Benign paroxysmal positional vertigo (BPPV) is the most common disorder of the inner ear’s vestibular system, which is a vital part of maintaining balance. BPPV is benign, meaning that it is not life-threatening nor generally progressive.

BPPV produces a sensation of spinning called vertigo that is both paroxysmal and positional, meaning it occurs suddenly and with a change in head position.

For more BPPV treatment alternatives click here                                              

For exercises for Positional Vertigo (BPPV) click here


Benign Paroxysmal Positional Vertigo

The vestibular organs in each ear include the utricle, saccule, and three semicircular canals. The semicircular canals detect rotational movement. They are located at right angles to each other and are filled with a fluid called endolymph.

When the head rotates, endolymphatic fluid lags behind because of inertia and exerts pressure against the cupula, the sensory receptor at the base of the canal. The receptor then sends impulses to the brain about the head’s movement.

BPPV occurs as a result of otoconia, tiny crystals of calcium carbonate that are a normal part of the inner ear’s anatomy, detaching from the otolithic membrane in the utricle and collecting in one of the semicircular canals.

When the head is still, gravity causes the otoconia to clump and settle (See image on the right: Inner ear anatomy. Otoconia migrate from the utricle, most commonly settling in the posterior semicircular canal (shown), or more rarely in the anterior or horizontal semicircular canals.).

When the head moves, the otoconia shift.

This stimulates the cupula to send false signals to the brain, producing vertigo and triggering nystagmus (involuntary eye movements).

The detached otoconia shift when the head moves, stimulating the cupula to send false signals to the brain that create a sensation of vertigo.

TYPES OF Benign Paroxysmal Positional Vertigo

Subtypes of BPPV (Benign Paroxysmal Positional Vertigo) are distinguished by the particular semicircular canal involved and whether the detached otoconia are free floating within the affected canal (canalithiasis) or attached to the cupula (cupulothiasis).

BPPV is typically unilateral, meaning it occurs either in the right or left ear, although in some cases it is bilateral, meaning both ears are affected.

The most common form, accounting for 81% to 90% of all cases, is canalithiasis in the posterior semicircular canal.

Understanding BPPV

In Benign Paroxysmal Positional Vertigo (BPPV) dizziness is generally thought to be due to debris which has collected within a part of the inner ear. This debris can be thought of as "ear rocks", although the formal name is "otoconia".

Ear rocks are small crystals of calcium carbonate derived from a structure in the ear called the "utricle" (figure1 ). While the saccule also contains otoconia, they are not able to migrate into the canal system.

The utricle may have been damaged by head injury, infection, or other disorder of the inner ear, or may have degenerated because of advanced age. Normally otoconia appear to have a slow turnover.

They are probably dissolved naturally as well as actively reabsorbed by the "dark cells" of the labyrinth, which are found adjacent to the utricle and the crista, although this idea is not accepted by all.

Benign Paroxysmal Positional Vertigo is a common cause of dizziness. About 20% of all dizziness is due to BPPV. While BPPV can occur in children, the older you are, the more likely it is that your dizziness is due to BPPV. About 50% of all dizziness in older people is due to BPPV. In one study, 9% of a group of urban dwelling elders were found to have undiagnosed BPPV.

The symptoms of BPPV include dizziness or vertigo, lightheadedness, imbalance, and nausea. Activities which bring on symptoms will vary among persons, but symptoms are almost always precipitated by a change of position of the head with respect to gravity. Getting out of bed or rolling over in bed are common "problem" motions .

Because people with BPPV often feel dizzy and unsteady when they tip their heads back to look up, sometimes BPPV is called "top shelf vertigo."

Women with BPPV may find that the use of shampoo bowls in beauty parlors brings on symptoms.

A Yoga posture called the "down dog", or Pilates are sometimes the trigger. An intermittent pattern is common.

Benign Paroxysmal Positional Vertigo may be present for a few weeks, then stop, then come back again.


BPPV symptoms overview

BPPV may be experienced for a very short duration or it may last a lifetime, with symptoms occurring in an intermittent pattern that varies by duration, frequency, and intensity. It is not considered to be intrinsically life-threatening. However, it can be tremendously disruptive to a person’s work and social life, as well as pose a health hazard due to an increased risk of falls associated with dizziness and imbalance.

The signs and symptoms of benign paroxysmal positional vertigo (BPPV) may include:

  • Dizziness
  • A sense that you or your surroundings are spinning or moving (vertigo)
  • Lightheadedness
  • Unsteadiness
  • A loss of balance
  • Blurred vision associated with the sensation of vertigo
  • Nausea
  • Vomiting
  • The signs and symptoms of BPPV can come and go, with symptoms commonly lasting less than one minute. Episodes of benign paroxysmal positional vertigo and other forms of vertigo can disappear for some time and then recur.

Activities that bring about the signs and symptoms of BPPV can vary from person to person, but are almost always brought on by a change in the position of your head. Abnormal rhythmic eye movements (nystagmus) usually accompany the symptoms of benign paroxysmal positional vertigo. Although rare, it's possible to have BPPV in both ears (bilateral BPPV).

When to see a doctor

Generally, see your doctor if you experience any unexplained dizziness or vertigo that recurs periodically for more than one week.

Seek emergency care

Although it's uncommon for dizziness to signal a serious illness, see your doctor immediately if you experience dizziness or vertigo along with any of the following:

  • A new, different or severe headache
  • A fever of 101 F (38 C) or higher
  • Double vision or loss of vision
  • Hearing loss
  • Trouble speaking
  • Leg or arm weakness
  • Loss of consciousness
  • Falling or difficulty walking
  • Numbness or tingling
  • Chest pain, or rapid or slow heart rate
  • The signs and symptoms listed above may signal a more serious problem, such as stroke or a cardiac condition.


For more BPPV treatment alternatives click here 

For exercises for Positional Vertigo (BPPV) click here

Post by:

Pavel Kotlykov

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