22 Jul The doctor said that I have crystals in my ears.” Demystifying BPPV

What is benign paroxysmal positional vertigo (BPPV)?

Vertigo is the feeling that the room or the world is spinning, and it has many causes.  Benign paroxysmal positional vertigo is a very common cause of brief vertigo spells that come and go.  Vertigo can last as little as a few seconds, but in some cases it can last a few minutes.  The feeling of dizziness after vertigo can last a few moments or several hours. 

What causes BPPV?

BPPV is caused by a problem in the inner ear. We all have tiny calcium carbonate “crystals” inside our inner ears that help keep us balanced.  When one has BPPV, these stones are allowed to shift errantly into the semicircular canals in the inner ear, where they can cause a feeling of spinning / vertigo.

What are the symptoms of BPPV?

The primary symptom of BPPV is a feeling that one is spinning or tilting their head when they are not.  It can happen when we move our head in a certain way, like rolling over in bed.  One may find it hard to walk or stand without losing your balance.

How is BPPV diagnosed?

BPPV is diagnosed with a physical examination. Your doctor will ask questions about your symptoms and past health. You may have them perform a series of tests, including the Dix-Hallpike test and Roll test. During these tests, your doctor watches your eyes and monitors for vertigo/dizziness as you turn your head in specific ways.

How is BPPV treated?

Vertigo due to BPPV is treated by performing a series of maneuvers that move the displaced crystals of the inner ear back to their proper positions.  Your physical therapist will often need to assist you with these maneuvers; however, some patients can be taught to perform them on their own.  Without treatment, 20% of those affected by BPPV will experience resolution of their symptoms within 1 month, and up to 50% will be better in 3 months.  Physical therapy can reduce this timeline down to a matter of days to resolve the condition. 

Can my vertigo come back? 

If a patient has experienced a single bout of vertigo/dizziness due to BPPV, there is a 10 to 20% reoccurrence rate.  If one has experienced several previous bouts of BPPV, then the recurrence rate is much higher.