by EBSCO Medical Review Board
(BPPV; Benign Positional Vertigo, BPV; Positional Vertigo of Barany)

Definition

Benign paroxysmal positional vertigo (BPPV) is a feeling of movement or spinning caused by changes in the position of the head. This might include standing after bending down, turning the head in bed, or stretching the neck to look up.

Causes

The inner ear contains tiny hairs and tiny crystals. These hairs can sense movement and help with balance. BPPV happens when these crystals shift or clump. This sends signals to the brain that makes it think a person is moving when he or she is not. This causes the feeling of movement.

Inner Ear
Inner ear deposits
The clump of ear crystals can lead to BPPV.
Copyright © Nucleus Medical Media, Inc.

In some people the cause is not known. In others, it may be caused by things like:

  • Surgery
  • Head injury
  • Reclining the head for a long time
  • Disorders of the inner ear

Risk Factors

Increased age raises your chances of getting BPPV.

Symptoms

Problems may be:

  • A feeling of spinning or moving when changing head position
  • Loss of balance
  • Nausea and vomiting
  • Ringing or buzzing sounds in the ear(s)
  • Vision or hearing problems

Diagnosis

You will be asked about your symptoms and health history. A physical exam will be done. Certain tests will be done to look for signs of BPPV. This is enough to make the diagnosis.

Treatment

BPPV may get better on its own in some people. In others, the goal of treatment is to manage symptoms. Choices may be:

Physical Therapy

Vestibular exercises may be given by a physical therapist. These use a series of eye, head, and body motions to get the body used to moving without a feeling of spinning.

Canalith Repositioning

A doctor or physical therapist will move the person's head in different positions to try to resettle the tiny crystals. It may be done more than once. A person may also be taught to do this at home.

Surgery

Some people may need surgery if other methods do not help. A piece of wax may be used to plug one part of the ear. This will prevent fluid in the inner ear from moving. Another surgery may be done to cut the nerve from the inner ear.

Prevention

There are no current guidelines to prevent BPPV.

RESOURCES

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 RESOURCES

Canadian Academy of Audiology  http://www.canadianaudiology.ca 

Canadian Society of Otolaryngology  http://www.entcanada.org 

References

Benign paroxysmal positional vertigo. The Merck Manual Professional Edition website. Available at: https://www.merckmanuals.com/professional/ear,-nose,-and-throat-disorders/inner-ear-disorders/benign-paroxysmal-positional-vertigo?query=bppv. Updated October 2018. Accessed April 7, 2020.

Benign paroxysmal positional vertigo (BPPV). EBSCO DynaMed website. Available at:  https://www.dynamed.com/condition/benign-paroxysmal-positional-vertigo-bppv  . Updated November 11, 2019. Accessed April 7, 2020.

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 November 6, 2019. Accessed April 8, 2020.

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 April 7, 2020.

You P, Instrum R, et al. Benign paroxysmal positional vertigo. Laryngoscope Investig Otolaryngol. 2019 Feb;4(1):116-123.

Revision Information

  • Reviewer: EBSCO Medical Review Board Rimas Lukas, MD
  • Review Date: 02/2020
  • Update Date: 04/08/2020