Benign Positional Paroxysmal Vertigo (BPPV)

What it is -  Calcium Carbonite Crystals (otoconia) become dislodged from their home in the utricle and migrate into a nearby 3 semicircular canals in the inner ear where they do not belong. 

Symptoms – When you turn your head, the otoconia artificially stimulate nerve endings in the inner ear that send signals to the brain that you are moving.  When these signals do not match the feedback from muscles, joints, and the eyes, the net effect is a false sense of spinning for less than a minute.   This commonly occurs when rolling onto your side in bed or with quick head movements.

Diagnosis – When the head is moved in a position that stimulates the otoconia, the signaling mismatch causes a pattern of movement with the eyes called nystagmus.  This can be visualized while performing a Dix Hallpike Maneuver, which will confirm which canal is involved. 

Treatment – Fortunately, the majority of cases can be resolved mechanically.  For greatest accuracy, the gold standard of vertigo assessment, Videonystagmography (VNG), is used to assess the direction of nystagmus to determine which of the semicircular canals is involved.  Once the doctor determines where the otoconia are residing, a repositioning maneuver, like the Epley Maneuver, is performed to facilitate mechanical movement of the crystals back to their home.  Positioning maneuvers are over 90% successful at resolving symptoms in 1-3 treatments (1).

Our approach – Following the repositioning maneuver with the aid of VNG, we perform brain rehabilitation to improve feedback between the relays involved in the sensory mismatch between the eyes, muscles and joints, and the inner ear to improve your symptoms as quickly as possible.

Self Treatment - It is ill-advised to perform the repositioning maneuvers on yourself.  Many do not find relief because they perform the maneuver incorrectly or they may not have BPPV. 

1. Parnes LS, et al. Diagnosis and management of benign paroxysmal positional vertigo (BPPV). CMAJ. 2003 169(7):681-693.