A shift in perspective, whether that is tiling the head in one direction or moving from laying down to sitting up, can suddenly send your world spinning. You soon lose direction of which way is up and down, and even closing your eyes does not offer a reprieve from the dizziness.

What do you do when this happens to you, and how can you prevent it from happening again? We have gathered all the important information surrounding BPPV, including what it is, why it happens, and how our new Advanced Dizziness and Balance Center can help.

What is BPPV?

BPPV is a condition that occurs due to a problem with the inner ear. For those who experience vertigo, it is most often due to BPPV, showing that despite the small size of the inner ear, it can dramatically impact your well-being.

Vertigo is a feeling of spinning or movement even though you are still. It is a way in which our brain misinterprets information, messing with our sense of balance and direction.

Causes of BPPV

Understanding the cause of BPPV first requires an understanding of the inner ear.

The inner ear contains a sensory organ called the utricle, which is composed of otoconia (calcium crystals). If these crystals detach from the utricle, they can freely flow within the spaces in the inner ear that are filled with fluid. This includes the semicircular canals (SCC), which help your brain interpret rotations in the head.

These crystals do not cause any problems until your head changes positions, such as when rolling over, looking up/down, or going from seated to lying or vice versa. When you make these movements, the otoconia can move to the lowest section of the canal, which then causes fluid to flow through the SCC. This fluid flow stimulates the balance nerve, causing vertigo and nystagmus (jumping eyes).

So, what causes these crystals to detach? There are many scenarios, including:

  • keeping the head in the same position for a long time
  • mild to severe head trauma
  • high intensity aerobics
  • bike riding on rough trails
  • other inner ear diseases (inflammatory, ischemic, infectious)
  • possibly allergy/sinus/barometric pressure changes

In some people, especially those who are older, there may be nothing in particular that causes BPPV.

Who Is Affected By BPPV?

While BPPV can affect individuals of all ages, it is most common in those over the age of 60.

Overall, BPPV is a common condition, and is estimated to affect 50% of all people at some point in their life.

Symptoms of BPPV

The most apparent symptom of BPPV is vertigo, or the sensation of movement despite the body remaining still, when moving the head forward/backward or in/out of bed. Many people describe vertigo as feeling like they are spinning, even though they know they are remaining still.

Vertigo can be dangerous, especially when it affects someone while they are standing or driving. Those who look up while walking and experience a BPPV attack may sway or fall over, which can cause an injury.

In addition to the injury risk, BPPV can also cause nausea and vomiting that lingers after the dizziness has subsided.

Diagnosing BPPV

When diagnosing BPPV, your doctor/audiologist will start with a detailed history of your health. They can then confirm the diagnosis by looking for nystagmus, which is a jerking of the eyes that occurs with vertigo due to changing head positions. To put you in a situation where this phenomenon can be observed, your doctor/audiologist will perform the Dix-Hallpike maneuver.

For this maneuver, your doctor/audiologist will have you start in a sitting position with the head turned 45 degrees to the side. Then, you will be laid backward, placing the head so it slightly hangs over the examination table’s edge. This quick movement often brings along vertigo, allowing the doctor to look for the eye jerking that accompanies it. If nystagmus is observed, the doctor/audiologist will diagnose you with BPPV. More involved diagnostic tests, such as CT scans or MRIs, are unnecessary in most cases.

It is often a relief for patients to receive a BPPV diagnosis because it provides a clear path for treatment to relieve their symptoms.

Treating BPPV

One of the most common treatments for BPPV is physical therapy, which is a focus of our Advanced Dizziness and Balance Center.

One standard treatment for the most common form of BPPV, where crystals find their way to the posterior SCC, is the Epley Maneuver. This maneuver involves a series of movements that sequentially turns the head to help the crystals move out of the SCC. In some cases, a patient may require one or two maneuvers within a single visit to fully relieve their symptoms.

In addition to the Epley Maneuver, physical therapy can offer other maneuvers that help with crystals that are in locations besides the posterior semicircular canal. However, they all have the same goal of removing the crystals from the semicircular canal.

For most cases of BPPV, these physical therapy maneuvers and interventions are enough to treat the symptoms of vertigo. However, if someone experiences severe nausea or vomiting from the dizziness, medication can be administered, especially for those who would otherwise not be able to perform the maneuvers.

Try Our New Advanced Dizziness and Balance Center

Our dizziness center contains state-of-the-art equipment and practitioners that allow us to determine the true cause of your dizziness, offering a more efficient treatment.

Around half of those who experience BPPV once will experience it again. To help with this, especially in those with frequent recurrences, home exercises and maneuvers can help to manage symptoms. However, if the home maneuver is not helping, our Advanced Dizziness and Balance Center is always here to provide professional guidance to ease your dizziness and return your world to right-side-up.

If you suffer from BPPV, visit our Advanced Dizziness and Balance Center to determine its cause and receive treatment that can finally bring some relief.


What is BPPV? Information and support/Vestibular disorders. (2022).  https://www.menieres.org.uk/information-and-support/symptoms-and-conditions/bppv


Palmeri R, Kumar A. Benign Paroxysmal Positional Vertigo. [Updated 2022 Jan 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470308//





















About the author : Advanced ENT & Allergy

About the author : Advanced ENT & Allergy