BPPV
Benign Paroxysmal Positional Vertigo (BPPV)
What is Benign Paroxysmal Positional Vertigo (BPPV)?
BPPV is a common inner ear condition that causes sudden, brief episodes of vertigo—a spinning sensation that can make you feel like the room is moving around you.
It’s one of the most frequent causes of dizziness, accounting for up to 17% of dizziness-related visits to medical clinics.
These dizzy spells are typically triggered by specific head movements, such as looking up or down, turning your head quickly, or rolling over or getting out of bed.
If you’re experiencing symptoms of BPPV, we can help. Contact us to book a thorough assessment and explore effective treatment options.
About BPPV
Benign Paroxysmal Positional Vertigo (BPPV) is caused by a disturbance in the vestibular system—the part of the inner ear responsible for balance. Each inner ear contains structures called the utricle, saccule, and three semicircular canals. In BPPV, tiny calcium carbonate crystals (called otoconia) become dislodged from their usual position and move into one of the semicircular canals. This movement interferes with normal balance signals, sending incorrect messages to the brain and triggering vertigo.
Common Symptoms of BPPV
Symptoms of BPPV can vary from person to person. Some people experience short, intense episodes, while others may have ongoing symptoms that persist without treatment. Along with vertigo (a spinning sensation), other common symptoms include:
Dizziness or light-headedness
Nausea and/or vomiting
Unsteadiness or imbalance while walking
Difficulty concentrating or feeling mentally “foggy”
A general sense of feeling “not quite right” (NQR)
What Triggers BPPV?
BPPV symptoms are typically brought on by changes in head position. When the head remains still, tiny crystals in the inner ear (otoconia) may settle due to gravity. However, when the head moves, these loose crystals can shift inside the semicircular canals, sending incorrect signals to the brain and triggering a sudden sensation of vertigo.
Everyday movements that may provoke symptoms include:
Rolling over or sitting up in bed
Standing up from a seated position
Bending forward
Looking up or down
If these movements consistently bring on dizziness or vertigo, BPPV could be the underlying cause.
What Causes BPPV and Who Does It Affect?
BPPV occurs when tiny calcium carbonate crystals (otoconia) in the inner ear become dislodged and move into one of the semicircular canals. While the head is still, gravity can cause these crystals to clump together. When the head moves—such as when getting out of bed—the crystals shift, sending misleading signals to the brain and creating a strong sensation of vertigo.
Common Causes and Risk Factors
Age-related Changes
In adults over 50, BPPV is often idiopathic (no clear cause) but is commonly linked to natural age-related degeneration of the inner ear, particularly the otolithic membrane.
Head Trauma
In individuals under 50, BPPV is most often caused by a head injury. The impact can dislodge the otoconia, leading to symptoms.
Other Vestibular Conditions
BPPV is more likely to develop in people with other inner ear disorders such as:
Vestibular neuritis (inner ear inflammation)
Migraines
Post-surgical effects involving the ear or skull
Medical and Lifestyle Risk Factors
Additional factors that may increase the likelihood of BPPV include:
Osteoporosis or osteopenia
High blood pressure or cholesterol
Diabetes
Hypothyroidism (low thyroid function)
A sedentary lifestyle
Idiopathic BPPV
When no obvious cause or risk factor is present, the condition is classified as idiopathic—meaning it arises without a known reason.
How Is BPPV Diagnosed?
BPPV is diagnosed based on your symptoms and thorough medical history, along with specific tests for this condition.
One particular test is known as the Dix-Hallpike test. This test involves lying down whilst the therapist observes your eye movements (called ‘nystagmus’) to determine which semicircular canal is affected by BPPV.
If you have symptoms of BPPV, we can perform a full physical assessment of your symptoms and guide you through potential causes and treatment options. Book an appointment with our team to get started.
Treatment for BPPV
Physiotherapy can offer fast and effective relief from BPPV through a series of specific movements known as particle repositioning manoeuvres. These manoeuvres are safe, gentle, and designed to guide the dislodged calcium crystals (otoconia) back to their correct position in the inner ear.
Your physiotherapist will take you through a sequence of slow, controlled head and body movements tailored to the location of the crystals. One of the most commonly used techniques is the Epley manoeuvre, which involves shifting from a seated to lying position while gently turning the head.
The choice of manoeuvre depends on:
Which semicircular canal is affected
Whether the crystals are free-floating or attached within the canal
In many cases, symptoms resolve after just one treatment. However, some patients may need multiple sessions to fully resolve their symptoms.