Benign Paroxysmal Positional Vertigo (BPPV)

What is Benign Paroxysmal Positional Vertigo (BPPV)?

The inner ear serves two main functions: hearing and balancing. When the inner ear is affected, dizziness and a feeling of unsteadiness can occur. Normally, there are small stones (calcium carbonate) that live inside a sac within the inner ear (Fig. 1), and they are important for balance, such as standing and walking.

Fig. 1 Normal inner ear

Benign Paroxysmal Positional Vertigo (BPPV) is characterised by the sudden feeling of short-lived dizziness (usually a “spinning” sensation) that is aggravated by certain head movements (for example, turning in bed and looking upwards). This dizziness is due to small stones, usually stuck to a sac of the inner ear, being dislodged (Fig. 2). They travel freely into the inner ear canals and stimulate the inner ear canals with certain head movements, which results in dizziness.

Fig. 2 Inner ear with BPPV

Common Vertigo or BPPV Causes

• Spontaneous (happens without a known cause)
• Head trauma
• Ear trauma
• Infection of the inner ear

Signs and Symptoms of BPPV

• Vertigo (a spinning sensation) lasting a few seconds to a minute
• In some cases, vertigo may last for a few minutes
• In BPPV, vertigo is always aggravated by head movements, such as turning in bed, looking out the window while in a car or even looking up to reach something on a shelf

What are the Risk Factors of Vertigo?

BPPV can occur to any person at any given age, but it tends to be more common in people who:

• Are 50 years old and above
• Are female
• Have family members who have similar dizziness

Types of Vertigo Treatment

At the early stage of BPPV, doctors may prescribe medication to reduce vertigo and nausea. However, it is not recommended for long-term use.

Your physiotherapist may help you by:

• Doing repositioning manoeuvres, for example, the Epley's manoeuvre, helps to reposition the small stones back into the sac inside the inner ear
• Teaching you specific exercises to help your brain to adapt to the movements that cause dizziness

What Is the Prognosis for BBPV?

This condition can be managed successfully by undertaking the repositioning manoeuvres described above. The recurrence rate may vary among individuals. In some cases, untreated BPPV can resolve spontaneously over time.

What Can I Do to Help Myself If I Have Vertigo?

• Avoid sleeping on the affected ear after treatment
• Do the exercises prescribed by your physiotherapist
• Avoid any physical impact to your ear, e.g. hitting the ear
• After treatment, if BPPV reoccurs, remain seated or keep still for a few minutes until the dizziness goes away; if there is no improvement, seek medical attention

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