Benign paroxysmal positional vertigo (BPPV) is a disease of the vestibular system of your inner ear that happens when crystals in the inner ear shift to the wrong place. When you change your head position, it causes vertigo, or a feeling that the room is spinning around you.

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About This Condition

Understanding Benign Paroxysmal Positional Vertigo (BPPV)

Understanding the vestibular system

The vestibular system of the ear is made up of very tiny parts. They include the utricle, saccule, and semicircular canals. The utricle is a tiny organ that contains calcium crystals. In some people, the crystals can move into the semicircular canals. When this happens, the system no longer works as it should. This causes BPPV. Benign means it is not life threatening. Paroxysmal means it happens suddenly. Positional means that it happens when you move your head. Vertigo is a feeling of spinning.

Your vestibular system helps sense motion and changes in space. It adds to your sense of balance. The vestibular organs are inside the innermost part of your ear. They include the utricle, saccule, and 3 semicircular canals. When your head moves, these small organs send this information to the brain.

The utricle contains small calcium crystals. These help you to sense motion. Sometimes these crystals detach from the utricle and land in one of the semicircular canals. Then the canals may send the wrong signals to the brain, especially when the crystals move. This confuses the brain and leads to BPPV symptoms.

The condition is called benign because it is not life-threatening. It does not get worse with time. Paroxysmal means that the vertigo comes and goes. Positional just means that symptoms come from a change in head position.

BPPV is fairly common, especially in women. Older adults have it more often. But people of any age can get it. It is one of the most common vestibular disorders.

What causes BPPV?

Anything that dislodges the crystals from the utricle can cause BPPV. Having a past head injury is a major cause. Other times, BPPV may result from other problems with the vestibular system. These can include Ménière's disease or vestibular neuritis. Ear surgery is a less common cause. In most cases, no one knows exactly what causes BPPV.

Who is at risk for benign paroxysmal positional vertigo?

People with certain health conditions may have a higher risk for BPPV. But many times the cause is not known. You may have a higher risk of developing BPPV if you have any of these:

  • Migraine.

  • Giant cell arteritis.

  • High blood pressure.

  • High cholesterol or other blood lipids.

  • History of stroke.

  • Head injury.

It’s not clear if treating these conditions might reduce your risk for BPPV.

Symptoms of BPPV

You many have repeated feelings of spinning (vertigo). The vertigo usually lasts less than 1 minute. Some movements, such as rolling over in bed, can bring on vertigo. The most common BPPV symptoms include:

  • A feeling of spinning (vertigo).

  • Lightheadedness.

  • Trouble with balance.

  • Nausea and vomiting.

How is benign paroxysmal positional vertigo diagnosed?

BPPV may be diagnosed and treated by your primary healthcare provider. Or by an ear, nose, and throat doctor (otolaryngologist). Or it may be diagnosed and treated by a neurologist. The provider will ask about your health history. You may also have a physical exam. This may include hearing and balance tests. It will also include an exam of the nervous and cardiovascular systems. Problems with these systems can also cause vertigo.

As part of the exam, your healthcare provider may have you do certain movements. These will include moving your head and body in certain ways. If you have BPPV, this test can bring on vertigo. It can also bring on quick, involuntary eye movements (nystagmus). Your provider can also use this test to find which semicircular canal is most likely affected.

If your healthcare provider is still not sure about the diagnosis, you may need other tests such as:

  • ENG (electronystagmography). This test uses electrodes to test your eye movements in response to stimuli that may cause your vertigo.

  • VNG (videonystagmography). This test is similar to an ENG but it uses cameras instead. Your eyes are a part of your sense of balance. So ENG and VNG tests may help find the cause of your vertigo.

  • Imaging tests. Tests such as an MRI can help rule out nervous system problems as a cause.

How is benign paroxysmal positional vertigo treated?

Your healthcare provider may try to move the calcium crystals. This is done by having you move your head and neck in certain ways. This treatment is safe and often works well. You may also be told to do these movements at home. You may still have vertigo for a few weeks. Your healthcare provider will recheck your symptoms, usually in about a month. Special physical therapy may also be part of treatment. In rare cases, surgery may be needed for BPPV that does not go away.

How is benign paroxysmal positional vertigo treated?

Treatment will depend on your symptoms, age, and general health. It will also depend on how severe the condition is.

First your healthcare provider may try to move the calcium crystals out of your semicircular canals. This may be done with a series of certain head and neck movements. This often takes about 15 minutes. Your provider may tell you to do certain movements at home. This treatment often works. Some people may still have vertigo with head movement for a few weeks.

Special physical therapy may also be part of your treatment.

Medicines are not often given for BPPV. This is because most of them don't help. In some cases, short-term use of motion sickness medicines may help to ease nausea.

If these other treatments fail, in rare cases, your healthcare provider may advise surgery. One option is called posterior canal plugging. It blocks the movement of calcium crystals in the posterior semicircular canal. The surgery can work well. But in rare cases, it can cause some hearing loss.

Your healthcare provider may also advise a watch-and-wait approach to your BPPV before trying surgery. BPPV does often go away on its own over time. But in many cases it does come back. If you are still having symptoms from BPPV, your healthcare provider may tell you how to prevent symptoms. For example:

  • Using two pillows in bed to raise your head.

  • Not sleeping on your affected side.

  • Rising slowly out of bed.

  • Not looking up.

  • Not bending over to pick things up.

  • Not doing exercises that use head rotation, such as swimming laps.

Even if you stop having symptoms, your healthcare provider may suggest that you follow similar instructions, at least for a few weeks. This may help prevent your symptoms from coming back.

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