Benign Paroxysmal Positional Vertigo (BPPV)

Benign paroxysmal positional vertigo (BPPV) is a very common cause of vertigo, or head spinning, caused by loose particles (“crystals”) of calcium in the inner ear. The vertigo is brief, disturbing, and brought on by a change in head position. It is abrupt, intense, and sometimes violent, and is occasionally accompanied by nausea. It lasts for a few seconds, but the after-effect can be longer.

The typical attack is brought on by lying back quickly with the head turned to one side. It can also be brought on by bending, stooping, turning in bed, reaching for the top shelf, or working under a car. It does not occur while stationary.

At Mount Sinai, our hearing and balance exerts have been treating BPPV for decades and find that in most cases, BPPV can be treated effectively. Other causes for vertigo exist, however, and a neurotologist specialized in balance disorders can usually make the proper diagnosis and prescribe an effective treatment.

Causes of BPPV

BPPV is caused by loose particles of calcium in the inner ear. The calcium particles are microscopic crystals that are normally attached to one of the balance organs in the inner ear. In BPPV, these particles drift into one of the balance canals, where they don't belong. Tilting the head quickly causes the particles to move, stimulating the nerve receptors in that balance canal and creating the false sensation of movement (vertigo).

The condition usually comes about for no known reason. Occasionally it can be caused by a head injury or an ear infection. BPPV should be differentiated by other causes of vertigo that may not be as easy to treat.

Treatments for BPPV

BPPV can be effectively treated in most cases by a physical maneuver that is performed in the office. The particle repositioning maneuver (also called the Epley maneuver, after the doctor who devised it) redistributes the particles of calcium that cause the vertigo. The procedure is effective in a single session in a large percentage of cases. The remainder usually improve after a second session.

The particle repositioning maneuver is illustrated below. With the patient seated, the head is first brought into the position that triggers the vertigo. After the vertigo is allowed to pass, the head is then rotated 180o to the opposite position, allowing the calcium crystals to disperse into an area of the ear where they no longer cause vertigo. The patient is then brought upright, and after a pause, the maneuver is repeated to be certain that it was effective in clearing the problem.

After the procedure, the patient is instructed to sleep at home in a semi-reclining position (two pillows under the back), for at least two nights.

If the procedure doesn't work, the procedure is effective in most cases. If the vertigo persists after one treatment, a second maneuver in the office is usually effective. In a few cases, the vertigo will not respond to this treatment, or it may improve temporarily and then recur. In these cases, home balance exercises or treatment by a physical therapist may be prescribed. In rare cases that don’t respond to these measures, surgical treatment can be effective.