Benign Paroxysmal Positional Vertigo (BPPV)

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Key points: non-harmful, intermittent, positional, brief spinning, treatable. You can treat this at home safely and effectively with the BPPV Video Kit, contained in the comprehensive Rock Steady program. Contact a local vestibular expert to help you diagnose and treat this condition if it persists.

What is it?

BPPV is a commonly seen form of dizziness. It is a condition of dislodged calcium carbonate particles inside the inner ear. The particles belong in neighbouring areas of the inner ear and are important for detecting acceleration movements such as starting and stopping. However, in this condition, some particles fall out of the area they belong to and cause annoyance in adjacent areas of the inner ear. BPPV can affect anyone, at any age. It is more common than we think. In our University of Melbourne office, 4 out of 16 people have had BPPV.

The situation:

The particles have moved into one of the semicircular canals of the inner ear where they do not belong. This is a problem because now when we move our head, such as rolling over in bed, the particles create a strong sensation of vertigo. As the head rolls in bed, the particles also move within the balance canal creating a vertigo response until they can resettle themselves somewhere less annoying. The vertigo will be triggered each time we make a head movement that shifts the crystals around the semicircular canal.

What might it feel like?

You will see the world spin around distorting your vision when you move your head in a certain position (e.g. rolling over. bending down or looking up). This spinning is a brief form of vertigo and may occur with a lingering sense of nausea or shock. Symptoms are transient and generally pass in less than a minute.

What can I do about BPPV?

Particle repositioning treatments are simple and straightforward. These can be done at home, however if you are anxious about symptoms please seek treatment from a specialist. Ask your vestibular audiologist, physiotherapist or General Practitioner if they know how to do the treatment. Find a vestibular specialist to assess your ‘nystagmus’ eye movement.

If you live remotely, or cannot find someone locally- use the BPPV Video Kit. We can take you through the BPPV treatment steps remotely with video demonstrations.  You don’t need to do it alone 😉  Finding a local person to support you would be preferable (but not always possible, we understand).

The Epley manoeuvre is most commonly performed to treat this condition, and has a success rate of around 80%. Treatment can be repeated twice daily until the condition resolves. BPPV may be intermittent and may recur for no known reason. Excessive treatments can further dislodge particles and create ongoing symptoms. The Brandt-Daroff exercises can make the BPPV more difficult to treat!

BUT … Why do I have persistent BPPV?

Most commonly, BPPV comes from loose particles in the posterior semicircular canal. When the particles are free-floating, this is called canalithiasis and is usually treated effectively. However, there are exceptions and some BPPV can persist or be difficult to treat. 

This can occur when:

  • Both ears are affected
  • The BPPV is intermittent and returns again (and again) following effective treatment (for unknown causes)
  • The calcium carbonate particles become adhered to the inner part of a balance canal, making it difficult to reposition them (referred to as cupulolithiasis BPPV)
  • Or the particles are found in one of the less common semicircular canals and require a different treatment

These rare types of BPPV may require treatments other than The Epley.  You can learn more about treating difficult BPPV in The BPPV Video Treatment Kit. It is best to only treat one ear at a time, so repeat treatments about one week apart may be required until symptoms resolve in each ear.  

For intermittent BPPV that returns despite effective treatment, the full ROCK STEADY Program is recommended to look at the many aspects of recovery including creating a daily plan, building emotional resilience and reducing triggers that exacerbate symptoms.

I have seen patients who have had BPPV for over 20 years without treatment (not all doctors or health professionals are trained in this treatment process.)  Since effective BPPV treatment in clinic, they are now completely free of their vertigo. See case studies here.

Try the ROCK STEADY Program for access to FULL BPPV video demonstrations and further information about preventing ongoing vertigo, dizziness or anxiety.