Definition of Benign Paroxysmal Positional Vertigo (BPPV)

Vertigo, a perception of motion where the individual or the individual’s environment seem to whirl dizzily, can be a rather uncomfortable experience. The sensations of vertigo occasionally include dizziness, spinning or falling. Any time vertigo impacts balance, it may lead to falls and personal injuries – especially among the elderly. More extreme cases of vertigo can also cause vomiting, nausea, migraine headaches, visual abnormalities known as nystagmus and fainting spells.

There are many root causes for vertigo, but one variety of it – benign paroxysmal positional vertigo, abbreviated BPPV – is related to your sense of hearing. It is due to calcium crystals that form naturally in the inner ear. Known as otoconia or otoliths, these crystals generally cause no problems for people. In benign paroxysmal positional vertigo, the crystals migrate from their normal locations into the semicircular canals of the inner ear. When somebody with benign paroxysmal positional vertigo reorients their head relative to gravity, these crystals cause an abnormal displacement of endolymph fluid and cause vertigo.

Benign paroxysmal positional vertigo is characterized by the brief (paroxysmal) nature of the episodes, and can be brought on by such commonplace motions as looking up or down, tilting the head, rolling over while laying down, or any other sudden head motion. Changes in barometric pressure, lack of sleep and stress can make the symptoms worse. Benign paroxysmal positional vertigo can occur at any age, but it is most often observed in people over 60. The specific cause of BPPV is difficult to determine for any given person, but sometimes it can be brought on by a blow to the head.

BPPV differs from other varieties of dizziness or vertigo because the episodes are quite short (usually under a minute), and because it is always triggered by head movements. Diagnosing BPPV generally involves a simple test where the affected individual lies on an examination table and tilts their head to the side or over the edge. More extensive tests can be used in selected cases including videonystagmography (VNG), electronystagmography (ENG) and magnetic resonance imaging (MRI). ENG and VNG test for abnormal eye movements while MRI is used to eliminate other potential causes of vertigo such as tumors or brain abnormalities.

BPPV is generally treated using a method called canalith repositioning which shifts the crystals to an area of the ear where there are less bothersome using a sequence of physical movements. Two forms of canalith repositioning that may be used are the Semont maneuver and the Epley maneuver. Surgical treatment is an option in the rare cases where these therapies are not effective. Visit your balance disorder specialist if you have experienced symptoms that seem as if they could be associated with benign paroxysmal positional vertigo, especially if they persist for more than a week.