Vertigo, defined as a sensation of motion in which the person or the person’s surroundings seem to whirl dizzily, is generally regarded as a rather uncomfortable experience. Feelings of vertigo can affect your balance and lead to falls that can be critical in the elderly; vertigo can also be combined with dizziness, sensations of spinning in space, and more rarely, nausea, vomiting, migraines, visual irregularities such as nystagmus, and fainting.

Vertigo can have many root causes, but one of them is connected to hearingbenign paroxysmal positional vertigo, abbreviated BPPV. BPPV is caused by calcium crystals that form naturally in the inner ear known as otoconia or otoliths, and which normally cause no issues. For people who have BPPV, however, these crystals travel from their normal position into one of the semicircular canals, which are crucial for our sense of balance. When this occurs, and the person with BPPV changes the orientation of their head relative to gravity, these crystals move around, and cause an abnormal displacement of endolymph fluid, which leads to vertigo.

BPPV is characterized by the episodic (paroxysmal) nature of the episodes, and can be triggered by such commonplace movements as looking up or down, tilting the head, rolling over in bed, or any other rapid head motion. The resulting vertigo can be made worse by anxiety, lack of sleep, or changes in barometric pressure (for instance, in advance of a snowfall or rainfall). Although BPPV can start at any age, it is more common in individuals over 60 years of age. The initial trigger for the BPPV is typically hard to establish. A sudden blow to the head (for example in a motor vehicle accident) is among the more common causes.

BPPV is differentiated from other varieties of dizziness or vertigo in that it is nearly always prompted by head movements, and in that its effects usually decrease in in under a minute. Diagnosing BPPV generally involves a simple test where the affected individual lies on an examination table and tilts their head sideways or over the edge. Other tests which can be used to diagnose benign paroxysmal positional vertigo include electronystagmography (ENG) or videonystagmography (VNG), which test for abnormal eye movement, and magnetic resonance imaging (MRI), primarily to rule out other potential causes, such as brain abnormalities or tumors.

Benign paroxysmal positional vertigo is generally treated using a technique called canalith repositioning which guides the crystals to a position in the inner ear where there are less bothersome using a series of physical motions. Two types of canalith repositioning that may be used are the Semont maneuver and the Epley maneuver. In some cases (under 10 percent), if these treatments don’t provide relief, surgery may be suggested. Visit your balance disorder specialist if you have felt symptoms which seem as if they could be associated with BPPV, particularly if they persist for over a week.