Benign Paroxysmal Positional Vertigo (BPPV)

What is Benign Paroxysmal Positional Vertigo?

Benign paroxysmal positional vertigo (BPPV) is a common cause of dizziness or the feeling of spinning, even when you are standing still. It can occur in people of any age, but mostly impacts older adults.

BPPV is caused by minor changes in the inner ear, which typically controls balance. Small calcium crystals move from their regular position inside the inner ear and form a clump or stone. When you move your head, the small stones dislodge more fluid than is typical inside the inner ear, which gives you a feeling of vertigo or dizziness. Even after you’ve stopped moving, the flow of this inner ear fluid can make you feel like you’re still in motion.

Sometimes this can occur after head trauma or high-intensity athletic activity where your head moves a lot. Other vestibular issues can make BPPV worse.

What are the Symptoms of Benign Paroxysmal Positional Vertigo?

If you have BPPV, you will likely notice dizziness and discomfort when you move your head, such as when you look up. You may also experience vertigo when you roll over in bed or get up from a chair — any time the position of your head changes quickly. Some people feel unsteady almost all the time when they are having particularly acute attacks.

The vertigo might cause you to feel nausea and even vomit, or it can cause you to become so disoriented that you fall.

Benign Paroxysmal Positional Vertigo Causes

Those who suffer from inner ear issues find that they can lead to benign paroxysmal positional vertigo (BPPV). The ear canals contain small calcium deposits which help to control balance. However, these deposits move around when the body is in different positions. When this happens, sensors are prompted and dizziness occurs.

Crystals within the otolith organs of the ear canals can become dislodged. When the body is lying down horizontally, the crystals can transfer into the semicircular canals. The semicircular canal takes on additional sensitivities that are atypical and this is what causes the symptoms.

The semicircular canals in the ear canal are highly sensitive. BPPV occurs due to a disruption within the inner ear. Fluid within the semicircular canals shifts when the position of the body changes. The brain receives unclear messages about the position of the body.

Another common cause can be suffering a blow to the head. Other causes that are less typical include inner ear disorders, damage that occurred during surgery, or periods of extended reclining, such as in a dentist’s chair. Migranes have also been identified as causes for BPPV.

How is Benign Paroxysmal Positional Vertigo Treated?

For mild cases of BPPV, your doctor may recommend simply waiting for the issue to resolve itself. Eventually, the inner ear is likely to heal itself and you’ll have fewer episodes of vertigo. If your dizziness is moderate to extreme or you are at risk of falling, your doctor may also prescribe medication that can help dampen the vestibular system’s reaction, but it may make you tired.

There are also methods that can redistribute the crystals and fluid in the inner ear and resolve the problem; these methods are cumulatively known as canalith re-positioning. Under the guidance of a physician or physical therapist, you complete multiple exercises that reposition the head to help the displaced crystals move into the correct location.

More extreme cases of BPPV may require surgery to change the way that the inner ear canal is shaped or to compress it so that fluid does not flow through. Because of the risk of hearing loss that are present with surgery, most doctors will recommend it as a last resort.

Benign Paroxysmal Positional Vertigo Prevention

There is not any effective prevention for BPPV if it occurs on its own; however, some cases which stem from a head injury can be prevented with the use of protective head gear when playing extreme sports.

There are many risk factors to keep in mind when it comes to preventing BPPV. Stress, depression, high caffeine intake, and excessive alcohol consumption could all be contributing factors. Existing ear conditions such as Menieres disease can also raise the risk of BPPV, which means sufferers of this condition should be on the look out for symptoms.

In addition, stress should be reduced as much as possible, while drugs and medications should be avoided so as to eliminate additional side effects. All medical matters should be approved by a physician.

Those who may be prone to exceptional dizziness may be able to prevent BPPV if they avoid situations which act as triggers. Situations to avoid could include heights, working with tools or heavy machinery, or possibly even driving.

Last Reviewed:
September 13, 2016
Last Updated:
November 15, 2017
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