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The Vestibular System Blog Series: Part 3
Benign Paroxysmal Positional Vertigo (BPPV)

Continuing with the Vestibular System Blog Series, we will now start to explore some more common disorders beginning with Benign Paroxysmal Positional Vertigo (BPPV).

If you missed the earlier blogs here is Part 1: What is the Vestibular System and Part 2: Signs and Symptoms of Vestibular Disorders.

BPPV is the most common form of position vertigo and accounts for over half of all peripheral vestibular dysfunction. It is more common as we age and is seven times more common in people over 60 years of age. BPPV is a specific diagnosis, and each word describes the condition:

Benign—it is not life-threatening, even though the symptoms can be very intense and upsetting

Paroxysmal – it comes in sudden, short spells

Positional—certain head positions or movements can trigger a spell

Vertigo—feeling like you are spinning or the world around you is spinning

BPPV occurs when calcium carbonate crystals (otoconia) or “ear rocks” sluff off from the membrane where they reside in the saccule of the inner ear and migrate into the semicircular canals. When the head moves a certain way, these crystals move around in the semicircular canals (where they aren’t supposed to be) and excite the neurons, which send false signals to the brain. The result of this is the sensation of vertigo (spinning), abnormal eye movements (nystagmus) and usually nausea.

The head movements that typically bring on symptoms including looking up, looking down, lying down flat quickly, rolling over when lying flat. Some activity of your daily life that may bring on symptoms include looking up into the cupboard, rolling over in bed, tilting your head back in a dentist chair or washing hair at the salon, and even some yoga or Pilates poses.

Symptoms typically last less than 60 seconds and go away if you stay in provoking position.

The cause of BPPV is unknown in most cases, it can less commonly be caused from head trauma or concussion or other vestibular dysfunctions.

BPPV is assessed in clinic by looking for the “ear rocks” in one of semicircular canals. This involves using the Dix‐Hallpike and Head Roll tests.

BPPV is treated by performing a repositioning maneuver to try to reposition the free-floating calcium carbonate crystals back to the saccule there they belong. The most common maneuver used is called the Epley maneuver. Many studies have shown that the BPPV treatment has success rates of over 80% with one treatment.

BPPV can reoccur in many people. The recurrence rate is between 18-37% and is most likely in the first year. BPPV can spontaneously resolve on its own, but it may take a long time and some never resolve without treatment.
Have a question? Ask Jennifer at info@alphahealthservices.ca

Jennifer Harvey
Registered Physiotherapist


Tonks, Bernard. (2017). Vestibular Rehabilitation Course Manual.

Otolaryngology–Head and Neck Surgery 2017, Vol. 156(3S) S1 –S47