Benign Paroxysmal Positional Vertigo

Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of vertigo that audiologists see in their offices.  A BPPV attack is usually precipitated by a change in head position, such as when lying down or getting up from bed or when rolling over in bed. Fortunately, it can be treated and typically resolves quickly.

inner ear diagram

BPPV seems to affect women more often than men and is most common in people 50-70 years of age.  While BPPV, Meniere’s disease, and labyrinthitis can all cause vertigo, BPPV vertigo dissipates once the motion of the head has ceased.  If you have had head trauma or injury, this can crop up as a result. Aging balance systems that present with BPPV are the result of otolith ‘crystals’ that have become dislodged in the utricle and have accidentally migrated into one of the semi-circular canals.  While this is not a serious health hazard, it can cause nausea and disorientation, often resulting in falls.

BPPV is diagnosed using a special in-office positioning test called the Dix-Hallpike maneuver.  Once the lateralization problem has been identified, another special positioning technique, the Epley maneuver, is performed to move the otolith out of the involved semi-circular canal. 

Avoiding BPPV

If you ever do experience BPPV and receive treatment, be sure to ask your healthcare professional to teach you how to perform the Epley maneuver yourself, as many people can safely manage their own BPPV episodes.  Women with osteoporosis should receive appropriate medical treatment, as this is a factor in otolith displacement.  Exercising and performing yoga or Tai Chi help to keep our bodies limber and healthy but also aid in maintaining good balance.  By placing our heads in more extreme positions, our brain receives stronger inputs from the balance systems, which then correlate to what we see and to where our bodies and limbs are in space.  This ‘brain training’ helps us to be more prepared when we find ourselves in an overbalanced situation and can help us to right ourselves rather than fall.