Benign paroxysmal positional vertigo, commonly referred to as BPPV, is a vestibular disorder that causes vertigo. It occurs when calcium deposits in the inner ear become dislodged from the otolithic membrane and settle in the semicircular canals. Any change in the position of the head causes these tiny crystals to shift, triggering dizziness.


What Causes BPPV?

It isn’t always known what causes these calcium deposits to break loose, though this is commonly the result of a head injury, inner ear infection, damage from ear surgery or prolonged back position associated with bed rest. Migraines might also play a role. Older patients are susceptible to degeneration of the otolithic membrane related to normal aging.

What Are the Symptoms of BPPV?

BPPV is the most common cause of vertigo. The episodes of vertigo may be severe, but usually lasts for less than a minute. Other symptoms include dizziness or lightheadedness, loss of balance, blurred vision, nausea, vomiting and concentration difficulties.

How Is BPPV Treated?

If you are experiencing dizziness and unexplained episodes of vertigo, your doctor will administer tests to determine what is causing your symptoms. A diagnostic physical exam evaluates eye movements in response to specific head movements.

Additional testing such as electronystagmography (ENG) and videonystagmography (VNG) may be used to detect abnormal eye movement; an ENG utilizes electrodes, while the VNG test relies on small cameras.

Fortunately, BPPV is one of the more easily treatable disorders. The standard approach involves a pattern of head movements used to move the calcium particle from the semicircular canal back to the utricle. Called the Canalith Repositioning Procedure (CRP) or the Epley maneuver, this brief procedure takes about five minutes and relieves symptoms in over 85 percent of patients.

While there are many videos available online that show the patterns and head movements of some of these maneuvers, it is important not to self-treat. These videos assume problems originate from one canal, but it will make matters worse if that is not the case. Treatment should be done with the guidance of a professional.

If CRP is ineffective, patients may undergo surgery; both posterior semicircular canal occlusion and vestibular nerve section have proven effective, but carry a risk of hearing loss following surgery. Treatment with the antibiotic gentamicin and vestibular rehabilitation may also prove successful.