Understanding Vertigo and BPPV
Vertigo—the sensation that you or your surroundings are spinning—can be a frightening and disorienting experience. While several conditions can cause vertigo, one of the most common and treatable forms is Benign Paroxysmal Positional Vertigo, or BPPV.
What Is BPPV?
BPPV occurs when tiny calcium crystals called otoconia (or “ear rocks”) become dislodged from their normal location in your inner ear and migrate into the semicircular canals. These canals are responsible for sensing head movement and maintaining your balance. When the crystals float freely in these canals, they send false signals to your brain about your head position, creating the sensation of spinning.
How BPPV Feels
People with BPPV typically experience:
- Brief episodes of intense spinning sensation
- Dizziness triggered by specific head movements (rolling over in bed, looking up, bending down)
- Nausea or vomiting during episodes
- Unsteadiness or loss of balance
- Abnormal eye movements (nystagmus) during attacks
- Episodes lasting seconds to minutes
The good news? BPPV is benign (not dangerous) and highly treatable.
What Causes BPPV?
BPPV can develop from:
- Head trauma or injury
- Inner ear infections or disorders
- Age-related degeneration of the inner ear
- Prolonged bed rest or inactivity
- In many cases, no clear cause is identified
Our Comprehensive Evaluation
When you visit our office with vertigo symptoms, we conduct a thorough assessment to:
- Rule out serious conditions: Screen for red flags that might indicate stroke, neurological problems, or other serious issues requiring immediate medical attention
- Confirm BPPV diagnosis: Perform specific positional tests (like the Dix-Hallpike maneuver) to identify which canal contains the displaced crystals
- Identify the affected canal: Determine whether crystals are in the posterior, horizontal, or anterior semicircular canal
- Assess contributing factors: Evaluate neck mobility, vestibular function, and other elements that may affect your balance
This precise diagnosis is crucial because treatment varies depending on which canal is affected.
The Epley Maneuver: A Proven Solution
For BPPV affecting the posterior canal (the most common type), the Epley maneuver is remarkably effective. This series of specific head and body movements guides the displaced crystals out of the semicircular canal and back to their proper location.
The procedure involves:
- Moving through a sequence of four positions
- Holding each position for about 30 seconds to 2 minutes
- Allowing gravity to move the crystals to where they belong
Research has shown that the Epley maneuver successfully resolves BPPV in approximately 80-90% of cases, often with just one or two treatments. Many patients experience immediate relief, though some may need multiple sessions.
Additional Treatment Options
Depending on your specific presentation, we may also utilize:
- Other canalith repositioning maneuvers (like the Semont maneuver or BBQ roll for horizontal canal BPPV)
- Vestibular rehabilitation exercises to improve balance and reduce dizziness
- Brandt-Daroff exercises for home management
- Cervical spine treatment if neck dysfunction is contributing to symptoms
What to Expect After Treatment
Following the Epley maneuver, you may be advised to:
- Keep your head upright for the remainder of the day
- Avoid lying flat for 24-48 hours
- Sleep semi-reclined or with extra pillows
- Avoid rapid head movements temporarily
Some patients experience mild residual dizziness for a few days as the brain readjusts, but this typically resolves quickly.
When to Seek Care
You should schedule an evaluation if you experience:
- Recurring episodes of spinning sensation
- Dizziness triggered by position changes
- Balance problems affecting your daily activities
- Any vertigo symptoms that concern you
BPPV can significantly impact your quality of life, making simple activities like getting out of bed or looking up feel dangerous. The good news is that with proper diagnosis and treatment, most people find complete relief. Don’t continue living with vertigo when such effective treatment is available.