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man suffering from vertigo holding his head in discomfort
man suffering from vertigo holding his head in discomfort
man suffering from vertigo holding his head in discomfort

by Joon Nah    BScPT
Certified Vestibular Physiotherapist
updated July 18, 2020

What is BPPV?

BPPV is short for Benign Paroxysmal Positional Vertigo.  It is a disorder of the inner ear that results in vertigo (spinning sensation) with specific changes in head position.

The vestibular organ (located in your inner ear) is a sensory organ that sends messages about movement and changes in position to your brain.  It is made up of 3 semi-circular fluid-filled canals and 2 otolith organs which contain the sensory nerves that communicate movement information when stimulated and also send information to your eye muscles to control your gaze and your body to help it stay upright.



The otoliths contain 2 beds of calcium carbonate “crystals” called otoconia.  BPPV results when pieces of these otoconia dislodge or break away and move into the semi-circular canal system, either floating in the fluid within one or more canals, or adhering to the “cupula” at the end of the canal.  The abnormal presence of these crystals in the canal now sends incorrect information about head movement to the brain, which can cause vertigo, abnormal eye movements (nystagmus), and imbalance.

Signs and Symptoms of BPPV

Potential signs and symptoms of BPPV include the following:

  • Intermittent bouts of a spinning type of dizziness that is usually short in duration (less than 30 seconds)
  • True sensations of vertigo (room is spinning around you, or you feel as if you are spinning)
  • Triggered by specific movements of the head, e.g. rolling in bed to the right or looking up
  • Irregular eye movement that occurs with the vertigo
  • Mild or no symptoms when your head is still
  • Nausea, vomiting and lightheadedness

What Are Causes for BPPV?

Currently for majority of cases, the cause of BPPV is unknown.  However in some cases, it can be due to the following:

  • Rapid acceleration/deceleration of the head (e.g. head trauma, concussion, whiplash)
  • An existing vestibular problem (e.g. neuritis, labyrinthitis, Meniere’s)
  • Natural age-related changes to the otolith organs
  • Following significant periods of inactivity
  • Following certain surgical procedures involving specific positioning of the head

Risk Factors

  • Aging (especially >60 years old)
  • Possibly existing osteopenia/osteoporosis
  • Traumatic brain injury
  • Prior episodes of BPPV or a family history of BPPV

Treatment for BPPV

Treatment aims to move the head in various directions to enable the otoconia (cystals) to dislodge and/or move through the canal and migrate back to the vestibule where they originated.

For the vast majority of cases, treatment is highly successful and relatively quick.  However this is dependent upon proper diagnosis and appropriate application of the correct manoeuvre.

There are 12 different variants of BPPV (6 per side).  An assessment will determine what type of BPPV exists.  Then manoeuvres specific to that variant would be applied.  This can be manually performed by a qualified therapist, or can be taught as a home exercise.  The Epley Manoeuvre (Maneuver) is the most well known corrective procedure that is often used to treat a posterior and anterior canalithiasis.  For more information about the Epley click here.  Other treatment manoeuvres include Gufoni’s, Semont’s, Brandt-Daroff, and the horizontal roll among others.

Once the BPPV is resolved, some patients may require some physiotherapy to address residual dizziness.

Prognosis and Outcomes

For most people BPPV can be easily corrected within 1-3 treatments.  However having BPPV does increase the likelihood of getting BPPV again.  This is largely due to the continued presence of risk factors that accompanied initial onset.

The more complicated variants of BPPV can require more time and more manoeuvres to resolve.  However these cases eventually improve as well.

Special Notes

Interestingly approximately 10% of those over 65 have an existing BPPV.  There is definitely a role for prevention of falls from imbalance in the elderly with some simple vestibular screening.

There are many reasons why a person can experience dizziness;  some of them quite serious.  Any uncertainty should absolutely be addressed by a qualified health professional.  Cornerstone Dizziness Clinic is proud to offer a research-based rehabilitation program in Vestibular and Balance Disorders.  Please contact our clinic for more information.

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