About benign paroxysmal positional vertigo (BPPV)

Vertigo is the sudden sensation that you are unsteady or that your surroundings are moving. You may feel like you’re spinning around on a merry-go-round or that your head is spinning inside. Benign paroxysmal positional vertigo (BPPV) is one of the most common disorders that can cause vertigo.

Benign paroxysmal positional vertigo is characterized by brief episodes of mild to intense dizziness associated with specific changes in the position of your head. It most commonly occurs when you move your head in a certain direction, lie down from an upright position, turn over in bed or sit up in the morning. Moving your head to look up or look down also can bring about symptoms of benign paroxysmal positional vertigo. You may also feel out of balance when standing or walking.

Although benign paroxysmal positional vertigo can be a bothersome problem, it’s rarely serious except when it increases the chance of falls. You can receive effective treatment for benign paroxysmal positional vertigo during a doctor’s office visit.

Symptoms

The signs and symptoms of benign paroxysmal positional vertigo (BPPV) may include:

  • Dizziness
  • A sense that you or your surroundings are spinning or moving (vertigo)
  • Lightheadedness
  • Unsteadiness
  • A loss of balance
  • Blurred vision associated with the sensation of vertigo
  • Nausea
  • Vomiting

The signs and symptoms of BPPV can come and go, with symptoms commonly lasting less than one minute. Episodes of benign paroxysmal positional vertigo and other forms of vertigo can disappear for some time and then recur.

Activities that bring about the signs and symptoms of BPPV can vary from person to person, but are almost always brought on by a change in the position of your head. Abnormal rhythmic eye movements (nystagmus) usually accompany the symptoms of benign paroxysmal positional vertigo. Although rare, it’s possible to have BPPV in both ears (bilateral BPPV).

Causes

Inside your ear is a tiny organ called the vestibular labyrinth. It includes loop-shaped structures (semicircular canals) that contain fluid and fine, hair-like sensors that monitor the rotation of your head. Other structures (otolith organs) in your ear monitor movements of your head and your head’s position. These otolith organs contain crystals that make you sensitive to movement. For a variety of reasons, these crystals can become dislodged. When they become dislodged, they can move into one of the semicircular canals — especially while you’re lying down. This causes the semicircular canal to become sensitive to head position changes it would normally not respond to. As a result, you feel dizzy.

Benign paroxysmal positional vertigo occurs most often in people age 60 and older. It can also occur after a minor to severe blow to your head. Less common causes of BPPV include disorders that damage your inner ear or, rarely, damage that occurs during ear surgery or during prolonged positioning on your back (supine).

Doctors can sometimes determine the cause of BPPV. It may require a consultation with an ear, nose and throat (ENT) specialist or a doctor who specializes in the brain and nervous system (neurologist). However, it is almost as common that no specific cause for BPPV can be determined.

Aside from aging, there are no definite factors that may increase your risk of benign paroxysmal positional vertigo. However, a prior head injury or any other disorder of the balance organs of your ear may make you more susceptible to BPPV.

Diagnosis

Your doctor may do a series of tests to determine the cause of your dizziness. During a physical examination, your doctor will likely look for:

  • Signs and symptoms of dizziness that are prompted by eye or head movements and then decrease in less than one minute
  • Dizziness with specific eye movements that occur when you lie on your back with your head turned to one side and tipped slightly over the edge of the examination bed
  • Involuntary movements of your eyes from side to side (nystagmus)
  • Your ability to control your eye movements

If the cause of your signs and symptoms is difficult to diagnose, your doctor may order additional testing, such as:

  • Electronystagmography (ENG) or videonystagmography (VNG). The purpose of this test is to detect abnormal eye movement. ENG (performed with electrodes) or VNG (performed with small cameras) can help determine if dizziness is due to inner ear disease by measuring involuntary eye movements while your head is placed in different positions or your balance organs are stimulated with water or air. Other tests can assess your ability to maintain an upright position under easy and difficult conditions.
  • Magnetic resonance imaging (MRI). This technique uses a magnetic field and radio waves to create cross-sectional images of your head and body. Your doctor can use these images to identify and diagnose a wide range of conditions. MRI may be performed to rule out acoustic neuroma — a noncancerous brain tumor of the nerve, which carries sound and balance information from the inner ear to the brain — or other lesions that may be the cause of vertigo.

Although benign paroxysmal positional vertigo (BPPV) is uncomfortable, it rarely causes complications. If severe, persistent BPPV causes you to vomit frequently, you may be at risk of dehydration.

Treatment

To help relieve benign paroxysmal positional vertigo (BPPV), your doctor, audiologist or physical therapist may treat you with a series of movements known as the canalith repositioning procedure.

Performed in your doctor’s office, the canalith repositioning procedure consists of several simple and slow maneuvers for positioning your head. The goal is to move particles from the fluid-filled semicircular canals of your inner ear into a tiny bag-like open area (vestibule) that houses one of the otolith organs (utricle) in your ear where these particles don’t cause trouble and are more easily reabsorbed. Each position is held for about 30 seconds after any symptoms or abnormal eye movements stop. This procedure is usually effective after one or two treatments.

After the procedure, you must avoid lying flat or placing the treated ear below shoulder level. That night, you should elevate your head on a few pillows when you sleep. This allows time for the particles floating in your labyrinth to settle into your vestibule and be reabsorbed by the fluids in your inner ear. It may be necessary to repeat the procedure several times over the course of several days. You’ll likely be taught how to perform the procedure on yourself so that you can do it at home before returning to the office for a recheck.

Surgical alternative
In rare situations in which the canalith repositioning procedure isn’t effective, your doctor may recommend a surgical procedure in which a bone plug is used to block the portion of your inner ear that’s causing dizziness. The plug prevents the semicircular canal in your ear canal from being able to respond to particle movements or head movements in general. This success rate for canal plugging surgery is about 90 percent. Less than 5 percent of people who undergo this procedure experience long-term hearing loss.

Self-care

If you experience dizziness associated with benign paroxysmal positional vertigo (BPPV), consider these tips:

  • Be aware of the possibility of losing your balance, which can lead to falling and serious injury.
  • Sit down immediately when you feel dizzy.
  • Move slowly when making movements that cause dizziness.
  • Use good lighting if you get up at night.
  • Walk with a cane for stability, if you are at risk of a fall.
  • Work closely with your doctor to manage your symptoms effectively.

Living with benign paroxysmal positional vertigo (BPPV) can be challenging. It may affect your interaction with friends and family, your productivity at work, and the overall quality of your life. You may find encouragement and understanding in a support group.

Although support groups aren’t for everyone, they can be good sources of information. Group members often know about unique coping skills and tend to share their own experiences. If you’re interested, your doctor may be able to recommend a group in your area.