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What is BPPV?
BPPV stands for benign paroxysmal positional
vertigo. It is a disorder of the vestibular system
of the inner ear.
It is the most common vestibular disorder.
The vestibular system in the inner ear is
responsible for maintaining balance.
Benign means that it is not life-threatening and
will generally not progress.
Paroxysmal describes how the symptoms occur
suddenly, in brief episodes of mild to intense
Positional describes how changes in head
position cause symptoms. These positional
changes may be looking up and down, laying
down or rolling over in bed, or sitting up quickly.
Vertigo is used to describe the sensation of
movement or spinning that occurs following a
Anatomy of BPPV
• The vestibular system of the inner ear is made up
– 2 organs called the utricle and saccule
– 3 semicircular canals: posterior, anterior, and
• Attached to a membrane within the utricle and
saccule are microscopic calcium carbonate
crystals called “otoconia” that help sense
What causes BPPV?
BPPV occurs when the otoconia become dislodged
from the membranes in the utricle and saccule and
collect in the semicircular canals.
What causes BPPV?
When the head moves, this causes the displaced
otoconia in the semicircular canals to move. This
movement of otoconia sends a false signal to
the brain, causing vertigo.
What causes BPPV?
• BPPV is more likely to occur over the age of 50 and is,
in most cases, a result of an age-related degeneration
of the vestibular system.
• Other causes may include:
– Mild to severe head injury
– Surgery causing trauma to the ear
– Extensive dental work
– Prolonged inactivity
– Other vestibular abnormalities
Types of BPPV
• Classified by which semicircular canal the
otoconia have migrated to: anterior, posterior,
• Classified by whether the otoconia are free-
floating in the semicircular canal (called
canalithiasis) or have become attached to the
membrane within the semicircular canal
• Classified as unilateral or bilateral.
The most common type of BPPV is
unilateral posterior canal
Types of BPPV
What are the symptoms of BPPV?
• Brief episodes of vertigo (spinning sensation)
triggered by head or body movements.
• Episodes of vertigo typically last less than 1
• In cupulothiasis type BPPV, episodes can last
• Symptoms range from mild to severe. In
severe cases of vertigo, nausea and vomiting
What is nystagmus?
Nystagmus describes the involuntary eye
movements that occur during episodes of BPPV.
It is a quick back and forth “beating” movement
of the eyes.
Diagnosis of BPPV
• Medical and case history
• Auditory evaluation
• Vestibulonystagmography Test (VNG)
• Positioning testing to include the Dix-Hallpike
The Dix-Hallpike maneuver is performed by
moving the patient’s head and body into
different positions and observing the nystagmus.
The characteristics of the nystagmus will
determine which semicircular canal is being
affected. Vertigo will likely occur during the Dix-
Hallpike if you have BPPV.
How is BPPV treated?
• Canalith Repositioning Procedure (CRP)
– A specific series of head and body movements.
– Used to relocate the otoconia from the semicircular
canal back into the utricle or saccule.
– Performed by a trained technician or Doctor.
• Brandt-Daroff exercises
– Home-based exercises involving repeating a series of
head movements 2-3 times for 3 weeks.
– Can be performed by the patient themselves without
Types of Canalith Repositioning
• The type of canalith respositioning procedure
performed to treat BPPV will depend on which
type of BPPV has been diagnosed.
• The two most common canalith repositioning
procedures used to treat posterior canal BPPV
– The Epley Maneuver
– The Semont Maneuver
The Epley Maneuver
Involves 4 sequential movements of the head
and body with a 30 second or more rest at
The Semont Maneuver
Involves quickly moving the patient from laying on
one side to the other. The head is held in a specific
position during movements.
Canalith Repositioning Procedure
Following a CRP, the patient should restrict head
and body movements for a period of 24-72
hours. Sleeping position may also be restricted
during this time as well. This gives the otoconia
sufficient time to “settle” back into the utricle
and saccule following treatment.
Can BPPV cause lasting problems?
• Most cases of BPPV can be successfully treated
after one or two canalith repositioning
• BPPV is likely to re-occur several times within a
• Although BPPV is not life-threatening, the
symptoms can be very debilitating before