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Benign Paroxysmal Positional Vertigo (BPPV)

Benign paroxysmal positional vertigo (BPPV) is the most common cause of inner ear dizziness. It is due to damage to one of the balance canals (semicircular canals) of the inner ear.

BPPV is a benign disorder because it is not life-threatening; a paroxysmal disorder since the symptoms occur sporadically; a positional disorder since it is produced by movement of the head or body; and it is a balance disorder since it causes vertigo, which is a sensation of spinning.

BPPV causes a sudden, sometimes violent, dizziness after movement or a change in head position. This sensation usually lasts only seconds. This form of imbalance may be noticed when trying to lie down, arise or turn over in bed. It may even awaken a person from sleep. BPPV can also occur when looking up, downward to the side, or, for instance, when lying back to have one's hair washed.

As a rule, BPPV does not cause hearing loss, ear fullness or head noise (tinnitus). If these symptoms are present, it is likely that a second inner ear problem exists.

Cause
BPPV is due to damage to the vestibular system. The damage may have occurred from trauma to the head, whiplash injury, infection, circulatory changes, degeneration of the inner ear due to aging, or from an unknown cause. In the majority of cases, the cause of BPPV is unknown. Specifically, BPPV occurs when calcium crystals become dislodged in the inner ear. These crystals interfere with the normal function of the semicircular canals.

Diagnosis
BPPV is diagnosed on the basis of a history of typical symptoms, findings on the physical exam, and the results of balance tests. Frequently, the doctor will try to see the patient during or around the time of the dizzy spell to confirm the diagnosis.

Prognosis
Typically, BPPV will go into complete remission with appropriate treatment. Remission means that the dizziness will eventually go away but it may return several months or years later. Treatment may include specific exercises for BPPV, medication, or surgery. Complete remission is achieved in over 98% of cases using nonsurgical treatment.

Physical therapy
One of the most effective treatments for BPPV is physical therapy. Physical therapy helps to place the dislodged calcium crystals back into their proper position in the inner ear. One of the most successful types of physical therapy is a form of head manipulation performed in the doctor's office. This treatment has various names, such as the Epley Maneuver, and the Canalith Repositioning Procedure. The treatment takes approximately 15 minutes. Sometimes the treatment is repeated in one to two weeks if dizziness is still present. Other forms of physical therapy include exercises performed at home. These exercises are known as the Brandt-Daroff exercises.

Surgical Treatment
In a very small number of cases, physical therapy or medications may not control the dizziness. In these instances, surgery may be necessary. Please talk to your doctor about the different types of surgery for benign positional vertigo.