropriate canal. Following are the common BPPV Maneuvers based on specific treatment.

  • Epley Maneuver / Modified Epley Maneuver
  • Semont Maneuver
  • Half-Somersault or Foster Maneuver
  • Brandt-Daroff Exercise
  • others
When to Call Doctor

When to Seek Medical Attention for BPPV? 

While BPPV itself is not life-threatening, it can significantly impact daily activities and increase the risk of falls, especially in older adults. Therefore, it is essential to seek medical attention if you experience any of the following: 

  • Persistent or recurrent episodes of vertigo 
  • Severe dizziness or imbalance affecting daily activities 
  • Nausea or vomiting associated with vertigo 
  • New or worsening symptoms of dizziness or unsteadiness 

Additionally, individuals with BPPV who experience sudden hearing loss, severe headache, or neurological symptoms such as weakness or numbness should seek immediate medical attention, as these may indicate other underlying health conditions requiring urgent evaluation and treatment. 

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Professionally Reviewed

Last reviewed by Sidharth Rajeev, Dr. Yugandhar Ramakrishna on April 27, 2024