An inner ear disorder called benign paroxysmal positional vertigo (BPPV) causes dizziness or vertigo when you move your head. BPPV is characterized by the sensation that the body or surroundings is spinning or moving. It is benign, meaning it is not life-threatening or serious. It is paroxysmal, meaning it occurs in short bursts. Positional means it is triggered by specific head movements or positions.
BPPV is thought to be caused by tiny solid fragments (otoconia) in the inner ear labyrinth. The labyrinth is a complex system of fluid-filled tubes and chambers that help you sense balance and orientation. Normally, the otoconia are attached to a membrane in the labyrinth called the utricle. They can sometimes break loose from the membrane and migrate into the semicircular canals, which detect rotation of the head. When this happens, the otoconia can interfere with the normal fluid movement in the canal and stimulate nerve endings that send signals to your brain about your head position. The mismatch between what your eyes see and what your inner ear senses can result in vertigo.
BPPV causes vertigo, which lasts less than a minute and occurs when you change your head position. For example, you may experience vertigo when you:
Lie down or sit up in bed
Turn your head to look over your shoulder
Bend over to pick up something from the floor
Tilt your head back to look up
BPPV may also cause the following symptoms:
Nausea or vomiting
Loss of balance or unsteadiness
Abnormal eye movements (nystagmus)
Some people may experience mild symptoms that do not interfere with their daily activities, while others may experience severe symptoms that affect their quality of life.
Doctors, audiologists, and physical therapists who specialize in balance disorders can diagnose BPPV based on your medical history, physical examination, and specific tests that produce vertigo. These tests include:
This test involves lying down on a table with your head turned to one side and rapidly lowering your head to the ground. If you have BPPV in the posterior semicircular canal, which is the most common location, this maneuver can trigger vertigo and nystagmus.
A roll test involves lying on your back with your head slightly raised and rapidly turning your head to one side and then the other. This maneuver may trigger vertigo or nystagmus if you have BPPV in the horizontal semicircular canal, which is less common.
A suine head turn test involves lying on your back with your head slightly raised and slowly turning your head one way and holding it for 30 seconds. In rare cases, BPPV in the anterior semicircular canal can cause vertigo and nystagmus with this maneuver.
Additionally, your doctor may order additional tests to rule out other causes of vertigo, such as:
In electronystagmography (ENG) or videonystagmography (VNG), your head is moved in different positions while electrodes or cameras measure involuntary eye movements.
A magnetic field and radio waves are used to create detailed images of your brain and inner ear during magnetic resonance imaging (MRI).
There are effective treatments available that can help relieve BPPV sooner if the condition persists or affects your daily activities. However, if the condition persists or affects your daily activities, there are effective treatments available that can help relieve BPPV sooner. A series of head movements referred to as the canalith repositioning procedure (CRP) or the Epley maneuver is usually used to treat BPPV. During this procedure, the otoconia are moved from the semicircular canal where they cause trouble to another area of the labyrinth where they do not cause problems.
Doctors, audiologists, or physical therapists can perform the CRP in their offices or clinics. Several simple and slow maneuvers are used to position the head at various angles. The procedure usually works after one or two sessions, but it may have to be repeated if the symptoms recur. Each position is held for about 30 seconds after any symptoms or abnormal eye movements stop.
You can also learn how to perform the CRP on yourself at home with the guidance of your doctor or therapist. You should not perform the CRP on your own without proper instruction, since you might worsen your symptoms or cause injury if you have frequent or recurrent episodes of BPPV.
Other treatments for BPPV may include:
It is possible for your doctor to prescribe medication to suppress vertigo, nausea, or vomiting. These medications include meclizine, dimenhydrinate, or scopolamine. These medications, however, do not treat the underlying cause of BPPV and may cause drowsiness or dry mouth as side effects.
When CRP does not work or is not suitable, your doctor may recommend surgery to block the semicircular canal affected by BPPV in rare cases. In this surgery, a bone plug is placed in the canal to prevent it from responding to head movements. It has a success rate of about 90%, but there are some risks, including hearing loss or infection.
BPPV can occur without any known cause or trigger, so there is no sure way to prevent it. However, some general tips can help reduce the risk or recurrence of BPPV.
Be careful not to dislodge the otoconia from the utricle with sudden or extreme head movements
When lying down or sleeping, keep your head elevated
If you know which canal is affected, avoid lying on that side
Avoid alcohol, caffeine, and tobacco and stay hydrated
Practice relaxation techniques to manage stress
Exercise regularly and eat a balanced diet to maintain a healthy lifestyle
When you move your head in certain ways, BPPV can cause episodes of dizziness or vertigo. The inner ear is affected by solid fragments that interfere with fluid movement in the semicircular canals. Doctors, audiologists, and physical therapists can diagnose BPPV using specific tests that induce vertigo in order to diagnose it. Treatment for BPPV involves moving the fragments out of the canal with a series of head movements called canalith repositioning. As a result, BPPV can sometimes go away on its own, but it may recur in the future. Maintaining a healthy lifestyle and avoiding sudden or extreme head movements can help prevent BPPV.
