Positional vertigo

Benign paroxysmal positional vertigo (BPPV) is an inner ear disorder. It causes dizziness and a spinning or tilting sensation, sometimes accompanied by nausea and vomiting or abnormal eye movements. This type of vertigo is more common in older individuals and affects more women than men.

Episodes of BPPV usually last less than a minute. It does not cause difficulty hearing or tinnitus (ringing or buzzing in the ears). It occurs when you move your head a certain way, like when you sit down while looking up or roll over in bed. If untreated, BPPV can recur frequently for weeks or months.

Causes and triggers

Positional vertigo is caused by the displacement of calcium crystals in the inner ear. The inner ear is an organ in your head that sits behind the eardrum. It's composed of semicircular canals that help you keep your balance. If the calcium crystals become dislodged, they can enter and overstimulate the sensory receptors in the semicircular canals, creating a false perception of motion.

It's often unclear how these crystals become displaced. Below are a few of the many possible causes:

• Ménière's disease (chronic inner ear disorder)
• Vestibular neuronitis (commonly called labyrinthitis)
• Herpes zoster oticus
• Poor blood circulation in the inner ear
• A lesion in the ear
• Head trauma or the after-effects of an accident (even a minor one)
• Ear surgery

Treatment

BPPV usually resolves itself after a few days or weeks. However, a relatively simple and effective treatment is to perform canalith repositioning manoeuvres (e.g., the Epley and Semont manoeuvres).

As it isn't possible to reach the inner ear, these exercises involve moving the head through a series of positions to shift the displaced calcium particles using gravity. The manoeuvres are different for each ear (left or right). Choosing the wrong one can aggravate your condition instead of improving it, so it's important to follow the method recommended by your health care provider. You may notice an improvement right away, or up to 2 days later. Some methods are simple enough to be done at home, if appropriate.

Almost all cases of BPPV can be treated using canalith repositioning manoeuvres. Surgery may be an option if positional vertigo is preventing you from functioning normally.

When should I see a health care professional?

Speak with your health care provider if your dizzy spells are:

• Repeated
• Sudden
• Severe
• Prolonged
• Seemingly unprovoked

Go to the emergency room in the following cases:

• Your vertigo is accompanied by the following symptoms:

  • An unusual headache
  • Fever
  • Blurred vision or vision loss
  • Hearing loss
  • Difficulty speaking
  • Weakness in your arms or legs

  • Loss of consciousness
  • Difficulty walking
  • Numbness or tingling
  • Chest pain
  • Persistent vomiting

• Your vertigo lasts several minutes and you meet the following criteria:

  • You're over 60 years old
  • You've previously had a stroke (cerebrovascular accident)
  • You're at risk for stroke (i.e., you smoke, have high blood pressure, or have diabetes)