What Is BPPV?
Benign paroxysmal positional vertigo (BPPV) is an inner ear disorder that is the most common cause of vertigo, a very specific kind of dizziness that makes you feel as if the room is spinning around you.
Each part of the name describes a key part of this condition:
- Benign means it's not very serious. Your life is not in danger.
- Paroxysmal means that it hits suddenly, lasts a short time, and comes and goes.
- Positional means you trigger the vertigo with certain postures or movements of your head.
- Vertigo causes you to feel like your surroundings are moving or spinning when they're not.
BPPV is common and usually can be treated in a doctor's office.
In rare cases, the problem can be serious if it makes you more likely to fall. If you get these attacks often, they could point to other medical conditions. But they're often hard to diagnose.
BPPV Symptoms
Episodes can happen any time you tilt or change the position of your head. You could lose your balance and fall. You might feel scared that something is seriously wrong. The most common symptoms may include:
- A feeling that the room is spinning
- Nausea
- Vomiting
- Unsteadiness
- Lightheadedness
- Hearing loss
- Problems with your vision
Usually, you can expect to have rhythmic eye movements when you get BPPV. Your doctor might call this "nystagmus," and it's what they'll likely look for if they think you have vertigo.
BPPV Causes
Inside your ear are tiny crystals of calcium carbonate. You might think of them as "ear rocks." They're also called canaliths.
Sometimes, the crystals come loose from their normal spot in your ear and move to other areas, including the canals in your ears that sense your head's rotation. Once there, they can clump together. Because the clump is heavy compared with other things in your ear, it will sink to the lowest part of your inner ear. When you turn or change position, the clump will cause the fluid in your inner ear to slosh around after you've stopped moving. That creates the sense that you're moving even though you are still.
There are any number of ways you could trigger BPPV by moving your head in a certain way:
- Rolling over in bed
- Getting in and out of bed
- Standing from a sitting position
- Tipping your head back in a salon to get your hair washed
- Quick head movements
BPPV Risk Factors
BPPV can happen spontaneously, without reason. You're more likely to get it if you're older. That's because parts of the inner ear start to show wear and tear. Women are more likely to get it than men.
Other risk factors include:
- You have family members with it
- You have had a head injury before, even a small one
- You have had labyrinthitis, an inner ear condition
BPPV Diagnosis
Your doctor will ask questions about your general health and your symptoms.
Physical exam. Your doctor will look for the telltale eye movement of nystagmus. They may ask you to lie on your back on a table with your head tilted back off it. This is to show whether you can control your eye movements.
Your doctor also will look to see if symptoms of dizziness happen when your eyes or head moves in a certain direction and if doing so makes you dizzy for less than a minute. They may use something called Frenzel goggles to detect involuntary eye movements.
Medical tests for BPPV
Your doctor might also run tests, including:
Electronystagmography or videonystagmography. These check your eye movements and how they react to things that might trigger your vertigo.
MRI. This and other imaging tests may help rule out other causes of your symptoms.
BPPV Treatments
This condition is episodic and often goes away on its own. Your doctor may be able to stop your BPPV with a treatment in the office that moves the loose crystals in your ear into a spot that will cause less trouble.
To do this, they may use these techniques:
Epley maneuver. A physical therapist or an audiologist also can do the maneuver, or you can even do it at home yourself.
Semont maneuver. This is less common in the U.S. than the Epley. Each one takes about 15 minutes.
Canalith repositioning. You hold four positions for about 30 seconds or until the symptoms go away.
You will have to rest in the office for about 10 minutes before you can go home to make sure you don't have any quick episodes of vertigo as the crystals resettle.
You will need someone to drive you. Wear comfortable clothes so you can move easily.
Surgery. This is done less and less often, but rarely, you might need an operation to cure your BPPV. Your surgeon will plug a part of your inner ear to prevent the small calcium crystals from moving in your ear canal. Surgery carries a small chance of complications, including loss of hearing.
What Can I Do at Home?
Even after successful treatment of your BPPV, it can come back. But you can come up with a plan at home to help keep future bouts at bay. You should:
- Be aware of your risks of falling.
- Sit down at once if you feel dizzy.
- Use good lighting if you get up at night.
If your BPPV comes back, you can take steps to deal with your symptoms until you see a doctor. For instance, you can:
- Avoid sleeping on the affected side.
- Sleep with two or more pillows under your head.
- When you wake in the morning, lift your head slowly and sit on the side of the bed for a moment before you stand up.
- Avoid bending over to pick things up.
Your doctor may teach you a maneuver you can try at home to move the loose ear crystals back into a better place.
When to See Your Doctor
If you have dizziness off and on for more than a week, you should make an appointment with your doctor.
Call your doctor at once if you're dizzy or:
Takeaways
BPPV is an inner ear condition that is the most common cause of vertigo. It can make you feel dizzy, nauseous, and wobbly when you tilt your head certain ways. It's usually not serious, unless it puts you at a risk of falling. If your symptoms last longer than a week, or accompanied by other worrisome symptoms, make an appointment with your doctor.
