Benign Paroxysmal

Positional Vertigo (BPPV)

What is BPPV?
BPPV stands for benign
paroxysmal positional vertigo. It is
a disorder of the vestibular
system of the inner ear.
It is the most common vestibular
disorder.
The vestibular system in the inner
ear is responsible for maintaining

Benign

Benign means that it is not lifethreatening and will generally not

progress.

Paroxysmal

Paroxysmal describes how the

symptoms occur suddenly, in brief
episodes of mild to intense vertigo.

Positional

Positional describes how changes in

head position cause symptoms. These
positional changes may be looking up
and down, laying down or rolling over
in bed, or sitting up quickly.

Vertigo

Vertigo is used to describe the

sensation of movement or spinning
that occurs following a position
change.

Anatomy of BPPV
The vestibular system of the inner ear is
made up of:
2 organs called the utricle and saccule
3 semicircular canals: posterior, anterior, and
horizontal

Attached to a membrane within the

utricle and saccule are microscopic
calcium carbonate crystals called
otoconia that help sense movement.

What causes BPPV?

BPPV occurs when the otoconia become

dislodged from the membranes in the
utricle and saccule and collect in the

What causes BPPV?

When the head moves, this causes the

displaced otoconia in the semicircular
canals to move. This movement of
otoconia sends a false signal to the
brain, causing vertigo.

What causes BPPV?

BPPV is more likely to occur over the age of 50 and
is, in most cases, a result of an age-related
degeneration of the vestibular system.
Other causes may include:
Mild to severe head injury
Whiplash
Surgery causing trauma to the ear
Extensive dental work
Prolonged inactivity
Migraine
Other vestibular abnormalities

Types of BPPV
Classified by which semicircular canal the
otoconia have migrated to: anterior,
posterior, or horizontal.
Classified by whether the otoconia are
free-floating in the semicircular canal
(called canalithiasis) or have become
attached to the membrane within the
semicircular canal (called cupulothiasis).
Classified as unilateral or bilateral.

Types of BPPV

The most common type of BPPV is

unilateral posterior canal canalithiasis.

What are the symptoms of

BPPV?
Brief episodes of vertigo (spinning
sensation) triggered by head or body
movements.
Episodes of vertigo typically last less than 1
minute.
In cupulothiasis type BPPV, episodes can
last several minutes.
Symptoms range from mild to severe. In
severe cases of vertigo, nausea and
vomiting can occur.

What is nystagmus?
Nystagmus describes the involuntary
eye movements that occur during
episodes of BPPV. It is a quick back and
forth beating movement of the eyes.

Diagnosis of BPPV
Medical and case history
Auditory evaluation
Vestibulonystagmography Test (VNG)
Positioning testing to include the DixHallpike maneuver.

Dix-Hallpike Maneuver
The Dix-Hallpike maneuver is
performed by moving the patients
head and body into different positions
and observing the nystagmus. The
characteristics of the nystagmus will
determine which semicircular canal is
being affected. Vertigo will likely occur
during the Dix-Hallpike if you have
BPPV.

How is BPPV treated?

Canalith Repositioning Procedure (CRP)
A specific series of head and body movements.
Used to relocate the otoconia from the semicircular
canal back into the utricle or saccule.
Performed by a trained technician or Doctor.

Brandt-Daroff exercises
Home-based exercises involving repeating a series
of head movements 2-3 times for 3 weeks.
Can be performed by the patient themselves
without assistance.

Types of Canalith
Repositioning
The type of canalith respositioning
procedure performed to treat BPPV
will depend on which type of BPPV
has been diagnosed.
The two most common canalith
repositioning procedures used to
treat posterior canal BPPV are:
The Epley Maneuver
The Semont Maneuver

The Epley Maneuver

Involves 4 sequential movements of

the head and body with a 30 second
or more rest at each position.

The Semont Maneuver

Involves quickly moving the patient from

laying on one side to the other. The head
is held in a specific position during
movements.

Canalith Repositioning
Procedure
Following a CRP, the patient should
restrict head and body movements for
a period of 24-72 hours. Sleeping
position may also be restricted during
this time as well. This gives the
otoconia sufficient time to settle
back into the utricle and saccule
following treatment.

Can BPPV cause lasting

problems?
Most cases of BPPV can be successfully
treated after one or two canalith
repositioning procedures.
BPPV is likely to re-occur several times
within a persons lifetime.
Although BPPV is not life-threatening, the
symptoms can be very debilitating before
treatment occurs.

Resources:
http://www.mayoclinic.org/diseases-conditions/v
ertigo/basics/definition/con-20028216
http://vestibular.org/understanding-vestibular-d
isorders/types-vestibular-disorders/benign-parox
ysmal-positional-vertigo