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Benign Paroxysmal Positional Vertigo (BPPV)

Benign Paroxysmal Positional Vertigo (BPPV) usually causes intense, brief episodes of dizziness or vertigo associated with moving the head, often when rolling in bed or getting up in the morning. Some people may also feel nauseous between episodes of vertigo. It occurs when tiny particles break loose and fall into the wrong part of the vestibular system in the inner ear, stimulating the nerves that detect head rotation. The brain receives the message that the head is spinning although the head has only moved position slightly. BPPV is the most common cause of vertigo.

What do the symptoms of BPPV feel like?

Activities that bring on BPPV symptoms vary from person to person, but getting out of bed or rolling over in bed is often the movement that triggers dizziness, vertigo, lightheadedness, imbalance or nausea. Some people feel dizzy when they tip their heads back to look up, and for this reason BPPV is sometimes called ‘top shelf vertigo’. Symptoms are usually intermittent, stopping for several weeks or months at a time and then coming back for a longer or shorter period.

What causes BPPV?

BPPV can be caused by head injury; degeneration of the vestibular system in the inner ear due to increasing age; or damage caused by an inner ear disorder. There is also an association between BPPV and osteoporosis, and people who work with a persistent head-tilt, such as dentists and barbers, can suffer from BPPV. However, in a large number of cases there is no known cause.

How is a diagnosis made?

Diagnosis of the condition will be made based on your medical history; answers to questions about when and where the symptoms occur; a physical examination; and possibly the results of tests carried out by an audiologist. Other tests may be required in cases where symptoms do not fit the usual pattern or are in both ears, both of which make diagnosis more challenging.

How is BPPV treated?

BPPV can be diagnosed and treated with simple exercises, taught by a GP or physiotherapist who is familiar with the techniques required. However, if symptoms persist and cause distress, you may be referred to a specialist. For more information about vestibular physiotherapy, including how to access a vestibular physiotherapy service, please click here.

Very short-term use of motion sickness medications is sometimes useful to control the nausea associated with BPPV, and a number of easily learnt maneuvers and exercises are proven to be very effective treatments.

BPPV can subside with time, but it is important to seek treatment in the early stages to prevent falls or injury. In extreme cases, surgery can be carried out to block the affected canal without disturbing the function of the rest of the vestibular system.

Epley Omniax Positioning System

In cases of BPPV where bedside diagnosis is difficult or your BPPV is difficult to treat you may be referred for an assessment on the Epley Omniax Positioning System.

The Epley Omniax Positioning System was obtained thanks to generous funding from a Gandel Philanthropy Community Build grant. The state-of-the-art balance disorder diagnostic and management system is housed in the Gandel Philanthropy Balance Disorders Diagnostics.

This is an automated patient positioning system used to diagnose and treat forms of dizziness brought on when a person moves.  During the assessment you will be seated in a chair, secured with a harness and slowly moved to various positions.  Infrared video goggles will record your eye movements and the clinician will analyse the results to help diagnose and treat your dizziness.

For more information on the Epley Omniax Positioning System, click here.


Epley Omniax Positioning System

Living with BPPV

If maneuvers and exercises have been recommended, it is important to persist with the treatment because they provide a simple and non-invasive way to halt the vertigo and nausea associated with BPPV.

Online resources

The Vestibular Disorders Association is a US-based, patient support group. Their website contains useful information about how to understand, live with, and find support for balance disorders: www.vestibular.org

Definition of BPPV medical terms

Benign: a mild disease that responds favourably to treatment and is not life-threatening

Paroxysmal: a sudden onset of symptoms

Positional: related to body position

Vertigo: false sensation that you or your surroundings are moving