Benign paroxysmal positional vertigo (BPPV)

Benign paroxysmal positional vertigo (BPPV) is a condition of the inner ear, which causes vertigo. 

With BPPV, you experience rotational vertigo when you move your head into certain positions. This means you may feel as if you or the environment around you is spinning. 

The particles that cause BPPV are thought to come from the vestibule, which a bag-like open area in your inner ear, where they have come loose — and lodge in one of the semicircular canals. 

Causes of this include:

  • Head injuries
  • Viral illness
  • Ageing

BPPV occurs in people of all ages but risk factors are more common in middle-aged people and the elderly.

What are its symptoms?

BPPV symptoms can come and go, with symptoms typically lasting less than a minute. Episodes of BPPV may also disappear for a while and then recur.

Symptoms include:

  • Dizziness
  • Vertigo 
  • Balance problems
  • Nausea
  • Ear pain
  • Vomiting

Activities that bring about the signs and symptoms of BPPV vary from person to person, but are usually triggered by a change in the position of your head. Some people also feel out of balance when standing or walking.

Although dizziness does not usually indicate a serious illness, consult with your doctor if you experience dizziness or vertigo along with any of the following:

  • Severe headaches
  • Fever
  • Blurred vision
  • Hearing loss
  • Difficulty speaking
  • Loss of consciousness
  • Falling or difficulty walking
  • Numbness or tingling
  • Fatigue

How is it diagnosed? 

A BPPV diagnosis will typically include your doctor asking about symptoms and medical history, and giving you a physical examination.

He/she will look into your ear with an otoscope to check whether your symptoms are due to an infection in your outer or middle ear.

A diagnostic test called the Hallpike manoeuvre can confirm whether you have BPPV. This involves your doctor moving your head into different positions, while you lie flat, to see if this triggers vertigo or eye movements. 

You may also be referred to a doctor specialising in balance disorders.

What are your treatment options? 

BPPV may go away on its own in a few weeks. To help relieve symptoms sooner, however, your doctor may recommend the canalith repositioning procedure. This consists of several slow, easy manoeuvres of the head. The aim is to move the particles from the fluid-filled semicircular canals of your inner ear into a small vestibule where they are harmless and can be more easily absorbed.

In rare situations where this is not effective, surgery may be recommended. During the procedure, a bone plug is used to block the area of your inner ear that is causing dizziness. 

If you experience dizziness linked to BPPV, try these remedies:

  • Work on improving your balance through exercise
  • Sit down if you feel dizzy
  • Use a walking stick if you think you’re at risk of falling

BPPV may recur even after effective therapy. Although there is no cure, it can be managed with physical therapy and treatment at home.

Can it be prevented? 

While in most cases, BPPV cannot be prevented, you can take some simple precautions. In cases resulting from head injuries, for example, the use of a helmet in contact sport can protect you.

You can also reduce the symptoms of vertigo by taking these steps:

  • Use two or more pillows in bed for elevation
  • Don’t lie on the side of your affected ear 
  • Avoid leaning over to pick things up or tipping your head too far back
  • Take care with physical activities that require you to turn your head excessively, lean over or lie flat on your back
  • Sit on the edge of your bed for a few seconds in the morning before standing up.
The accuracy of this information was checked and approved by physician Dr Thomas Blake in May 2016