Benign Paroxysmal Positional Vertigo
February 26, 2017
What is Benign Paroxysmal Positional Vertigo?
Benign Paroxysmal Positional Vertigo, or BPPV, is described as a sensation of dizziness as if the world around you is spinning. This sensation can be caused by nausea, vomiting, and most seriously, falls.
Benign: meaning that is not severe or life threatening
Paroxysmal: sudden onset of symptoms lasting for short durations
Positional: symptoms are usually brought on by a change in position (E.G. rolling in bed or sitting up from laying down)
Vertigo: a sensation that the external world is moving or spinning
- Onset of spinning within between 1 and 30 seconds of position change
- May be caused consistently with certain movements
- Lasts from 10-20 seconds, sometimes up to a minute
Who is affected by BPPV?
BPPV can affect all age ranges, but is most common in the older population(1). It is the number one cause of dizziness in individuals over 60 years old, and will affect 50% of the population over 70 years old(2). Women are also affected far more than men with the ratio of differences being documented as high as 3:1(3).
Other risk factors include a history of:
- Cardiovascular disease
- Head trauma
What is the cause?
The balance center of the ear is comprised of a complex labyrinth of 3 semicircular canals and 2 other sensory organs known as Otolith organs. The canals are filled with fluid that moves through the canals, providing information about movement by pushing small hair fibers one way or another. The Otolith organs (Utricle and Saccule) contain small rock like crystals called Otoconia. These crystals are attached to a gelatinous membrane that shifts back and forth providing more information about motion.
BPPV is caused by a mechanical problem in the inner ear. Sometimes the crystals of the Otolith organs can become dislodged from their membrane and work their way into one of the canals. This change in location alters the ability of the canals to do their job and causes the sensation of vertigo.
How is it treated?
Luckily, in most cases, BPPV is one of the more easily treatable vestibular issues with the help of a trained Physical Therapist. Studies have shown a 79% success rate with a single treatment and 96% success rate with two treatments(4). During the treatment session, the Physical Therapist will guide the patient through a series of positions that will clear the rogue crystal from the canal effectively removing the cause of the dizziness. If left untreated, symptoms may resolve spontaneously but can last weeks or months.
- Parnes L, Agrawal S, Atlas J. Diagnosis and Management of Benign Paroxysmal Positional Vertigo (BPPV) 2003; 169(7): 681-693.
- Froehling DA, Silverstein MD, Mohr DN, Beatty CW, Offord KP, Ballard DJ. Benign positional vertigo: incidence and prognosis in a population based study in Olmsted County, Minnesota. Mayo Clinic Proceedings. 1991;66:596-601.
- Solomon, Caren G, MD, MPH; Kim, Ji-Soo, MD, PhD; Zee, David S, MD. Benign Paroxysmal Positional Vertigo. The New England Journal of Medicine; Boston 370.12 (Mar 20,2014): 1138-47.
- Gans, R. E., & Harrington-Gans, P. A. Treatment Efficacy of Benign Paroxysmal Positional Vertigo (BPPV) with Canalith Repositioning Maneuver and Semont Liberatory Maneuver in 376 Patients. Seminars in Hearing, 23(2), 129-142. doi:10.1055/s-2002-33002