• Benign Paroxysmal Positional Vertigo

    (BPPV; Benign Positional Vertigo, BPV; Positional Vertigo of Barany)


    Vertigo is a feeling of movement or spinning when you are still. Benign paroxysmal positional vertigo (BPPV) happens when the vertigo is caused by changes in the position of the head. This might include standing after bending down, turning the head in bed, or extending the neck to look up. People with BPPV can often identify which moves cause the most problems.


    The inner ear contains tiny crystals. These crystals can sense movement and help you keep your balance. BPPV occurs because of a shift in location of these crystals or the clumping of these crystals. When this happens, your brain gets signals that you are moving when you are really not moving. This causes the feeling of movement.
    Inner Ear
    Inner ear deposits
    The clump of ear crystals can lead to BPPV.
    Copyright © Nucleus Medical Media, Inc.
    In some cases, the cause of BPPV is unknown. In others, it may be caused by:
    • Head injury
    • Viral infection
    • Disorders of the inner ear
    • Prolonged immobility of the head
    • Age-related changes to inner ear

    Risk Factors

    Increasing age increases your chances of getting BPPV.


    Symptoms may include:
    • Sensation of spinning or rotation when you change head position that last less than one minute
    • Loss of balance
    • Nausea
    • Vomiting
    • Ringing or buzzing sounds in the ear
    • Vision or hearing problems


    Your doctor will ask about your symptoms and medical history. A physical exam will be done. Part of the process will be to eliminate other disorders. Your doctor may recommend tests to help determine the cause of vertigo symptoms. Tests may include:
    • Blood pressure test, both lying down and standing up
    • Blood tests
    • Auditory tests
    • Vision tests
    • Dix-Hallpike maneuver—moving your head or body in certain ways to test response
    • MRI scan
    • Electronystagmography (ENG)


    Many times BPPV can resolve on its own, usually within months of onset. Talk with your doctor about the best treatment plan for you. Treatment options include the following:

    Vestibular Rehabilitation

    Your doctor may suggest specific vestibular exercises. These exercises use a series of eye, head, and body movements to get the body used to moving without dizziness. You may work with a physical therapist to learn these.

    Canalith Repositioning

    This procedure (also called the Epley maneuver) is done in your doctor’s office. Your doctor will move your head in different positions to try to resettle the tiny crystals. The procedure is sometimes repeated and you may be taught how to do it at home.


    Some people with BPPV undergo surgery. During surgery, a piece of wax may be used to plug one area of your ear. This will prevent fluid in your inner ear from moving. Another type of surgery that may be done involves cutting the nerve from the inner ear.


    There are no current guidelines to prevent BPPV.


    American Academy of Otolaryngology—Head and Neck Surgery http://www.entnet.org

    Family Doctor—American Academy of Family Physicians Family Doctor http://familydoctor.org


    Canadian Academy of Audiology http://www.canadianaudiology.ca

    Canadian Society of Otolaryngology http://www.entcanada.org


    Benign paroxysmal positional vertigo (BPPV). American Academy of Family Physicians Family Doctor website. Available at: http://familydoctor.org/familydoctor/en/diseases-conditions/benign-paroxysmal-positional-vertigo.html. Updated July 2010. Accessed April 25, 2013.

    Benign paroxysmal positional vertigo (BPPV). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated January 14, 2013. Accessed April 25, 2013.

    Benign paroxysmal positional vertigo. The Merck Manual Professional Edition website. Available at: http://www.merckmanuals.com/professional/ear%5Fnose%5Fand%5Fthroat%5Fdisorders/inner%5Fear%5Fdisorders/benign%5Fparoxysmal%5Fpositional%5Fvertigo.html. Updated November 2012. Accessed April 25, 2013.

    Benign paroxysmal positional vertigo (BPPV). Vestibular Disorders Association website. Available at: https://vestibular.org/understanding-vestibular-disorders/types-vestibular-disorders/benign-paroxysmal-positional-vertigo. Accessed April 25, 2013.

    Post RE, Dickerson LM. Dizziness: A diagnostic approach. Am Fam Physician. 2010;82(4):369.

    9/10/2014 DynaMed's Systematic Literature Surveillance. http://www.ebscohost.com/dynamed: University of Texas at Austin School of Nursing, Family Practitioner Program. Evaluation of vertigo in the adult patient. Austin (Tx): University of Texas at Austin, School of Nursing; 2014 May. 19 p. Available at: http://www.guideline.gov/content.aspx?id=48220#Section427. Accessed September 10, 2014.

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