What is Benign Paroxysmal Positional Vertigo and How is BPPV Treated?

  • By Dizzy & Vertigo Institute
  • June 30, 2020
For people with Benign Paroxysmal Positional Vertigo (BPPV), the simple act of moving or tipping their head triggers an instant inconvenience to their life. The world spins viciously. And in the worst cases, a period of disequilibrium and imbalance follows the episode. BPPV is one of the top causes of vestibular vertigo, accounting for 20-30% of diagnoses in specialized dizziness clinics. We treat many BPPV patients at the Dizzy & Vertigo Institute and have a great success rate at resolving their symptoms swiftly.

What is BPPV?

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
Although BPPV has a lifetime prevalence of 2.9%, which means 2.9% of the population will get BPPV over the course of their lifetime. BPPV tends to increase with age and is more common in people over the age of 50 due to the gradual use of the otolithic membrane over time. Other conditions possibly connected to BPPV include, but not limited to: head injuries, migraine, Meniere’s disease, viruses that affect the ear (vestibular neuritis and labyrinthitis), otologic surgeries, vascular issues, vitamin D deficiency, medications, and infection. However, for the most part, BPPV is spontaneous in origin.

Why Do I Get Dizzy?

Most commonly, patients report getting their vertigo attacks when they:
  • Get out of bed in the morning
  • Bend over to tie their shoes
  • Turn to look at something while driving, walking, or sitting
The reason that vertigo flares up in 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. Fluid fills each canal. And 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 thought to be the location of “ear crystals” (otoconia). In people with BPPV, those crystals dislodge themselves from their proper place. Then, the otoconia find itself with the fluid in your semicircular canals and throw off your body’s sense of position.
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 thought to be the location of ‘ear crystals’ (called otoconia). In people with BPPV, those crystals get dislodged. The otoconia find itself 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.

BPPV Symptoms

BPPV patients often realize over time which motions and head movements will set off a vertigo attack. It’s important to track your triggers. Take note of exactly when you routinely experience vertigo attacks, as it is helpful for the diagnosis and treatment process. These are the common symptoms of BPPV:
  • Dizziness during head movements: a sense of spinning or dizziness during head motion. Occurs with or without nausea.
  • Internal Vertigo: the false sensation that your body is rotating, twirling, swaying, or wobbling.
  • External Vertigo: the false sensation that the world around you is spinning or flowing.
  • Risk of Falling: these sudden vertigo attacks greatly increase the risk of falling or tumbling.

How is BPPV Treated?

Fortunately, BPPV has one of the highest resolutions of all vestibular disorders. Commonly, repositioning maneuvers resolve BPPV after as few as one session. 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 diagnoses and throughout the maneuvers. This allows us to precisely measure and record eye movements during the procedures. Surprisingly, the eyes are the key to diagnosis and treatment. Prior to performing these maneuvers, though, we need to understand any issues with the neck & spine, neurological abnormalities, and other physical limitations. This helps us rule out certain maneuvers we must avoid for that patient. Therefore, a comprehensive case history is critical for new patients. Take caution, though, as many resources online will say it’s safe to self-administer these repositioning maneuvers. But we highly advise against treating your BPPV on your own. You risk moving the ear crystals (otoconia) incorrectly and making your symptoms worse than before.
For some patients, it only takes one treatment to get them back to a dizzy-free life. Others require a few treatments along with ongoing check-ins when the vertigo returns months or years later.
If you or someone you know is experiencing these sudden bouts of dizziness, please reach out to us at (310) 954-2207 or schedule a consultation here. Fortunately, there is hope for you and it’s just one appointment away!

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