How BPPV (Benign Paroxysmal Positional Vertigo) affects your ear and body balance

BPPV (Benign Paroxysmal Positional Vertigo) is an inner ear problem that is entirely mechanical. Among all the ear problems that cause balance disorder, BPPV is the most prevalent one.

The inner ear is also the hub of many complex organs, called vestibular organs that help balance the body.

Body balance; image source:

Here with this post, we are trying to take the word across to readers to help them understand how BPPV affects their lives and what the treatment for it.

Meaning, Causes & Symptoms of BPPV

The BPPV is a condition where the microscopic calcium carbonate particles also called otoliths or otoconia, migrate to semi-circular canals of the inner ear from their original place – utricle in the vestibule.

Let’s explain the mechanism in detail

The semi-circular canals are fluid-filled and contain minute hair-like sensors that move according to the head position to transmit the relative position to the brain and help the body maintain equilibrium.

The otoliths are crystals that are sensitive to gravity. The dislodgement of otoliths from utricle to semi-circular canals disturbs this mechanism of body equilibrium triggering false signals to the brain about the head position, the result? Disequilibrium of the body; experienced as vertigo or dizziness.

The nature of the medical condition is easy to understand if you know the full term of the name:

Benign meaning the situation is not life-threatening and does not progress over the period.

Paroxysmal indicates that the symptoms of this condition occur in sudden and short spells.

Positional in the term points to the causes of the BPPV. The condition’s symptoms are triggered as a result of changing head positions.

Vertigo is the result of such head position that triggers false signal transmission. Dizziness or vertigo is the sensation of spinning or whirling of self or the world around.



The otoconia are freely moving in the semi-circular canals of the inner ear.


In this type of BPPV, the otoconia get stuck to the membrane of the canals called ‘cupula’.

The otoliths may migrate to any one or more of the canals in the inner ear – posterior, anterior (also referred as superior) or horizontal canals. Posterior BPPV is the most common one, simply because of its position.


BPPV is mainly seen in old age people above 60 years. However, this condition may affect anyone in the age group below 60 years also. Apart from ageing, below are some of the causes of otolith dislodgement-

  • Prolonged time of bed rest
  • Ear infection or surgery
  • Ototoxicity
  • Head injury


Vertigo is the predominant symptom of BPPV. The dizziness is felt in sudden and short durations.

  • Nausea
  • Tinnitus or ringing in the ear
  • Loss of balance
  • Nystagmus or involuntary eye movements
  • Sensation of spinning or light headedness in particular head position

The symptoms last for a couple of seconds to minutes and subside when the head position is changed.

Diagnosis and Treatment of BPPV

The instant giveaway of BPPV is nystagmus. The abnormal and involuntary eye movements indicate BPPV and also the problem ear. Doctors conduct the Dix-Hallpike test to check for this indication to diagnose BPPV. Going further to arrive at the accurate evaluation of BPPV; MRI, ElectroNystagmography (ENG), Videonystagmography (VNG) are carried out.


To ease the discomforting symptoms of BPPV; anti-vertigo, antiemetic drugs are prescribed to control the severity of vertigo spells and its associated symptoms of nausea and vomiting.


Canalith repositioning exercises

Canalith repositioning exercises are well received by the BPPV patients as they show satisfactory results in few sessions.

The below-mentioned exercises reposition the Otolith’s back to the utricle in the vestibular region and correct the positional vertigo syndrome.

  • Epley Maneuver
  • Semont Maneuver
  • Brandt-Daroff Exercises
  • Roll Maneuver

Although one can learn and do these exercises at home, it is best to be conducted by a professional to get quick and desired results. Epley and Semont manoeuvres are most acclaimed ones to treat BPPV.

After the re-positioning, one should limit the head movement for 2-3 days and sleep in an elevated position, by stacking up the pillows.

Vestibular Rehabilitation Therapy

Vestibular Rehabilitation Therapy comprises of retraining the brain to get used to the false signals and readjust its sensory reception to meet the current scenario. It includes gaze stabilisation, sensory reorganisation, desensitisation and developing alternate compensatory pathways.

Expert doctors at NeuroEquilibrium’s chain of vertigo clinics across India are intensely trained and experienced in handling various BPPV conditions. The diagnostic equipment uses advanced technology to locate which ear has the problem and what kind of BPPV it is. The error-free diagnosis helps more focused treatment and ensure quick results.

Surgery is an option when in spite of canalith repositioning and vestibular rehabilitation; one does not get relieved from BPPV symptoms.

So it is safe to assert that although BPPV is not dangerous, its symptoms may disrupt the day-to-day life of the sufferer. Mild to severe vertigo episodes may make you vulnerable to fall and injury. Since advanced treatment is available for BPPV, there is no reason why one should suffer from it!

About author:
This article was contributed to by a guest author.


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