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Benign paroxysmal positional vertigo (BPPV)

Published by Bupa's health information team, August 2008.

This factsheet is for people who have benign paroxysmal positional vertigo (BPPV), or who would like information about it.

BPPV is the commonest cause of vertigo. Vertigo is the sensation that you, or things around you are moving, even when you are standing still. In BPPV, you get vertigo when you move your head in certain positions.

• About BPPV
• Symptoms of BPPV
• Causes of BPPV
• Diagnosis of BPPV
• Treatment of BPPV
• Questions and answers
• Related topics
• Sources

About BPPV

Your ear is made up of three parts: the outer ear, the middle ear and the inner ear. The inner ear consists of a system of fluid-filled tubes (the labyrinth), which is made up of the cochlea, which senses sound, and the vestibule and semicircular canals, which sense movement of your head.

The structures of the inner ear

The semicircular canals are responsible for sensing rotational movements. When you move your head, fluid moves around the semicircular canals, bending tiny hairs that line the canal walls. This triggers nerve messages to be sent to your brain, giving your brain information about the change in position or movement of your head.

In BPPV, tiny particles from the vestibule in your inner ear become dislodged and enter the semicircular canals. These particles prolong the movement of the hair cells in the semicircular canals, so that signals continue to be sent to your brain indicating movement, even when your head is still. This gives the sensation of vertigo. In BPPV, the vertigo you experience is described as rotational (as if you are spinning).

Symptoms of BPPV

In BPPV, you get vertigo when you move your head into certain positions. The type of vertigo you get in BPPV is rotational - this means that you may feel as if you or the environment around you is spinning, even when you are standing still. It may make you feel sick or be sick.

Attacks of vertigo in BPPV last for less than one minute (usually only a few seconds) and are almost always provoked by the following head movements:

• moving your head to one side - for example, when turning in bed
• tilting your head backwards to look up - for example, when hanging up washing on a washing line or taking something from the top shelf
• bending your head down - for example, to tie your shoe laces

The attacks can stop or improve after a few weeks or months. However in some cases, they can persist for longer.

If you have BPPV, you may also get an involuntary, shaking of your eye (nystagmus). This may only be noticed by your GP.

Although not necessarily a result of BPPV, if you have these symptoms, you should visit your GP.

Causes of BPPV

The particles that cause BPPV are thought to come from the vestibule in your inner ear, where they have come loose - and lodge in one of your semicircular canals. There are a number of reasons why this may happen, including:

• head injury
• viral illness
• ageing

However, there is often no obvious reason why you have developed the condition.

Diagnosis of BPPV

Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history.

Your GP will look into your ear using an instrument called an otoscope, to check whether your symptoms are due to an infection in your outer or middle ear.

You will need to have a test called the Hallpike manoeuvre to confirm whether you have BPPV. This involves your GP moving your head into different positions, while you lie on a couch/bed, to see if this sets off your vertigo or eye movements.

Your GP may do this test himself/herself, or he or she may refer you to a doctor specialising in balance disorders - such as an audiovestibular/audiological physician, or an ear, nose and throat (ENT) consultant. You should also be referred to a balance specialist for further tests if you don't respond to the usual treatments for BPPV (see below), in order to check whether your symptoms may be due to another condition.

Treatment of BPPV

BPPV can stop by itself or improve after a few weeks or months, as the particles disappear or move out of your semicircular canals. However, in some rare cases, it can persist for years.

Medicines aren't usually helpful for the treatment of BPPV. However, physical therapies have been found to be very effective at stopping the vertigo.

Physical therapy

The physical techniques designed for BPPV work by moving the particles in your semicircular canals back into a position where they will no longer cause vertigo.

Your GP may carry out these techniques, or he/she may refer you to an audiovestibular/audiological physician, an ENT consultant or a physiotherapist for treatment.

The techniques may include the following.

• The Epley manoeuvre. This involves moving your head through a precise sequence of four positions, designed to force the particles out of the semicircular canal where they have lodged, into the adjoining area of your inner ear.
• The Semont manoeuvre. In this procedure, you are moved rapidly from lying on one side to the other.
• The Brandt-Daroff exercises. These are usually suggested if the other types of exercise haven't got rid of your vertigo. You will be shown how to do them at home. They involve a precise sequence of moving from a sitting position to specific lying positions and need to be repeated several times a day for two to three weeks.

Although these manoeuvres can be effective in stopping your vertigo, it's possible that your BPPV may re-occur (come back). However, your doctor or physiotherapist may teach you how to do these techniques yourself, so that you can do them at home if your BPPV keeps coming back.

Related topics

• Labyrinthitis
• Meniere's disease

Sources

• Ludman H. ABC of Otolaryngology. 4th ed. London: BMJ Publishing Group, 1997:23
• Simon C, Everitt H, Kendrick T. Oxford Handbook of General Practice. 2nd ed. Oxford: Oxford University Press, 2005:928
• Hilton M, Pinder D. Benign paroxysmal positional vertigo. BMJ 2003; 326:673
• Benign paroxysmal positional vertigo (BPPV). American Hearing Research Foundation. www.american-hearing.org, accessed 25 June 2008
• Hilton M, Pinder D. The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo. Cochrane Database of Systematic Reviews, 2008(2): Art. No.: CD003162

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. It has also been reviewed by Deafness Research UK. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: August 2008.