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BCM - Baylor College of Medicine

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Center for Balance Disorders

Benign Paroxysmal Positional Vertigo (BPPV)

Benign (non life-threatening) Paroxysmal (sudden onset) Positional (occurring with certain changes in head position) Vertigo (dizziness) or "BPPV" is one of the most common causes of vertigo in adults. The classic symptom is that of vertigo, the illusion of movement, which occurs within a few seconds after a position change. Most commonly a brief sensation of spinning is experienced after lying down in bed, arising in the morning, or rolling over in bed at night, but may also occur when one looks up to a high shelf, or down under furniture. Typically, the symptoms last a a few seconds or a minute or so before resolving. To many people, the BPPV experience is very frightening, and should one observe a person having this type vertigo, one would witness jerking movements of the eye called nystagmus. Sometimes these eye movements are in a circular or torsional direction. View these short videos for a demonstration of the following balance disorders:

  • Nystagmus. Occurs normally with horizontal head movement.
  • Circular or Torsional Nystagmus. Frequently seen with BPPV.

Evaluation and Treatment

Illustration of the bony chambers of the inner ear

BPPV is due to microscopic crystals, or otoconia, floating around in one of the compartments of the inner ear. The movement of these particles stimulate the sensory endings of the vestibular (balance) nerve, producing vertigo. These crystals arise from the surface of a specialized membrane in the inner ear and occasionally break loose from that membrane to float freely in the inner ear and enter the semicircular canals. Any of the three semi-circular canals can be affected and the changes in position which precipitate the vertigo, vary according to the canal involved. For an excellent description of the inner ear, please see How the Ear Works by Dr. William Brownell. The Center for Balance Disorders routinely performs positional tests as part of the ENG, or electronystagmography, a test battery used to evaluate patients with dizziness.

The good news is that BPPV responds well to physical therapy maneuvers. Medications rarely help. A trained vestibular therapist can perform therapy which can rapidly eliminate the symptoms of dizziness. These maneuvers are designed to relocate the crystals to a part of the inner ear where they will not produce any symptoms. Treatments for BPPV can usually be performed in one or two sessions. Referral for treatment must come from a medical doctor.

It is important to remember that vertigo can be produced by a number of different medical problems, and a thorough evaluation is often necessary to determine the underlying cause. Most otolaryngologists (ear, nose, and throat doctors) are skilled in performing these evaluations. Baylor's otolaryngology head and neck physicians work in the Bobby R. Alford Department of Otolaryngology - Head and Neck Surgery.