Benign Paroxysmal Positional Vertigo

Definition

Causes

Risk Factors

Benign Paroxysmal Positional Vertigo

(BPPV; Benign Positional Vertigo, BPV; Positional Vertigo of Barany)

Pronounced: Ba-nine Par-ox-see-mal Positional Ver-ta-go

by Patricia Griffin Kellicker, BSN

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 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.

Inner Ear

The clump of ear crystals can lead to BPPV.

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

Risk Factors

Increased age raises your chances of getting BPPV.

Symptoms

Symptoms may include:

Sensation of spinning or rotation when you change head position that last less than 1 minute
Loss of balance
Nausea
Vomiting
Ringing or buzzing sounds in the ear(s)
Vision or hearing problems

Diagnosis

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)

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

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.

Canalith Repositioning

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.

Surgery

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.

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 (BPPV). Family Doctor—American Academy of Family Physicians website. Available at:
...(Click grey area to select URL)
Updated July 2017. Accessed February 15, 2018.

Benign paroxysmal positional vertigo (BPPV). EBSCO DynaMed Plus website. Available at: http://www.dynamed... . Updated December 18, 2017. Accessed February 15, 2018.

Benign paroxysmal positional vertigo. The Merck Manual Professional Edition website. Available at:
...(Click grey area to select URL)
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. http://www.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:
...(Click grey area to select URL)
Accessed September 10, 2014.

Last reviewed March 2018 by EBSCO Medical Review Board Rimas Lukas, MD
Last Updated: 9/10/2014

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