Benign paroxysmal positional vertigo (BPPV)

Benign paroxysmal positional vertigo (BPPV) is a disorder that causes vertigo, dizziness, and other symptoms due to debris that has collected within a part of the inner ear. This debris, called otoconia, is made up of small crystals of calcium carbonate (sometimes referred to colloquially as “ear rocks”). With head movement, the displaced otoconia shift, sending false signals to the brain.

Symptoms of BPPV are almost always precipitated by a change in head position. Getting out of bed and rolling over in bed are two common "problem" motions. Some people feel dizzy and unsteady when they tip their heads back to look up. An intermittent pattern of these symptoms is usual.

About 20% of all dizziness is due to BPPV. The most common cause of BPPV in people under age 50 is head injury. About 50% of dizziness in older people is due to BPPV. In half of all cases, BPPV is idiopathic, which means that it occurs for no known reason. BPPV is also associated with migraine.

Diagnostic tests for BPPV include tests that look for the characteristic nystagmus (jumping of the eyes), such as the Dix-Hallpike test and electronystagmography (ENG).
 
Particle-repositioning maneuvers, including the Epley maneuver and the Semont-liberatory maneuver, are very effective in treating BPPV and can be performed in the doctor's office in about 15 minutes. The goal of these maneuvers is to move the detached otoconia out of one of the semicircular canals. Treatment may also include individualized vestibular physical therapy exercises designed to help “retrain the brain.” The Brandt-Daroff habituation exercises are sometimes recommended and can be done at home. Canal-plugging surgery may be another option.

From VEDA publication R-5, Benign Paroxysmal Positional Vertigo (BPPV). VEDA also publishes the book BPPV—What You Need to Know (publication B-8).