10 Common BPPV Questions Answered

  • By Dizzy & Vertigo Institute
  • May 31, 2021

The body’s ability to balance is one of nature’s most incredible developments. Although our balance system is made up of inputs throughout our body, the inner ear (vestibular system) houses the GPS of our balance. Particles called otoconia that are so microscopic you’d need more than 25,000 of them to equal an inch, get dislodged in our GPS, and cause the system to go haywire. Anyone with BPPV will tell you that these microscopic particles can have a macroscopic effect on life. Below are the questions we most often hear from BPPV patients.

Why Do I Get Dizzy When I Bend Over?

The most common actions that cause vertigo attacks are:

  • Getting out of bed in the morning
  • Bending over to tie your shoes
  • Turning to look at something while driving, walking, or sitting

The reason that vertigo flares up with these specific head movements is that one of our main balance centers is located in the inner ear. We have three semicircular canals in our inner ear which are filled with fluid. As we turn our heads, that fluid moves and helps inform our body of our head’s location in space. A part of the inner ear called the utricle is the location of the particles called otoconia (unofficially called ‘crystals or rocks’). In people with BPPV, those crystals get dislodged, find themselves with the fluid in your semicircular canals, and throw off your body’s sense of position. The vertigo you feel is your body trying to understand this new information in the wrong part of your inner ear. In other words, your body is trying to make sense of mixed signals.

What Does BPPV Stand For?

BPPV is a vestibular disorder found in the inner ear that causes short bursts of false spinning sensations (generally lasting less than a minute) after moving one’s head in a certain way. The acronym says a lot about BPPV:

  • Benign – not harmful
  • Paroxysmal – a sudden attack
  • Positional – relating to one’s head position
  • Vertigo – false sensation that the world around you or you are spinning

What are the Telltale Symptoms of BPPV?

Although dizziness is the symptom of practically everything, there are commonalities in the dizziness experienced by BPPV patients. If you get dizzy with short bursts of spinning lasting less than a minute or so after certain head movements, like bending over, turning, or looking up this is a sign that you might have BPPV. If your vertigo lingers for hours on end, it’s likely not BPPV. BPPV could also happen after head injuries, be associated with migraine, Meniere’s disease, viruses that affect the ear, surgeries, blood flow issues, vitamin deficiencies, medications, and infections.

How Is BPPV Diagnosed?

BPPV is diagnosed based on a combination of history, physical examination, and the results of vestibular tests. We always start with a comprehensive conversation to really understand what type of dizziness the patient is feeling, as there are dozens of feelings that make dizziness more descriptive. Following the conversation, we have a good idea of what tests we need to run the patient through. We’re essentially testing the body’s ability to respond to certain head movements. Specifically, we’re looking for bursts of nystagmus (jumping of the eyes). We use Frenzel goggles, which monitor the eye movements. Depending how the eyes are jumping in these tests, this tells us which of the six semicircular canals are affected. BPPV diagnosis is very much a precise science.

How Common is BPPV?

BPPV has a lifetime prevalence of almost 3% and is more common in people over the age of 50 and women. That means about 3 in 100 people will have BPPV at some point in their life. In our clinic and other specialized dizziness clinics, BPPV is one of the top causes of vestibular vertigo accounting for 20-30% of all diagnoses.

Should I Sleep Differently With BPPV?

Many patients report feeling vertigo when getting up and out of bed. This is because as we lay on our backs, gravity naturally pulls the dislodged crystals in our inner ear downward, affecting two of the inner ear canals in particular. For this reason, it is common for patients to develop BPPV on the side they regularly sleep. Although still a debated topic in the vestibular community, following BPPV treatment, some specialists will advise their patients to avoid sleeping in their regular position and instead keep their head propped up.

How is BPPV Treated?

Fortunately, BPPV has one of the highest resolutions of all the vestibular disorders. Commonly, BPPV can be resolved through procedures known as repositioning maneuvers. These involve rotating the head and body in a series of movements to put the dislodged crystals back where they belong. There are six different canals within your inner ear that may have the misplaced crystals – the posterior and horizontal canals being the most common. Each canal requires a different repositioning maneuver for treatment. We use Frenzel goggles during the initial diagnostic process and throughout the maneuvers to get the exact measurement of the eyes recorded. The eye movements help make the proper diagnosis of the involved ear canal. Before doing these maneuvers, a comprehensive case history and examination should be performed to rule out concerns with the neck, spine, and other physical limitations.

Can I Treat BPPV At Home?

You wouldn’t set a broken bone on your own, so why treat your dizziness alone? BPPV is especially vulnerable to Dr. Google. A quick Internet search will land you with hundreds of resources coaching you through the at-home maneuvers for BPPV relief. The problem, though, is that BPPV can inflict any one of your six semicircular canals. Depending on which canal is affected, there are different maneuvers to reposition the displaced crystals. Taking the Internet advice and doing an at-home maneuver is equivalent to changing a tire blindfolded and simply guessing which tire is flat. Yes, you have a chance of changing the correct tire, but ¾ of the time (⅚ of the time with BPPV) you could change the wrong tire. We recommend you steer clear of trying to fix your dizziness at home because you run the risk of making things worse.

Will BPPV Return After It Is Treated?

While it is common to feel residual dizziness or slight disorientation after having your BPPV treated, this usually subsides within a few days. After 1 or 2 treatment sessions, 91.3% of patients reported complete symptom resolution. However, around 25-33% of patients have a recurrence in the first year after treatment, and by five years, about half of all patients have a recurrence. Having a solid relationship with your treatment team is important to ensure swift treatment if your symptoms return.

What Should I Do Now?

If you or someone you know experiences BPPV or thinks they do, then give us a call at (310) 954-2207 or schedule an appointment here. We can help you get the resources and treatment you need.

Posted in All, Blog, BPPV

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