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 hairs and tiny crystals. These tiny hairs 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.
|The clump of ear crystals can lead to BPPV.|
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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 the inner ear
Symptoms may include:
- Sensation of spinning or rotation when you change head position that last less than 1 minute
- Loss of balance
- Ringing or buzzing sounds in the ear(s)
- Vision or hearing problems
You will be asked about your symptoms and medical history. A physical exam will be done. Part of the process will be to eliminate other disorders. Tests may be advised 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:
Specific vestibular exercises may be advised. 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.
This procedure (also called the Epley maneuver) is done in your doctor’s office or your physical therapist'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 have surgery. During surgery, a piece of wax may be used to plug 1 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.
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). Family Doctor—American Academy of Family Physicians website. Available at: http://familydoctor.org/familydoctor/en/diseases-conditions/benign-paroxysmal-positional-vertigo.html. Updated July 2017. Accessed February 15, 2018.
Benign paroxysmal positional vertigo (BPPV). EBSCO DynaMed Plus website. Available at: https://www.dynamed.com/topics/dmp~AN~T113695/Benign-paroxysmal-positional-vertigo-BPPV . Updated December 18, 2017. Accessed February 15, 2018.
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 January 2017. Accessed February 15, 2018.
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 February 15, 2018.
Post RE, Dickerson LM. Dizziness: A diagnostic approach. Am Fam Physician. 2010;82(4):369.
9/10/2014 DynaMed Plus Systematic Literature Surveillance. https://www.dynamed.com/topics/dmp~AN~T113695/Benign-paroxysmal-positional-vertigo-BPPV : 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.
- Reviewer: EBSCO Medical Review Board Rimas Lukas, MD
- Review Date: 03/2018
- Update Date: 09/10/2014