BPPV: Treatment is Available

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June 5, 2017

BPPV: Treatment is Available

Written by: Dr. Matthew Seldine

Benign paroxysmal positional vertigo, or BPPV for short, is the most common cause of vertigo arising from the vestibular system (balance system) within the inner ear. This condition causes benign, sudden, brief, false senses of movement triggered by certain head positions. The good news is that BPPV treatment is available, highly effective, and non-invasive. However, this does not eliminate the sometimes-debilitating effects of the condition while it is present. Let’s take a closer look.


BPPV is caused by a displacement of calcium carbonate crystals, called otoconia, in the inner ear. This occurrence is commonly idiopathic, meaning it occurs for no apparent reason. Think of when we find a couple loose hairs after combing or brushing. We see this as normal, but if a big lock of hair falls off we notice this as abnormal and it is noticeable. When a large enough clump of otoconia breaks away from where it usually resides it may accidentally end up in one of three fluid filled canals in the inner ear before it can dissolve naturally. This is abnormal. As affected individuals go about their daily routine and move their head the otoconia may shift inside the affected canal. The most common reports of BPPV occur when individuals roll over in bed, get in or out of bed, tip the head to look upwards, bend over, or move their head quickly. This ends up causing a mismatch of information being received by the brain from the healthy ear, the eyes, and the muscle and joint system. This mismatch of information results in a brief episode of vertigo which typically subsides if we return our head back to the position it previously was in prior the start of the episode or until the episode passes.


It is recommended to seek a diagnosis from a healthcare professional trained in the assessment of BPPV. Audiologists and other healthcare professionals (physical therapists, ear, nose, and throat physicians) are a great resource for this diagnosis as many are trained in the various presentations of BPPV. In-office head and body treatment maneuvers are utilized to allow the professional to assess whether any eye movement indicative of BPPV is present. Based on the characteristics of the eye movements the healthcare professional will gain clues about the location of the abnormal crystals in the inner ear. They will then be able to perform the appropriate treatment maneuver to reposition the loose crystals from the improper canal to their original location.


Resolution of BPPV is high, above 90%, for most individuals after 1-3 effective treatment maneuvers are performed. If multiple canals are affected, repeated appointments may be necessary to perform follow-up treatment maneuvers safely and effectively. Once the treatment maneuver has been performed most patients feel relief from the spinning and unsteadiness they previously experienced right away. However, it is not uncommon for others to continue to feel mild residual unsteadiness or motion intolerance after the procedure. Reoccurrence of the condition is unfortunately a possibility.


If you feel you are experiencing brief episodes of vertigo with specific head movements seek guidance from a qualified healthcare professional. BPPV treatment is available to allow you to return to your daily routine in a steady, stable, and safe manner.







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