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What is Benign Paroxysmal Positional Vertigo?

What Is Benign Paroxysmal Positional Vertigo?

If you ever had vertigo you know how intense and terrifying the sensation feels. Vertigo may be caused by central involvement (brain trauma, stroke, or infection), peripheral involvement (inner ear) or medications (Vertigo: Symptoms, Causes & Treatment, 2023). The most common form of vertigo comes from the inner ear, which are the patients we treat at Levine Hearing.

Your Inner ear helps with sending sound waves that are converted to electrical signals to your brain and also helps maintain balance and where your head is in space (Purves & Fitzpatrick, 2001)  Specifically, there are crystals called otoconia in the utricle and saccule, which send signals to the brain about linear acceleration of the head. These structures are located at the base of the semicircular canals. There are 3 semicircular canals that are filled with fluid and that fluid moves as your head rotates, providing more input to the brain of where your head is in space.The internal ear

Sometimes, the otoconia (the crystals) sneak out of their proper location and float around in the semicircular canals. When that happens, the fluid within the canals cannot move smoothly and is unable to send the appropriate signal to the brain as the head rotates and causes true vertigo (spinning, swaying, dizziness) to occur. The sensation feels like your eyes are moving frantically and the world around feels like it is spinning, which is called Benign Paroxysmal Positional Vertigo (BPPV).

The emphasis is on positional. The only time vertigo is felt is if you move your head in specific ways: looking up, rolling over in bed, going from a lying to seated position or lying down in bed, causing the fluid in the semicircular canals to move (Benign Paroxysmal Positional Vertigo (BPPV), n.d.). The majority of BPPV cases are idiopathic, meaning that it arises with no known cause. (Palmeri & Kumar, 2022). Other times, BPPV can be caused by head trauma, vestibular neuronitis, labyrinthitis, Ménière disease, migraine, ischemia, and iatrogenic causes (Palmeri & Kumar, 2022).

How Is BPPV Fixed?

Although the sensation is very intense to those who experience it, treatment for BPPV is relatively simple. The treatment is typically performed by Physical Therapist, Audiologist, or physicians through canalith repositioning. Like previously mentioned, specific head movement provokes symptoms, so in order to treat BPPV, patients are put into specific positions and moved through specific movements to move the crystals back where they belong. Don’t worry though, if you are seen by 2 different providers to treat the same canal and they use different movements. There are a couple different maneuvers that can be used for the same canal!

Why Did My BPPV return?

Typically, after one appointment of canalith repositioning, vertigo due to BPPV should not occur again. But unfortunately for some, it does occur again. If you are an individual that has recurring BPPV, you now are educated on what is happening and where to go to fix it. Recurrence typically happens within the first 6 months, but has been observed to reoccur within the first 4 years of initial treatment. Here is a list of external and internal factors affecting recurrence:

  • Advanced age
  • Female Gender
  • Trauma
  • High blood sugar
  • Hormonal factors
  • High blood pressure
  • Heart disease
  • Sleep disorders
  • Mineral density score in both men and women
  • Vitamin D and calcium deficiency, which is related to bone density because both vitamins play a role in improving bone density
  • Seasonal variation causing temperature and pressure changes: sinus or upper respiratory infections, which typically occur in colder climates potentially indicating that environmental factors play a role. Additionally, in the colder weather months, individuals are typically more sedentary causing demineralization and osteoporosis, which like stated above can increase prevalence. Furthermore, allergy season causing nasal allergies/seasonal change

If you’re feeling vertigo sensations or suspect that you may have BPPV, or if you’re feeling dizzy and off balanced, give us a call at Levine Hearing for a battery of tests to diagnosis and provided the next steps to get you feeling better:



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