Form: D-5758
Benign Paroxysmal
Positional Vertigo
Information for patients and families
Read this booklet to learn about:
• what Benign Paroxysmal Positional Vertigo (BPPV) is
• symptoms you can expect
• how your doctor will diagnose it
• treatment options
What is BPPV?
BPPV is a balance disorder of the inner ear that causes vertigo, dizziness and
other symptoms. It happens when calcium crystals inside the ear become
loose and begin collecting in the canal at the back of the inner ear.
Otoconia
How does this happen?
The organ in your inner ear that helps you keep your balance is made up
of 3 semicircular canals, a saccule and a utricle, all connected by inner
ear fluid.
• The utricle and saccule have sense receptors loaded with tiny crystals
that help detect small movements of your head.
• If some of these crystals become loose, they will float freely in the inner
ear fluid.
• When this happens, moving your head in certain positions will cause
these crystals to shift and travel within the fluid of the semicircular
canal. This will irritate the balance organ inside your inner ear, and will
send false signals to your brain that will make you dizzy.
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What causes BPPV?
There are a few reasons why crystals may become loose inside your inner
ear and cause BPPV, including:
• if you have had a mild to moderate head injury (including whiplash)
• if you have had Vestibular Neuritis (an inner ear infection)
• if you have Meniere’s Disease (combination of vertigo, tinnitus (ringing in
the ears) and hearing loss)
For many older people, dizziness is often due to BPPV. In half of all cases,
BPPV happens for no known reason.
What are symptoms of BPPV?
Many people with BPPV say that one symptom they have is a short spinning
(vertigo) or falling sensation that happens when they sit up to get out of bed,
roll over or lie back in bed or, bend forward to pick up something on the
ground. Some people complain that they also feel nauseated afterward.
They also say that:
• the vertigo usually lasts a few seconds to 1 minute
• you may have several attacks of these symptoms every day
• these attacks can happen for a few days or few weeks, but, in some
cases, the attacks can last as long as a few months
• most of the time, the BPPV symptoms will go away within a few weeks
without any treatment
How will my doctor know that I have BPPV?
Your doctor will diagnose BPPV based on your symptoms and after an
examination. Your doctor will also look for “nystagmus” (“nis-tag-mus”), or
jumping of your eyes, when doing positional manoeuvre tests.
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The most common manoeuvre will be the “Dix-Hallpike” test.
• The doctor asks you to sit on the bed, then turns your head and helps you
lie down quickly to one side.
• This quick movement causes the loose crystals in your inner ear to
become displaced, triggering your dizziness.
• At the same time, the doctor will look at your eyes for “nystagmus”.
• Once both ears have been tested, the doctor decides which ear and which
semicircular canal has been affected by BPPV.
To find out more about your inner ears, your doctor may also
send you for a hearing test or other balance tests, such as an ENG
(electronystagmography).
How will my BPPV be treated?
“Particle repositioning manoeuvres” treat BPPV and can be done in your
doctor’s office in about 15 minutes.
Two common repositioning techniques used are the “Epley manoeuvre” and
the “Semont-Liberatory manoeuvre”.
Epley Manoeuvre
For this procedure, your doctor follows these steps:
1. Asks you to sit on the bed with your head turned to the side that brings on
your dizzy symptoms.
2. Helps you lie down quickly with your head placed over the end of the bed
and supports ou with his or her hands.
3. Guides you through 3 or more head movements over the next few
minutes. These movements help move the crystals out of your
semicircular canal and into the utricle where they will not cause irritating
symptoms.
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Semont-Liberatory Manoeuvre
For this manoeuvre, your doctor does the following steps:
1. Asks you to sit on the bed.
2. Helps you lie down on the side that brings on your dizzy symptoms with
your face turned upwards about 45 degrees.
3. Brings you quickly to a sitting position and rapidly swings you to the
opposite side with your face turned downwards by 45 degrees. You will
then stay in this position for 5 minutes.
The manoeuvres effectively treat your BPPV symptoms.
Are there any other treatments for BPPV?
Other treatments for BPPV may also include vestibular physical therapy
exercises to help you “retrain your brain”.
• The “Brandt-Daroff” positional exercises are rapid head and body tilts
that can be done at home. Your doctor or physiotherapist will show you
how to do these exercises and tell you how often to do them.
• “Canal-plugging” surgery may be an option to treat BPPV if all therapies
have been considered and tried (and the correct ear and affected semi-
circular canal have been identified).
Surgery for BPPV is only recommended if you have had symptoms for at
least 6 to 12 months and these symptoms are causing unwanted changes to
your lifestyle.
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Are there any possible side effects or complications with
these manoeuvres?
You may have vertigo and nausea during any of the repositioning
manoeuvres, but this should settle afterwards.
You may also feel slightly off-balance and have a sick feeling. This should go
away over the next couple of days.
Who can I contact for more information about BPPV?
To learn more about BPPV, or to ask a question, please call:
Wanda Dillon RN
Clinical Vestibular Nurse
The Multi-Disciplinary Neurotology Centre
Toronto General Hospital
Phone: 416 340 5226
Email: [Link]@[Link]
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© 2020 University Health Network. All rights reserved. Use this material for your information only. It does not replace advice from your
doctor or other health care professional. Do not use this information for diagnosis or treatment. Ask your health care provider for advice
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Form: D-5758 | Author: Wanda Dillon, RN | Reviewed: 2020
