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.
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:
In most people, only a single ear is affected by BPPV, although both ears may be involved on occasion.
With advances in medical technology, BPPV can easily be diagnosed and treated. The diagnosis can usually be made in the office based on medical history and a physical exam. Treatment also involves a short, simple in-office procedure known as the particle repositioning maneuver. (See the treatment section).
Steps to determine affected side:
The particle repositioning procedure takes about 15 minutes to complete and involves a series of physical movements that change the position of the head and body. These actions shift the otoconia out of the semicircular canals and back into their proper location in the utricle.
The particle repositioning procedure begins with the patient sitting up and then lying down on a treatment table. The procedure is very easy to perform. Patients should wear comfortable clothing that will allow them to move freely.
A single particle repositioning procedure is effective in treating about 80% to 90% of cases of BPPV. Additional exercise or repositioning maneuvers may be needed if symptoms continue.
Step 1: Turn your head toward your affected ear.
Step 2: Lay back quickly. Hold.
Step 3: Keep your head back against the bed and turn it toward the good ear. Hold.
Step 4: Roll onto your side with your good ear down. Your nose should be turned toward the floor. Hold.
Step 5: Sit up, keeping your chin tucked in toward your shoulder. Hold. When you end, you should be sitting over the side of your bed so your feet touch the floor.
Step 6: Follow your post-particle repositioning instructions.
A new episode of BPPV can develop after successful treatment. On average, the rate of recurrence (new episode) is 15-50%.
However, it may be possible to treat recurrent BPPV at home by performing a series of movements when an episode occurs. Patients will receive information on ways to handle recurrences on their own, or they can work with an audiologist or physical therapist to develop a plan.
In general, if you wake up with positional vertigo, try the following steps:
Another method is to sit toward the foot of the bed, leaving enough room to lay back with your head resting comfortably at the end of the bed, slightly extended. Be careful not to overextend your neck, as this may aggravate existing neck problems. If your symptoms are severe, you may need assistance to complete the maneuver.
Without treatment, the symptoms of BPPV may persist. However, with time (usually within 6 weeks), the otoconia dissolve on their own. Until then, the number and severity of episodes may be reduced simply by paying careful attention to head position. In addition, anti-motion sickness drugs can control nausea.
However, before drugs are taken, it is usually best to try the particle repositioning procedure first. It is a very safe and rapid way to relieve symptoms and reduce the chance for falls. Medications should not be taken for a long period of time.
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or healthcare provider. Please consult your healthcare provider for advice about a specific medical condition. This document was last reviewed on: 06/04/2019