BPPV: Benign Paroxysmal Positional Vertigo

The normal inner ear includes small calcium particles located on the balance nerve endings. These particles give the nerve endings mass. As we move in space, the nerve endings bend within the fluid of the ear causing the nerves to fire and to send a signal to the brain from the balance organ of the inner ear. In some cases, the particles become dislodged and float to abnormal positions in the inner ear. In these instances, certain positions cause brief but intense periods of a perception of motion called vertigo.  Precipitating causes can be a blow to the head or a viral illness although the majority of cases happen apparently without cause.

The symptoms of BPPV include vertigo, lightheadedness, imbalance and nausea usually associated with certain head positions. The most common sensation is a brief spinning sensation (vertigo) lasting less than one minute, associated with head movement.  Any movement which involves changing the position of the head including getting out of bed or rolling can aggravate this condition. BPPV can be intermittent and may be present for a few weeks or only for a day, or disappear and return.


Physical examination by an experienced medical provider or a video infrared electronystagmogram make the diagnosis. In most patients symptoms abate without therapy. In the remaining patients the particles can be re-positioned using the Epley Maneuver with relief afforded to over 90% of patients.  For ongoing symptoms, additional balance exercise regimens can be used.  In rare instances, a surgical procedure is necessary (Singular Neurectomy, Posterior Semicircular Canal Occlusion).