Benign Paroxysmal Positional Vertigo (BPPV): Causes, Symptoms and Treatment

Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause of vertigo, a sensation of everything spinning around you. It results in brief episodes of dizziness, usually triggered by a change in head positioning.

BPPV is a condition affecting the inner ear. The inner ear contains semicircular canals and otolith organs that play a role in balance. The semicircular canals are three loop-shaped structures, positioned at right angles of each other. They contain fluid and fine, hairlike sensors. The fluid within the semicircular canals move with head movements stimulating the hairlike sensors, signaling to the brain the direction of angular acceleration. The otolith organs detect motion in a similar way. There are calcium carbonate crystals within the otolith organs. Movement of these crystals within the otolith organs signal to the brain the direction of linear acceleration.

BPPV occurs when the calcium carbonate crystals become dislodged and displaced from the otolith organs to the semicircular canals. When head movements occur, the hairlike sensors are stimulated. However, even when head movement ceases, the crystals within the semicircular canals continue to displace the hairlike sensors, resulting in the ongoing sensation of head movement. This is the feeling of dizziness and spinning.

What Causes BPPV?

Although there is no known cause for BPPV, it can be affected by degenerative changes with age, head trauma, inner ear viruses, and post-surgical interventions involving the ear.

How Can Physiotherapy Help with BPPV?

BPPV can be diagnosed and treated by a Physiotherapist. The diagnosis of BPPV will involve a series of tests and maneuvers (Figure 1 & Figure 2) that aim to provoke symptoms of vertigo and nystagmus (involuntary rhythmic movement of the eyes). A positive test will indicate which semicircular canal the crystals are located, and the direction to which the treatment will be performed.

Epley’s Maneuver (Figure 3) is the particle repositioning procedure that aims to relocate the crystals from the semicircular canals back to the otolith organs. It involves a series of physical movements that change the position of the head and body, in order to utilize gravity to move crystals back into their proper location.

Figure 1: Dix Hallpike Maneuver

Figure 2: Supine Roll Test

Figure 3: Epley’s Particle Repositioning Procedure

What Should be Avoided with BPPV?

Symptoms may include dizziness and a sensation that your surroundings are spinning (vertigo), nystagmus (involuntary rhythmic movement of eyes), loss of balance, nausea or vomiting. Consult a healthcare practitioner if these symptoms are present. Avoid positions that provoke these symptoms, for example, looking up or change in head position.

How Long does it take to Recover from BPPV?

When triggered, episodes of BPPV may be brief, lasting less than a minute, but could be longer. Research suggests that the calcium carbonate crystals can dissolve within the semicircular canals, but can take up to 6 weeks. Epley’s particle repositioning procedure can be performed in a clinical setting and takes about 15 minutes. However, it may take a few sessions to completely reposition the crystals.

If you are suffering from BPPV and would like to book in with one of our experienced Vestibular Rehabilitation providers, please book an appointment online or contact us today!