BPPV is one of the most common causes of brief episodes of spinning vertigo triggered by changes in head position. It occurs when tiny crystals in the inner ear become displaced and interfere with the body’s normal balance signals.
Although the sensation can be alarming, BPPV is usually treatable. A properly trained health professional can perform positional testing to confirm the diagnosis and use specific repositioning manoeuvres to move the crystals back into the correct part of the inner ear.
What is BPPV?
The name sounds complicated, but it describes the condition quite well:
- Benign means it is generally not caused by a serious or life-threatening condition.
- Paroxysmal means the symptoms come on suddenly and occur in short episodes.
- Positional means symptoms are triggered by changes in the position of your head.
- Vertigo is the false sensation that you, or the environment around you, are moving or spinning.
BPPV occurs in the inner ear, which is responsible not only for hearing but also for helping your brain understand where your body is in space and maintain your balance.
Inside the inner ear are tiny calcium crystals. These crystals normally sit in a part of the balance system where they help detect movement and gravity. In BPPV, some of these crystals become loose and move into one of the fluid-filled balance canals.
When you move your head, the loose crystals shift within the canal. This movement sends confusing signals to your brain about the position and movement of your head. Your eyes and other parts of your balance system may be sending different information, resulting in the sensation of spinning.
What does BPPV feel like?
The main symptom of BPPV is vertigo. Many people describe it as feeling as though the room is spinning, tilting or moving.
The episodes are usually triggered by particular head movements, such as:
- Rolling over in bed
- Lying back
- Bending down
- Tilting your head backwards
The spinning sensation often lasts for only a few seconds to around a minute. However, you may feel unsteady, light-headed or slightly “off balance” for longer afterwards.
Some people also experience nausea and, occasionally, vomiting.
BPPV does not usually cause constant dizziness throughout the day. Symptoms are typically brought on by movement or changes in head position.
Who can get BPPV?
BPPV can affect people of almost any age, but it becomes more common as we get older.
Sometimes there is no obvious reason why the inner ear crystals become loose. In other cases, BPPV may occur after:
- A knock or injury to the head
- A period of prolonged bed rest
- An inner ear problem
- Surgery involving the ear or head
- Other conditions affecting the balance system
Many people develop BPPV without any clear trigger.
How is BPPV diagnosed?
BPPV is usually diagnosed by a health professional taking a careful history of your symptoms and performing specific positional tests.
One commonly used assessment involves moving the person from a sitting position into a lying position with the head turned in a particular direction. The clinician watches the person’s eyes for a characteristic involuntary eye movement called nystagmus.
The timing and direction of the eye movement can help identify which part of the balance system is affected and which ear is involved.
How is BPPV treated?
The good news is that BPPV can often be treated effectively without medication or surgery.
Treatment usually involves a repositioning manoeuvre. These are a series of carefully controlled head and body movements designed to guide the loose crystals out of the affected balance canal and back to where they belong.
The Epley manoeuvre is one of the best-known treatments for a common form of BPPV involving the posterior semicircular canal.
During treatment, the clinician will move your head and body through several positions. This may temporarily bring on your vertigo, but the purpose is to move the loose crystals through the canal.
Some people improve after a single treatment, while others may need the manoeuvre repeated. The exact treatment depends on which canal is affected, so it is important that the assessment is performed correctly.
You should avoid trying random manoeuvres from the internet if you are unsure whether you actually have BPPV or which ear and canal are involved. The wrong manoeuvre may not help and can sometimes make symptoms more confusing.
When should you seek medical help?
Not all dizziness or vertigo is caused by BPPV. Other conditions affecting the inner ear, brain, nervous system, heart or circulation can also cause dizziness.
Seek urgent medical attention if vertigo occurs with symptoms such as:
- New weakness or numbness
- Difficulty speaking or understanding speech
- Facial drooping
- Double vision or a sudden major change in vision
- Severe difficulty walking
- A sudden, severe headache
- Fainting or loss of consciousness
These symptoms may indicate a more serious condition and should not be assumed to be BPPV.
So, what can you do…
If you are experiencing repeated episodes of vertigo, an assessment can help determine whether BPPV is the cause and whether treatment may provide relief. If this is you, do not hesitate to contact the friendly team at our Greenslopes clinic on (07) 3112 7439 to organise an assessment.