BENIGN PAROXYSMAL POSITIONAL VERTIGO

(BPPV)
AMANDA FLOEN, COLE SIMMONS,
JOE KLUMPP, BRANDON SVORINIC 

•HSC 630 
•SUMMER 2021 
WHAT IS BENIGN PAROXYSMAL POSITIONAL
VERTIGO (BPPV)
• Most common type of vertigo 
• Vertigo- the feeling of spinning 
• Paroxysmal – temporary and sudden
• Often idiopathic but symptoms can
result from head movement or
trauma
 Sciencephotos.com, Researchgate, prabook

• In 1825 Jean Pierre Flourens discovered that when a pigeon's horizontal

semicircular canal was destroyed, it would stay turning horizontally in a
ETYMOLOGY circle.

OF BPPV • Jan Evangelista Purkinje later found that when humans changed head
position a feeling of dizziness could occur.
• In 1861, Prosper Ménière observed vertigo came from the inner ear, rather
than another structure (many thought that the brain caused episodes of
vertigo and ringing in the ear)
• In 1870, Friedrich Goltz observed that destruction of semicircular
canals would cause dizziness, implying that the function of the semicircular
canal is to maintain equilibrium. 
ETYMOLOGY OF BPPV 

• Robert Barany discovered that nystagmus, uncontrolled eye movements

that often accompany vertigo, happened in a specific direction when
filling a patient's ear with cold water, and the opposite way when filling
the patient's ear with warm water. 
• He found that the changes in temperature made the fluid in the inner ear
rise or fall.
• This discovery allowed him to extend his research, and in 1921 he
described benign positional vertigo as "episodic vertigo" that occurred
with abrupt movement of the head.
• In 1952, Margaret Dix and Charles Halpike published a paper with
details regarding inner ear syndromes, naming this syndrome "benign
paroxysmal positional vertigo"

NobelPrize.org
BPPV ANATOMICAL RELEVANCE 

• Problem in the inner ear

• Specifically vestibular labyrinth that contains semicircular canals
• Semicircular canals- contain fluid and hair cell 
• Action: Movement of fluid and hair cells communicates with brain (via vestibular nerve) to tell body where it
is in space
• Saccule and utricle "crystals"- monitor head position to gravity
• Calcium crystals are usually contained in a jelly like matrix within the utricle 
• Crystals dislodge and enter semicircular canals- causes these canals to be sensitive to abnormal changes=
causes dizziness 
SEMICIRCULAR CANALS 

• Anterior Canal detects changes in sagittal plane,

"yes" motion of the head.
• Posterior canal detects changes in coronal plane,
"tilting head to the side" motion.
• Lateral Canal detects changes in transverse
plane, "no" motion of the head.

MSK neurology 
UTRICLE AND SACCULE 

• Within utricle and saccule, there are maculae. 

• In maculae, there are hair cells embedded in
gelatinous membrane. 
• There are also crystals (otoliths) within this
membrane
• When the head is upright, otoliths are evenly
spread, but when we move our head (ex: tilt our
head forward), structures of maculae pull on the
hair cells and fire a nerve impulse to detect gravity
changes in head position.
• BPPV may occur when an Otolith becomes
detached and is lodged into a semicircular canal.   Brain Made Simple
BPPV DETAILED MECHANISM 

• Otoliths become detached from the utricle. 

• Otolith usually drifts into posterior semicircular canal
naturally due to gravity.
• Normally, the semicircular canals only sense head
rotation (transverse, sagittal, coronal plane
movements)  
• However, otoliths respond to gravity changes as well,
causing response to occur with changes in head
position. 
• This is why with BPPV, dizziness occurs with head
position changes – the otoliths lodged within the
Brainstudy.info semicircular canal detect changes in gravity (changes in
head position)
BPPV ANATOMICAL
RELEVANCE
• Innervation: Vestibular branch of
vestibulocochlear nerve (CN VIII) ScienceDirect
• Labyrinthine artery- divides into vestibular and
cochlear arteries, occipital artery, and posterior
auricular artery 
• Vestibular cochlear vein, labyrinthine vein- drain
into the vestibular aqueduct which drains into
the sigmoid sinus and then the internal jugular
vein  Physio-pedia
JaypeeDigital
SIGNS AND SYMPTOMS OF BPPV

• Sudden dizziness
• Nausea 
• Feeling like everything is spinning 
• Loss of balance
• Vomiting
• Condition itself is not "dangerous" but it increases risk for falling
*Almost always brought on by change in head position 
• Sit to stand
• Laying to sitting 
TREATMENT FOR BPPV

• Brandt-Daroff exercise procedure

https://www.youtube.com/watch?v=laRHBIN-tgY&t=2s
• Sit on edge of bed
• Complete withing1-2 seconds –lay to the left on your side, turning
your head so you are looking up on a 45* angle, stay there for 30
seconds 
• Sit up and stay up for 30 seconds and repeat on the right side
• Complete five reps on each side
• Maybe dizzy after completing, let dizziness subside before standing up
TREATMENT FOR BPPV CONTINUED

• Eply and Semont maneuver- PT commonly perform

• Eply- PT quickly drops patient backwards, quickly turn head
45* to affected side- held until eye bounce (nystagmus) stops
• Then patient rolled onto other side until facing ground while
therapist still holds head- stay until eye bounce stops
• Semont- PT quickly drops patient backwards, quickly turning
head to 45* to least affected side- hold until eye bounce stops
• PT then quickly moves head to other side without stopping until
eye bounce stops
TREATMENT FOR BPPV CONTINUED

• Thomas Richard Vitton chair (TRV)

• Can be used to diagnose - more commonly for treatment when other measures do
not work
• https://youtu.be/6KaQU58Yvq4 
REFERENCES

• Benign paroxysmal positional vertigo (BPPV). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/vertigo/symptoms-causes/syc-20370055. Published

August 18, 2020. Accessed July 16, 2021.
• Benign paroxysmal positional vertigo (BPPV). John Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/benign-paroxysmal-
positional-vertigo-bppv. Accessed July 19, 2021. 
• Benign Paroxysmal Positional Vertigo, David Solomon. https://www.med.upenn.edu/solomon/images/BPPV.pdf. Published 2000. Accessed July 22,2021. 
• Benign Positional Vertigo - Symptoms and Causes. https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/benign-
positional-vertigo. Accessed July 19, 2021.
• Epley and Semont Maneuvers for Vertigo. Epley and Semont Maneuvers for Vertigo | Michigan Medicine. https://www.uofmhealth.org/health-library/hw205519.
Accessed July 19, 2021.
• Gotter A. Can Brandt-Daroff Exercises Treat Vertigo? Healthline. https://www.healthline.com/health/fitness-exercise/brandt-daroff-exercises. Published September
18, 2020. Accessed July 16, 2021.
• Moini J, Piran P. Labyrinthine Artery. Labyrinthine Artery - an overview | ScienceDirect Topics. https://www.sciencedirect.com/topics/neuroscience/labyrinthine-
artery. Published 2020. Accessed July 20, 2021.
• Robert Bárány. National Centers for Biotechnology Information (NCBI). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2117637/. Published March, 2007.
Accessed July 19, 2021. 
• Robert Bárány - Facts. The Nobel Prize. https://www.nobelprize.org/prizes/medicine/1914/barany/facts/. Accessed July 19, 2021.