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Benign Paroxysmal Positional Vertigo (Bppv)

What is BPPV

BPPV is the most common cause of vertigo. Vertigo is a type of dizziness where you feel like you or the room are spinning, a sensation of tilting or swaying or just feeling off balance. In BPPV, the vertigo is triggered by changes in positions of the heads such as looking up or down, rolling in bed or getting out of bed.  It may be bothersome but it is rarely serious.

  • Benign – it is not life-threatening
  • Paroxysmal – it comes in sudden, brief spells
  • Positional – it gets triggered by certain head positions or movements
  • Vertigo – a false sense of rotational movement

It is common in adults but less so in children.

What are the causes of BPPV?

BPPV is caused by dislodgment of small calcium crystals in the inner ear. These calcium crystals are called canaliths. When dislodged, they create a false sensation of rotation.

In majority of cases, we don’t why this happens. However, in certain scenarios, BPPV is caused by head trauma, Meniere’s disease, reduced blood flow to the inner ear, ear surgery, herpes zoster, decompression sickness and certain types of autoimmune diseases like Giant Cell Arterities.

What are the symptoms of BPPV?

The vertigo is triggered by certain changes in head position such as looking up or down, lying or getting out of bed, rolling over in bed. It is brief but occurs frequently. The spells wax and wane and may even suddenly get better. However, recurrence is known to occur.

How is BPPV diagnosed?

Your doctor or audiologist will take a detailed history of the vertiginous episodes and perform a physical examination to exclude other causes of your vertigo.

During a physical examination, your doctor or audiologist will likely look for:

  • Signs and symptoms of dizziness that are prompted by eye or head movements and then decrease in less than one minute
  • Dizziness with specific eye movements that occur when you lie on your back with your head turned to one side and tipped slightly over the edge of the examination bed
  • Involuntary movements of your eyes from side to side (nystagmus)
  • Inability to control your eye movements

Other tests that may be ordered for are VNG (to detect abnormal eye movement) or an MRI (an imaging test to look inside of your body)

What are the treatment options?

In most people, vertigo is bothersome but it is not caused by a serious problem. Treatment for vertigo aims to treat the underlying cause, relieve the bothersome symptoms, and help with recovery. This section will discuss treatment for symptoms and treatments to help with recovery.

Canalith repositioning  — The treatment will be done by the ENT doctor or audiologist in the office by moving your head into certain positions, sometimes called the Epley manoeuvre. You may be given instructions on how to perform similar movements at home, if needed.

These movements encourage the calcium collection to move into a part of the ear where it will be reabsorbed. You may begin to feel better immediately after this treatment or within a day or two.

Treatment for symptoms  — Treatment with medication is not usually recommended if your vertigo lasts only second or minutes.. If you have spells of vertigo that are severe your ENT doctor may recommend a medication to relieve severe vertigo symptoms, like vomiting.

What happens after treatment

Rates of resolution well into the 90% range by 1-3 treatments. It is possible to have more than one canal involved, especially after trauma, in which case your doctor or audiologist would typically have to correct them one at a time. You may be advised to avoid certain head positions for a few days following treatment.

Even after the crystals are back in the correct chamber and the spinning sensation has stopped, people can often feel some mild residual sensitivity to motion and unsteadiness, so it is important to follow up with your doctor or audiologist so that they can evaluate this and provide home exercise techniques that typically correct this promptly.

Will it come back?

Unfortunately, BPPV is a condition that can re-occur periodically with long-term recurrence rates as high as 50% within 5 years. If it seems to always reoccur in the same canal and if deemed safe, your doctor or audiologist may teach you to perform a specific treatment manoeuvre on yourself.

Daily performance of particle repositioning manoeuvres does not affect either the rate of or the time to recurrence in BPPV; we advise the patients to cease performing these manoeuvres at home once the symptoms of the current bout have resolved.


The content on the Nairobi ENT website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions.


  1. Bhattacharyya, Neil, et al. “Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update) Executive Summary.” Otolaryngology–Head and Neck Surgery 156.3 (2017): 403-416.