Benign Paroxysmal Positional Vertigo (BPPV)

Causes of benign paroxysmal positional vertigo

In many cases, there isn’t a known cause for BPPV. If a cause can be found, it is often due to trauma to the head. Other causes may include:

• Damage to the ear or inner ear 
• Migraines
• Calcium carbonate breaking free and entering the semicircular canals of the ear or when crystals form inside the canals. This can cause someone to feel dizzy or unbalanced.

Risk factors for benign paroxysmal positional vertigo

Factors that increase your likelihood of developing BPPV include:

• Age — BPPV is most prevalent in people over the age of 50
• Gender — BPPV is more common in women than men
• Head trauma or injury — if you have had a head injury, you are more likely to develop BPPV
• Osteoporosis
• Diabetes
• Inner ear condition 

Symptoms of benign paroxysmal positional vertigo

Symptoms of benign paroxysmal positional vertigo include:

• Dizziness
• Lightheadedness
• Nausea
• Losing balance 
• Feeling unsteady
• Vertigo — feeling like you are spinning or swaying
• Vomiting
• Blurred vision
• Abnormal eye movements

Symptoms typically last less than one minute but can come and go at erratic intervals.

Patients with BPPV may experience symptoms triggered by:

• Changing the position of your head
• Lying down
• Turning over in bed
• Standing up from a seated position
• Moving your head up or down

It is common for symptoms to disappear for weeks, months or even years before experiencing another episode.

Diagnosis of benign paroxysmal positional vertigo

BPPV can be diagnosed with a Dix-Hallpike test during a physical exam. Your doctor, typically an otolaryngologist, will hold your head while instructing you to quickly lie down on a table. Your doctor will examine your eyes for abnormal movements and ask if you feel like you are spinning or swaying.

Other tests that your doctor may order include:

• Neurological exam — determines if you have any other conditions that may cause similar symptoms
• Caloric stimulation — observes eye movements by warming and cooling the inner ear with water
• Imaging — MRI, MRA or CT scan of the head and brain
• Hearing exam 
• Electronystagmography — records movement of the eyes
• Electroencephalogram — measures activity in the brain

Treatment of benign paroxysmal positional vertigo

In many cases, BPPV goes away on its own within weeks or months. In severe cases where symptoms relief is necessary, your doctor may treat you with the Epley maneuver.

The Epley maneuver, also known as the canalith repositioning procedure, which can be performed during a clinic visit, involves making slow movements that position the head. The goal of the procedure is to move any built-up particles from the semicircular canals to the vestibule where the particles don’t cause issues.

During the exercises, your doctor will hold your head in a certain position for 30 seconds after the abnormal eye movements stop and symptoms subside. Most patients can perform the exercises on themselves and need two or more treatments for maximum efficacy.

Other treatments for BPPV include:

Medications such as sleeping aids, anticholinergics, antihistamines

In some cases, these medications are not effective in treating your symptoms associated with vertigo.

Surgery 

In rare cases, when more conservative treatments have failed, you may need surgical intervention. During this procedure, the portion of the inner ear that is causing your symptoms is blocked with a bone plug. This procedure allows your ear to stabilize itself when you move your head.