Our vestibular balance disorder specialists have extensive expertise in diagnosing and treating BPPV. You’ll receive a careful evaluation to pinpoint the cause of your symptoms and a tailored treatment plan to help you find relief.
What is BPPV?
BPPV is defined as:
- Benign = “not harmful”
- Paroxysmal = “brief episodes”
- Positional = “occurs in certain positions”
- Vertigo = “sensation of motion or spinning”
BPPV is caused by a problem in the vestibular system of the inner ear. The vestibular system is made up of fluid-filled structures that sense movement and send signals to the brain. The structures include:
- Otolith organs: These organs, called the utricle and saccule, sit in the center of your inner ear. They detect the position of your head in relation to the world around you.
- Semicircular canals: These three ring-shaped, fluid-filled tubes are open to the utricle on one end and closed on the other end. Their orientation at right angles to one another allows them to detect head motion in three dimensions. Your brain processes signals from the canals to maintain balance.
BPPV occurs when motion-sensing crystals on the lining of the utricle break off and become trapped in the semicircular canals. The crystals disrupt fluid movement, sending false signals to the brain. This incorrect information leads to vertigo and other symptoms.
People who are assigned female at birth may be more likely to develop BPPV.
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Understanding Benign Paroxysmal Positional Vertigo
The main symptom of BPPV is intermittent episodes of vertigo that last less than one minute. Episodes occur with specific head motions, such as turning your head to the side, lying down, or rolling over. The movements that trigger BPPV depend on which semicircular canal is affected.
Other symptoms of BPPV include:
- Dizziness
- Involuntary eye movements (nystagmus)
- Lightheadedness
- Loss of balance
- Nausea and vomiting
BPPV may also cause distress and anxiety. People may fear symptoms are the result of a more serious condition. They may also go to extreme lengths to avoid head movements that bring on symptoms.
People with BPPV should take care when performing certain activities, such as driving, climbing a ladder, or operating heavy equipment. An episode during such activities could be dangerous.
Often, there is no known cause of BPPV, meaning it’s idiopathic. In some cases, clinicians can trace the condition to:
- Head injury
- Infections of the inner ear, such as vestibular neuronitis and viral labyrinthitis
- Ménière’s disease, a buildup of fluid in the inner ear
- Migraine
- Surgery of the ear, face, jaw, mouth, or neck
BPPV may also be associated with other health conditions such as vitamin D deficiency, osteoporosis, diabetes, and high cholesterol.
Diagnostic Tests for Benign Paroxysmal Positional Vertigo
BPPV can mimic other conditions, so a skilled evaluation is essential. Your clinician will ask about your medical history and symptoms, including when they occur and how long they last.
Tests your clinician may recommend include:
Diagnostic maneuvers are specific movements your clinician performs on you to find out if they trigger symptoms. The Dix-Hallpike maneuver is a standard test for BPPV. You start in a seated position on an exam table. Your clinician turns your head 45 degrees to the right, then lowers you onto your back. After 20 to 30 seconds, you sit up. They repeat the maneuver on the other side. During the test, your clinician watches your eyes for involuntary eye movements.
Your eyes play an important role in maintaining balance. Information from your inner ears helps your eyes remain focused when you move your head. In BPPV, displaced motion-sensing crystals make your brain think you are moving. Your brain then sends signals to your eyes to move accordingly. These abnormal eye movements during diagnostic maneuvers are telltale signs of BPPV.
Another type of maneuver involves rolling you from your back to your side while monitoring your eyes.
Based on your eye movements during the maneuvers, your clinician can also determine which of the three semicircular canals is affected.
Vestibular diagnostic tests evaluate your vestibular system to check the function of your inner ears and eyes. They include:
- Audiogram: Assesses how well you hear loud and soft sounds at different frequencies
- Electronystagmography (ENG) and videonystagmography (VNG): Checks your eye movements
- Rotary chair test: Determines whether your brain or inner ear is causing dizziness
- Vestibular evoked myogenic potential (VEMP): Evaluates vestibular organ and nerve function
- Video head impulse testing (vHIT): Assesses how well your eyes and ears work together
Benign Paroxysmal Positional Vertigo (BPPV)
BPPV is a balance disorder of the inner ear that causes short episodes of vertigo. It often goes away without treatment or with BPPV exercises.
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