Benign paroxysmal positional vertigo (BBPV)

If you’ve ever experienced vertigo, you’re familiar with the extremely uncomfortable sensation of the room spinning around you. Benign paroxysmal positional vertigo (BPPV) is the most common inner ear problem and cause of vertigo. As indicated by the name, this condition isn’t life-threatening, is sudden with mild to intense dizziness that typically lasts less than a minute, is triggered by certain head positions, and results in a false sense of spinning. Of course, anyone who has experienced BPPV firsthand knows that the symptoms can be challenging and debilitating.

BPPV Facts & Stats

  • About 17–42% of people with vertigo are ultimately diagnosed with BPPV
  • An estimated 1 to 2.4 million outpatient visits in the U.S. are attributed to BPPV every year
  • Nearly 86% of individuals with BPPV experience some disruption in daily activities and lost days of work
  • About 68% of people with BPPV reduce their workload, 4% change jobs, and 6% quit jobs due to this condition

Causes of BPPV

Tiny calcium carbonate crystals that normally reside in an inner-ear organ (utricle) help you maintain your balance. When these particles break free and travel into the three semicircular canals of your inner ear, BPPV can occur. As mentioned, the disorder is triggered by position, so moving your head in certain ways (e.g., dropping it forward to pick up something from the floor) can cause the crystals to move and provoke an episode.

The prevalence of vertigo is higher in individuals 60 and older, likely due to age-related blood vessel and circulation changes in the inner ear. BPPV is often classified as a degenerative change in the inner ear associated with aging. About 50% of people 65 and older will experience a BPPV episode at some point in their lives. And the incidence of falls, depression, and impairments of daily activities increases in older adults with BPPV.

Some studies suggest that cerebrovascular risk factors influence BPPV recurrence and symptom severity. One study found a relationship between BPPV and an increased risk of ischemic stroke. And individuals with BPPV and co-occurring high blood pressure and cholesterol levels were at a higher risk of symptom recurrence. Although aging is a risk factor for BPPV, a recent study found that it wasn’t associated with recurrence. Additional risk factors include:

  • Trauma
  • Inner ear infection or disease
  • Diabetes
  • Osteoporosis
  • Intubation (likely due to prolonged time lying in bed) 

BPPV Symptoms

The symptoms of BPPV are the same as the other types of vertigo, although the duration is typically much quicker. BPPV episodes are associated with:

  • Dizziness
  • Feeling like you or your surroundings are spinning or moving (vertigo)
  • A loss of balance or unsteadiness
  • Nausea
  • Vomiting
  • Abnormal rhythmic eye movements (nystagmus) 

BPPV Diagnosis

BPPV tests used for diagnosis include the Dix-Hallpike maneuver and Roll Tests. These tests involve moving your head into specific positions. This causes dislodged crystals to move and trigger vertigo, while a trained practitioner watches for telltale eye movements (nystagmus). Abnormal eye movement is a clue that an underlying mechanism is causing fluid to move in your inner ear canal.

BPPV Treatment

For most people, BPPV clears up on its own within weeks of the first episode. If it doesn’t clear up in a few weeks, then you should consider treatment. The Epley maneuver (also called the particle repositioning procedure) is the gold standard treatment, painless, and easy to perform. It consists of a series of four quick movements of the head and body from sitting to lying, rolling over, and back to sitting. These movements allow the crystals to migrate out of the semicircular canals back to the utricle. About 85–90% of people experience complete relief after just one or two treatment sessions. If you’re not sure which ear is impacted, get an assessment prior to ding this maneuver so that you don’t cause more damage.

If symptoms persist after treatment, it’s recommended that you consult a vestibular rehabilitation therapist, who will suggest specific exercises to help you regain stability and balance. It’s important to get an accurate diagnosis because these symptoms can be the sign of a more severe disease. Don’t delay and see a licensed hearing care professional as soon as possible.

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