- Benign paroxysmal positional vertigo (BPPV) causes dizziness, vertigo, unsteadiness and nausea when you move your head.
- Common triggers include rolling over in bed, getting out of bed, and lifting your head to look up.
- BPPV is generally an easily treated disorder.
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About benign paroxysmal positional vertigo (BPPV)
Benign paroxysmal positional vertigo (BPPV) is a common disorder of the inner ear with symptoms including dizziness, vertigo, unsteadiness and nausea.
BPPV is the most common cause of vertigo, especially in people over 65 years old.
BPPV occurs when crystals (called otoconia), normally located in one part of the vestibular (or balance) system of your inner ear (the utricle), become dislodged and collect in another part of the inner ear balance system (one of the semi-circular canals).
As your head moves, the dislodged crystals also move and incorrect messages are sent to your brain and then to your eyes.
The brain receives the messages that the head is moving although the head has only moved position slightly. This will cause symptoms such as an illusion of movement or spinning with common movements or changes in position such as rolling over in bed, getting in or out of bed, or looking or reaching up (for example to the top shelf or to put drops into your eye).
Symptoms of BPPV
Activities that bring on BPPV symptoms vary from person to person.
Getting out of bed or rolling over in bed are movements that often trigger dizziness, vertigo, light-headedness, imbalance or nausea.
Some people feel dizzy when they tip their head back to look up.
Symptoms are usually intermittent, stopping for several weeks or months at a time and then coming back for a longer or shorter period.
Causes of BPPV
Inside the inner ear is a series of canals filled with fluid. These canals are oriented at different angles. When the head is moved, the rolling of the fluid inside these canals tells the brain exactly how far, how fast and in what direction the head is moving.
BPPV is thought to be caused by little calcium carbonate crystals (otoconia) coming loose within the canals. Usually, these crystals are held in special reservoirs within other structures of the inner ear (utricle). It is thought that injury or degeneration of the utricle may allow the crystals to escape into the balance system and interfere with the fluid flow.
BPPV can be caused by:
- head injury
- degeneration of the vestibular system in the inner ear due to ageing
- damage caused by an inner ear disorder.
There is also an association between BPPV and osteoporosis. However, in a large number of cases, there is no known cause.
Diagnosis of BPPV
Diagnosis of the condition may be made based on:
- your medical history
- answers to questions about when and where the symptoms occur
- a physical examination
- results of medical tests.
Other tests may be required in cases where symptoms do not fit the usual pattern or are in both ears, both of which make diagnosis more challenging.
Treatment for BPPV
BPPV can be treated with simple exercises, taught by a doctor or physiotherapist who is familiar with the techniques required. However, if symptoms persist and cause distress, you may be referred to a specialist.
BBPV is usually treated using a range of positional manoeuvres that aim to move the crystals out of the semi-circular canal of the inner ear to an area that will not stimulate the wrong messages to be sent by the balance system.
Sometimes a second treatment may be necessary. Your health professional can perform these manoeuvres in their rooms or they may give you exercises to perform at home.
If manoeuvres and exercises have been recommended, it is important to persist with the treatment because they provide a simple and non-invasive way to treat the vertigo and nausea associated with BPPV.
BPPV can subside with time, but it is important to seek treatment in the early stages to prevent falls or injury. This is particularly important for older people when additional balance exercises may also be useful.
In extreme cases, surgery can be carried out to block the affected canal without disturbing the function of the rest of the vestibular system.
Very short-term use of motion sickness medications is sometimes useful to control the nausea associated with BPPV.
Where to get help
- Your GP (doctor)
- Specialist physiotherapist
- Audiologist
- Balance Disorders and Ataxia , Neuro-otology Investigation Unit, The Royal Victorian Eye and Ear Hospital Tel. (03) 9929 8270
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