Benign paroxysmal positional vertigo (BPPV)

Benign paroxysmal positional vertigo (BPPV)

BPPV is a common cause of dizziness. It occurs in people of all ages but is more common in middle-aged
and elderly people. It causes short bursts of intense dizziness when the body or head is placed in certain
positions such as lying on one side in bed or looking upwards. People can feel sick and are sometimes
unsteady for a few hours after the dizziness has gone away.

Benign – this means the cause of dizziness is not a threat to your health.
Paroxysmal – the dizziness comes in short bursts.
Positional – the dizziness is provoked by certain body or head positions.
Vertigo – the medical name for the spinning sensation.

What causes the dizziness?
The dizziness is caused when small crystals float away from another part of the ear and find their way
into one of the semi-circular canals. There are three semi-circular canals in each of your ears and they
detect which direction your head is moving in. So, when you put your head into certain positions, the
crystals move about in the canal making your brain think that you are moving, when in fact you are not.
If you stay in the position that makes you dizzy for a minute or so, the crystals will usually float to the
bottom of the canal and stay there – this is when the dizziness wears off.

The crystals can become unstuck from their normal place, as a result of head injury, or following an
infection of the inner ear, but most commonly it happens for no particular reason. It is usually just in
one ear but occasionally people have it in both ears at the same time.

How is BPPV diagnosed?
BPPV is diagnosed by your description of the problem you have been experiencing and the result of a
test for BPPV. Normally, the semi-circular canals tell the brain which way your head is moving so that
the brain can move the eyes in the right direction. Because of this we can tell if something is wrong with
your semi-circular canals by looking at your eyes. If you have got BPPV, your eyes will move in certain
ways when your head is placed in a position that makes you feel dizzy.

Treatment
It is common for BPPV to clear up by itself after a few weeks or months and no treatment is required. If
it does not resolve itself treatment is a safe, simple and quick procedure. For most patients the dizziness
is stopped after just one treatment, though occasionally the treatment may need to be repeated a
second or third time.

To stop the dizziness we have to move the crystals back to where they came from. This can be done by
moving your body and head through a series of slow, controlled movements. The exact positions will
depend on which canal the crystals are in and whether the crystals are floating around or have become
attached to another part of the ear

What happens after the treatment?
It is not unusual to feel imbalanced or slightly unwell for up to 48 hours after treatment. After this, if
the treatment has been successful, you should be able to move into positions that used to make you
dizzy without any problems.

Whilst at home some patients may be advised to try a series of specific head movements whilst lying
down, if this is the case your doctor will have discussed this with you.

If you continue to have symptoms more than one week please contact your GP.

What happens if the dizziness comes back?
It is not unusual for BPPV to return after a few months or years. If it does come back, you should
contact your GP.

General advice about Vertigo:
Avoid movements that trigger vertigo: Be mindful of head positions that cause dizziness and try to
minimize them.

Get out of bed slowly: Sit on the edge of the bed for a few minutes before standing up to allow the
dizziness to subside.

Use good lighting: Turn on lights if getting up at night to reduce the risk of falls.

Use a walking stick if necessary: If you’re at risk of falling, a walking stick can provide stability.

Avoid driving while dizzy: If vertigo occurs while driving, inform the DVLA and avoid driving until
symptoms are under control.

Manage anxiety: Anxiety can worsen vertigo, so try to relax and manage stress.

Acknowledgements:
https://www.uhs.nhs.uk/Media/UHS-website-2019/Patientinformation/Audiology/Benign-paroxysmal-positional-vertigo-1279-PIL.pdf

https://www.uhs.nhs.uk/Media/UHS-website-2019/Patientinformation/Audiology/Benign-paroxysmal-positional-vertigo-1279-PIL.pdf

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If you are unable to understand this leaflet, please communicate with a member of staff.

For additional medical advice, if your symptoms or condition worsens:
Contact your GP
NHS 111: Telephone 111
Get help with your symptoms, NHS111: https://111.nhs.uk/
Information to help you manage your health: www.nhs.uk
In an emergency telephone 999

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