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Benign Paroxysmal Positional Vertigo

Definition

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.

Causes

The inner ear contains tiny crystals. These crystals 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.

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

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 inner ear

Risk Factors

Increasing age increases your chances of getting BPPV.

Symptoms

Symptoms may include:

  • Sensation of spinning or rotation when you change head position that last less than one minute
  • Loss of balance
  • Nausea
  • Vomiting
  • Ringing or buzzing sounds in the ear
  • Vision or hearing problems

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done. Part of the process will be to eliminate other disorders. Your doctor may recommend tests 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
  • Electronystagmography (ENG)

Treatment

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:

Vestibular Rehabilitation

Your doctor may suggest specific vestibular exercises. 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.

Canalith Repositioning

This procedure is done in your doctor’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.

Surgery

Some people with BPPV undergo surgery. During surgery, a piece of wax may be used to plug one 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.

Prevention

BPPV can't be prevented.

Revision Information

  • Reviewer: Rimas Lukas, MD
  • Review Date: 03/2014 -
  • Update Date: 09/10/2014 -
  • American Academy of Family Physicians Family Doctor

    http://familydoctor.org

  • American Academy of Otolaryngology—Head and Neck Surgery

    http://www.entnet.org

  • Canadian Academy of Audiology

    http://www.canadianaudiology.ca

  • Canadian Society of Otolaryngology

    http://www.entcanada.org

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  • Benign paroxysmal positional vertigo (BPPV). EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated January 14, 2013. Accessed April 25, 2013.

  • Benign paroxysmal positional vertigo (BPPV). Merck Manual for Health Care Professionals website. Available at: http://www.merckmanuals.com/professional/ear%5Fnose%5Fand%5Fthroat%5Fdisorders/inner%5Fear%5Fdisorders/benign%5Fparoxysmal%5Fpositional%5Fvertigo.html. Updated November 2012. Accessed April 25, 2013.

  • 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 25, 2013.

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  • 9/10/2014 DynaMed's Systematic Literature Surveillance. http://www.ebscohost.com/dynamed: 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.