Benign paroxysmal positional vertigo, or BPPV, is one of the most common causes of brief spinning dizziness. Many people simply describe it as suddenly feeling dizzy, spinning, or off-balance when they roll over in bed, look up, bend down, or move their head into a particular position. Frequent episodes of BPPV can reduce quality of life and increase the risk of falls.
What causes BPPV?
The inner ear contains tiny calcium carbonate crystals called otoconia (singular: otoconium), often referred to simply as “ear crystals.” Otoconia are part of the utricle and saccule, which together are known as the otolith organs of the vestibule. In BPPV, otoconia—most often from the utricle—become displaced from their normal position and enter one of the semicircular canals. When the head moves, these loose particles shift within the canal and stimulate the balance system inappropriately, producing brief episodes of vertigo.
What does BPPV feel like?
Symptoms are usually brief—often seconds rather than hours—and are strongly linked to position changes. Nausea and temporary imbalance may occur. Some people describe lingering motion sensitivity after the strongest spinning passes.
How is BPPV diagnosed?
A clinician uses positional tests that move the head through specific orientations while watching for characteristic eye movements called nystagmus. The pattern helps identify which ear and which semicircular canal are involved.
How is BPPV treated?
Treatment commonly involves a canalith repositioning maneuver designed to move the displaced otoconia out of the affected semicircular canal and back toward the vestibule. For the most common form of BPPV—posterior-canal BPPV—the Epley maneuver is the most commonly used treatment. Other repositioning maneuvers may be used depending on which canal and which side are involved. Medication may reduce nausea, but it does not reposition the crystals.
BPPV can recur. People who have experienced at least one episode—even after successful treatment with a canalith repositioning maneuver—are more likely to experience another episode. If symptoms return, additional positional testing is recommended to confirm the affected ear and canal, followed by review or repetition of the appropriate repositioning maneuver.
Could positional dizziness be something else?
Yes. Not every episode of dizziness with movement is BPPV. Vestibular migraine, blood-pressure changes, neck problems, neurologic disorders, and other vestibular conditions can produce overlapping symptoms. A careful history and examination matter.
Learn more about balance and vestibular testing or contact Merit Hearing.