What is benign paroxysmal positional vertigo (BPPV)?

Benign paroxysmal positional vertigo (BPPV) is an inner ear disorder in which changes in the position of the head, such as tipping the head backward, lead to sudden vertigo – a feeling that the room is spinning. The vertigo sensation can range from mild to severe and usually lasts only a few minutes. It may be accompanied by other symptoms, including:

Anatomy of the right inner ear

BPPV is not a sign of a serious problem, and it usually disappears on its own within 6 weeks of the first episode. However, the symptoms of BPPV can be very frightening and may be dangerous, especially in older people. About half of all people over age 65 suffer an episode of BPPV. The unsteadiness caused by BPPV can lead to falls, which are a leading cause of fractures in this age range.

What causes benign paroxysmal positional vertigo (BPPV)?

BPPV develops when calcium carbonate crystals, which are known as otoconia, shift into and become trapped within the semicircular canals (one of the vestibular organs of the inner ear that control balance). The otoconia make up a normal part of the structure of the utricle, a vestibular organ next to the semicircular canals. (See illustration.)

In the utricle, the otoconia may be loosened because of injury, infection, or age. They land in a sac – the utricle – where they are naturally dissolved. However, otoconia in the semicircular canals will not dissolve. As a person’s head position changes, the otoconia begin to roll around and push on the tiny hair-like processes (cilia) within the semicircular canals. Those cilia help to transmit information about balance to the brain. Vertigo develops when the cilia are stimulated by the rolling otoconia.

Movements that can bring about an episode of BPPV include:

  • Rolling over or sitting up in bed;
  • Bending the head forward to look down, or;
  • Tipping the head backward.

In most people, only a single ear is affected by BPPV, although both ears may be involved on occasion.

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