Benign Paroxysmal Positional Vertigo (BPPV)

“If you have a feeling of the room spinning when you change positions you could have Benign Paroxysmal Positional Vertigo (BPPV). BPPV can be managed by clinicians, including physiotherapists, trained in the treatment of BPPV by performing specific maneuvers of the head”.

What is BPPV?

BPPV is vertigo that is caused by debris that has collected in the fluid in the inner part of the ear. The debris consists of crystals of calcium carbonate called otoconia or ‘ear rocks’. These ear rocks abnormally stimulate the cupula via hair cells. The cupula is a structure in the vestibular system providing the sense of spatial awareness.


BPPV Symptoms

  • Vertigo: Is a sensation of spinning or moving. In BPPV it typically lasts for less than one minute. The vertigo occurs during a change of position of the head in respect to gravity. Rolling over in bed or getting from lying to sitting can cause the dizziness.
  • Lightheadedness
  • Imbalance
  • Nausea

Causes of BPPV

In younger persons under the age of 50 the most common cause of BPPV is a head injury. BPPV is also associated with migraine. In the older patient the most common cause is degeneration of the vestibular system of the inner ear. BPPV is more common in older individuals. In the majority of cases BPPV is idiopathic occurring for no apparent reason. Other causes include viruses, post surgery, minor strokes and following some medications.


Dix-Hallpike test: This simple test can help determine if you have BPPV. The patient is laid down with the head turned and tilted backwards a little. A positive test results in a jumping of the eyes (nystagmus). See figure below.

Dix-Hallpike test

Treatment of BPPV

Treatment of BPPV involves the therapist positioning the patient into 4 different positions each held for 30 to 45 seconds. The aim is to move the otoconia or ear rocks into a less sensitive part of the ear canal. The procedure is repeated 2 to 3 times. Usually 2 treatments will result in a cure in about 80 per cent of patients.

Post Treatment

Patients attending our clinic for BPPV treatment are given written instructions in what to do post treatment which are essential for the success of the treatment.