What is it? BPPV is one of the most common causes of dizziness and usually affects about 10% of the general population. It is not a serious condition and is usually easily resolved. It tends to occur with certain head movements often patients will feel dizzy when rolling over in bed or with certain head movements. What does it feel like? BPPV generates a spinning or rotational sensation and this may sometimes make the patient feel nauseous. What causes it? Otoconia which have the consistency of tiny crystals dislodge from the ‘otolith’, an organ in the ear and become trapped in one of the ‘semicircular canals’. The semicircular canal is responsible for a person knowing which way their head is positioned. Gravity causes otoconia to move with changes of the head position and the weight of the dislodged crystal affects the flow in the semi-circular canal. The information from the canal is distorted telling the brain the head is moving or moving further than it is despite this not being the case. A less common variation is when the Otoconia adhere to a part of the canal making it extra sensitive to

gravity. Either way, this mismatch of information makes the patient feel dizzy with certain head movements. Otoconia may become dislodged just as part of a natural process or as result of a head injury/trauma. How is it diagnosed? A history will be taken to rule out other diseases. Then the specialist will complete some positioning tests with you, which involves putting you in certain positions based on which semi-circular canal they feel is most like to be affected. Sometimes it is possible for more than one canal to be affected.  During this stage your eyes will be monitored and some of your symptoms may themselves, but they will pass.    Treatments Based on the results of your positioning test the specialist will be able to take you straight into the repositioning or treatment manoeuvres. You may feel dizzy during this as the Otoconia make their way out of the semi-circular canals.Sometimes you may have to repeat the manoeuvres on a different day. Occasionally BPPV may return - if you are at risk of this your specialist will discuss this with you. Medications are usually unnecessary for BPPV

BENIGNPAROXYSMALPOSITIONALVERTIGO (BPPV)Patient Information Sheet

References : Von Brevern M, Bertholon P, Brandt T, et al. Benign paroxysmal positional vertigo: Diagnostic criteria. J Vestib Res. 2015;25:105-117. doi:10.3233/VES-150553 Image taken from: Kerber K. Vertigo Presentations in the Emergency Department. Semin Neurol. 2009;29(05):482-490. doi:10.1055/s-0029-1241036

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Figure A: Shows the Dix-Hallpike Manouvere (Positions A-B) to test whether the posterior semi-circular canal is affected with the Epely Manouvere (Positions C-E) for treatment. How can I help myself? Usually this condition can be easily resolved by specialists and you shouldn’t need to adopt too many lifestyle changes. Older publications suggest rest after treatment however in most cases this is not necessary, and you should be able to resume normal activities. However, in rare cases it may be secondary to another vestibular ailment. Communicate with your specialist if you have received treatment and your symptoms haven’t resolved or if they have but you are now feeling dizzy in a different way.

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