Benign Paroxysmal Positional Vertigo (BPPV)

Benign Paroxysmal Positional Vertigo (BPPV) is a degeneration of the inner ear that increasingly affects people as they age. It is the most common cause of vertigo (spinning sensation).

Causes of BPPV
BPPV is caused by calcium carbonate particles (otoconia or balance crystals) becoming dislodged inside the inner ear. When people with the condition move their head, the particles also move within the balance canal creating a vertigo response.

Prominent symptoms of BPPV include a sudden feeling as if everything is spinning around when the head is moved or changes position, such as when lying down, getting up, rolling over, lifting the head up and bending the head down. The symptoms last only a short time following a head movement and then gradually abate. When people with the condition move their head again in the same position, the symptoms may recur, but less intensely. In case of intense vertigo, the symptoms may include nausea and vomiting.


Vertigo may occur several times a day. The usual course of the illness is a gradual lessening of symptoms over a period of weeks to months, but the symptoms may recur after months or years.

The doctor will make a diagnosis based on an analysis of the following information:
  • History of symptoms, including the characteristic symptoms of dizziness and the head positions that cause dizziness
  • Physical examination, including of the ear, nose, throat and neurological system
  • Dix-Hallpike maneuver, a diagnostic test for BPPV: The patients lie down backwards quickly and tilt their head way back at the end of an examining table. If any jerking of the eyes is observed in conjunction with the vertigo, then the test is considered positive for BPPV.
  • Hearing test
  • The first option is lifestyle changes, such as avoiding positions and activities that cause the symptoms. Anti-dizziness medication treats the symptoms, but there is currently no medication that can cure BPPV. However, in most cases, the symptoms disappear gradually after the first month.
  • Physical therapy is currently an effective treatment option.
    • Canalith repositioning therapy, including Semont, Epley and Lempert (BBQ) Maneuvers
    • Vestibular compensation to allow the brain to regain balance control such as Brandt and Daroff exercise
  • If the medication and physical therapy are not effective, the doctors may recommend surgery.

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