Benign Paroxysmal Positional Vertigo
(BPPV; Benign Positional Vertigo, BPV; Positional Vertigo of Barany)
Pronounced: Ba-nine Par-ox-see-mal Positional Ver-ta-go
Vertigo is a feeling of movement, including spinning. Benign paroxysmal positional vertigo (BPPV) happens when the position of the head is changed. This might include standing after bending down, turning the head in bed, or extending the neck to look up. People with BPPV can often identify which moves cause the most problems.
If you suspect you have this condition, contact your doctor.
The inner ear contains tiny crystals. These crystals can sense movement and help you keep your balance. BPPV occurs because of a shift in location of these crystals. When these crystals move to the wrong location or clump in one spot, BPPV can result.
BPPV may be caused by:
- Head injury
- Viral infection, such as labyrinthitis , an infection of the nerve to the ear
- Disorders of the inner ear
- Prolonged immobility of the head
- Age-related changes to inner ear
These factors increase your chance of BPPV. Tell your doctor if you have any of these risk factors:
- Advancing age
- Head injury
- Prolonged immobility of head
If you have any of these symptoms do not assume it is due to BPPV. These symptoms may be caused by other conditions. Tell your doctor if you have any of these:
- Sudden dizziness that lasts less than a minute
- Feeling of spinning
- Dizziness with certain movements
- Loss of balance
- Feeling unsteady
Your doctor will ask about your symptoms and medical history. A physical exam will be done. Your doctor will look for symptoms of dizziness as you move your head. Abnormal eye movements common to BPPV may be found. You may be referred to a doctor who specializes in treating ears (otolaryngologist).
Tests may include the following:
- Electronystagmography (ENG)—test that uses electrodes to measure eye movements; used to evaluate inner ear disease
- MRI scan —test that uses magnetic waves to form a picture of body structures; used to look for other problems in the brain that may cause symptoms
Many times BPPV can resolve on its own, usually within months of onset. Talk with your doctor about the best treatment plan for you. Treatment options include the following:
Vestibular Exercises (Vestibular Rehabilitation)
Your doctor may suggest specific vestibular exercises. These exercises use a series of eye, head, and body movements to get the body used to moving without dizziness. You may work with a physical therapist to learn these.
This procedure is done in your doctor’s office. Your doctor will move your head in different positions to try and resettle the tiny crystals. The procedure is sometimes repeated and you may be taught how to do it at home.
Some people with BPPV undergo surgery. During surgery, a piece of wax may be used to plug one area of your ear. This will prevent fluid in your inner ear from moving. Another type of surgery that may be performed involves cutting the nerve from the inner ear.
of Family Physicians
of Otolaryngology – Head and Neck Surgery
Canadian Academy of Audiology
Canadian Society of Otolaryngology – Head and Neck Surgery
Benign paroxysmal positional vertigo (BPPV). American Academy of Family Physicians website. Available at: Benign paroxysmal positional vertigo (BPPV). DynaMed website. Available at: http://familydoctor.org/online/famdocen/home/articles/200.html . Accessed November 12, 2008.
Benign paroxysmal positional vertigo (BPPV). DynaMed website. Available at: http://dynaweb.ebscohost.com/Detail.aspx?id=113695&sid=59f8ee48-9574-480a-9a0a-77a2548cb2cb@sessionmgr7 . Accessed November 12, 2008.
Benign paroxysmal positional vertigo. Mayo Clinic website. Available at: http://www.mayoclinic.com/health/vertigo/DS00534 . Accessed November 12, 2008.
Froehling DA, Bowen JM, Mohr DN; Brey RH, Beatty CW, Wollan PC, Silverstein MD. The Canalith Repositioning Procedure for the Treatment of Benign Paroxysmal Positional Vertigo: A Randomized Controlled Trial. Mayo Clin Proc [serial online]. 2000;75:695-700. Available from: http://www.mayoclinicproceedings.com/inside.asp?ref=7507a4 . Accessed November 21, 2008.
Kerber KA, Baloh RW. Dizziness, vertigo, and hearing loss. In: Bradley WG, Daroff RB, Fenichel GM, Jankovic J, eds. Neurology in Clinical Practice . 5th ed. Philadelphia, PA: Butterworth Heniemann Elsevier; 2008:237-254.
Schroeder K. Vertigo. EBSCO Health Library website. Available at: http://healthlibrary.epnet.com/GetContent.aspx?deliverycontext=&touchurl=&CallbackURL=&token=D39207C8-9100-4DC0-9027-9AC6BA11942D&chunkiid=11471&docid=/dci/vertigo . Accessed November 12, 2008.
Last reviewed November 2008 by
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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