Article Summary
Benign Paroxysmal Positional Vertigo (BPPV) is the most common reason people feel dizzy, specifically a spinning feeling called vertigo. It happens when tiny crystals in the inner ear, called otoconia, get loose and move into the wrong part of the ear. This can make you feel dizzy when you change positions or move your head.
What Happens During a BPPV Episode?
BPPV is the most common vestibular disorder. BPPV is not dangerous, but it can be annoying. Here’s what it means:
- Benign: It’s not life-threatening.
- Paroxysmal: It comes in sudden and brief episodes.
- Positional: It happens with certain head movements.
- Vertigo: A false sense of spinning or moving.
During a BPPV episode, the loose crystals move with gravity, causing fluid in the ear to move when it normally wouldn’t. This confuses the brain and makes you feel like you’re spinning, even when you’re not. These dizzy spells usually last less than a minute, and some people feel normal between episodes, while others may feel slightly off-balance. BPPV doesn’t cause constant dizziness, affect your hearing, or lead to fainting or other serious symptoms. If you have those issues, you should see a doctor, as it might be another problem. Some people with chronic BPPV might feel ongoing balance issues, even if they aren’t in the middle of a dizzy spell.
Who Is Affected?
BPPV is a common condition, affecting about 107 people out of every 100,000 each year. About 2.4% of people will experience it in their lifetime. It’s rare in children but can happen to adults, especially older ones. Most people get BPPV for no clear reason—many say they just woke up one morning and the room started spinning. Some things that might increase the risk include: head injuries, migraines, inner ear infections, low vitamin D, diabetes, osteoporosis, and prolonged bed rest. Your preferred sleep side might also matter.
Where Should I Seek Help?
If you think you have BPPV, start with your family doctor. They might recognize the symptoms, especially since BPPV can be triggered by rolling over in bed or quickly moving your head. However, they may not know how to treat it and might refer you to a specialist like a vestibular therapist, physical therapist, or an ENT doctor. Unfortunately, some doctors don’t know about the effective treatments, and they may tell you to just wait and hope it goes away.
How Is BPPV Diagnosed?
Getting an MRI won’t help in diagnosing BPPV because it doesn’t show the small crystals that have moved in the inner ear. Instead, BPPV is diagnosed by observing eye movements. When the head is moved, the dislodged crystals cause the eyes to move in a specific way, known as nystagmus. This usually looks like the room is spinning, which is a common sign of vertigo. The eye movement is the clue that something must be happening to move the fluid in the inner ear canals when it shouldn’t be. Based on what type of nystagmus a person has, doctors can identify which ear and canal is affected using tests like the Dix-Hallpike or Roll Tests. These tests involve tilting the head in certain positions to let gravity move the crystals.
There are two types of BPPV. In the more common type, called canalithiasis, the crystals move freely, and the spinning sensation lasts less than a minute after a head movement. In the rarer type, called cupulolithiasis, the crystals are stuck on the nerves, causing the spinning to last longer. Knowing which type you have is important because the treatments are different.
How Is BPPV Treated?
BPPV is often treated without medication because it doesn’t really help. Most of the time, BPPV can be fixed with specific movements that use gravity to move the tiny crystals in your ear back to where they belong. Your doctor will find out which canal has the crystals and then guide you through specific movements. One well-known method for treating BPPV is the Epley maneuver, but it doesn’t work for everyone. There are actually three canals in each ear, and BPPV can vary, so it’s important to make sure you’re getting the right treatment. If you try to do these maneuvers on your own or have someone untrained help you, it might not work and could cause problems.
What Happens After Treatment?
Research shows that these treatment maneuvers are effective in over 90% of cases after 1-3 treatments, though some types of BPPV may take longer to resolve. After treatment, your therapist may advise you to avoid certain head positions for a few days, but this typically doesn’t significantly impact the results. Even if the spinning feeling goes away, you might still feel a little unsteady, so it’s important to see your therapist for follow-up and exercises to help you feel better.
Will It Come Back?
BPPV can come back, with about 50% of people experiencing it again within 5 years, especially if it was caused by an injury. If it keeps returning in the same ear, your therapist might show you how to do a special maneuver by yourself. However, many people choose to visit their therapist again to confirm it’s the same issue and to get the right treatment since BPPV can vary.
Conclusion
BPPV is a common problem, especially as people get older. It can range from a minor annoyance to a serious issue that affects everyday life. Luckily, symptoms often improve over time or go away on their own. With help from a trained healthcare professional, most people can find relief and stop the spinning sensations.
RESOURCES
- Resources for veterans and active military service members
- The American Academy of Otolaryngology-Head and Neck Surgery’s Clinical Practice Guidelines on BPPV.
- For more in-depth information about BPPV, you may wish to purchase VeDA’s book, “BPPV – What You Need To Know” from our online store.
“BPPV – What You Need to Know” is for people who have or suspect they have Benign Paroxysmal Positional Vertigo (BPPV) and want to know more about its nature, diagnosis, and treatments, as well as strategies for coping with its effects. - Check out the American Academy of Otolaryngology-Head & Neck Surgery’s BPPV Clinical Practice Guidelines.
