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Benign Paroxysmal Positional Vertigo (BPPV)


Benign Paroxysmal Positional Vertigo (BPPV) is an inner ear dysfunction that causes dizziness upon head movements.


What is Benign Paroxysmal Positional Vertigo (BPPV)?

The inner ear serves two main functions: hearing and balancing. When the inner ear is affected, dizziness and the feeling of unsteadiness can occur. Normally, there are small stones (calcium carbonate) that live inside a sac within the inner ear (Fig. 1) and they are important for our balance, such as while standing and walking.

Benign Paroxysmal Positional Vertigo (BPPV) is characterised by the sudden feeling of short-lived dizziness (usually 'spinning' sensation) that is aggravated by certain head movements (for example, turning in bed and looking upwards). This dizziness is due to small stones, usually stuck to a sac of the inner ear, being dislodged (Fig. 2). They travel freely into the inner ear canals and stimulate the inner ear canals with certain head movements which results in dizziness.

What are the common causes?

  • Spontaneous (happens without a known cause)
  • Head trauma
  • Ear trauma
  • Infection of the inner ear

What are the signs and symptoms?

  • Vertigo(spinning sensation) lasting a few seconds to a minute
  • In some cases, vertigo may persist up to few minutes
  • In BPPV, vertigo is always aggravated by head movement, such as turning in bed, looking out to the window while in a car or even looking up to reach something on a shelve

What are the risk factors?

BPPV can occur to any person at any given age, but it tends to be more common in:

  • 50 years old and above
  • Female
  • Family members who have similar dizziness

What types of treatment are available?


At the early stage of BPPV, doctors may prescribe medications to reduce vertigo and nausea. However, it is not recommended for long term use


Your Physiotherapist may help you by:

  • Doing repositioning maneuvers, for example the Epley's maneuver, that help to reposition the small stones back into the sac inside the inner ear
  • Teaching you specific exercise to help your brain to adapt to the movements that cause dizziness

What is the prognosis?

  • This condition can be managed successfully by doing the repositioning maneuvers described earlier
  • The recurrence rate may vary among individuals
  • In some cases, untreated BPPV can resolve spontaneously with time

What can I do to help myself?

  • Avoid sleeping on the affected ear after treatment
  • Do the exercises prescribed by your physiotherapist
  • Avoid any physical impact to your ear e.g. hitting the ear
  • After treatment if BPPV reoccurs, remain seated or keep still for a few minutes until the dizziness goes away; if there is no improvement, seek medical attention


- Last updated 5 Jun 2014,4:06 pm

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