The ear normally uses small crystals called “otoconia” to determine the direction of gravity.

                           Otoconia crystals [1]

In “Benign Paroxysmal Positional Vertigo (BPPV)” otoconia have dislodged and migrated into one of the fluid-filled semicircular canals. When moving the head, the otoconia cause abnormal fluid displacement, which causes an intense spinning dizziness called “positional vertigo” or “positional dizziness”.

The “otoconia” crystals are primarily made up of calcium.

Although they are a normal part of the inner ear, they are not supposed to be free floating. [1]

Ear anatomy [1]

Displaced otoconia [1]


There are three main reasons for BPPV:

  • Increasing age predisposes you to get loose particles in the inner ear.
  • Infections of the ear often cause these particles to come loose.
  • Head trauma and car accidents are the main cause of BPPV in young people.

The episodes themselves can last up to several minutes each over a period of several months. Most people get better spontaneously after months or years. However, people who have a single episode of BPPV will likely have further episodes in their lifetime.

BPPV is the most common cause of dizziness related to the ear. It resolves spontaneously in most people after a period of between 3 months to 2 years. [1]

Tests for BPPV

There are a number of different tests to find out if it’s a BPPV. The easiest way to determine if BPPV is present although is to review the following symptoms:

  1. Dizziness when lying down, rolling over or moving the head in certain ways
  2. The sensation lasts only for a few minutes, but the nausea can last longer


  • Romberg’s test
  • Unterberger’s test
  • Dix-Hallpike test
  • Head impulse test
  • Videonystagmography – imaging test for nystagmus
  • Electronystagmography – electrical test for nystagmus

Romberg’s test

This test is positive if the person standing up becomes unsteady when they shut their eyes, where before they were steady with eyes open.

 Standing still with arms outstretched and eyes closed. Balance is lost usually to the side affected. [2]

Unterberger’s test

Marching on the spot for 30 seconds with eyes closed, Unterberger’s test looks for any sideways rotation, which will be toward the side affected. [2]

Dix-Hallpike test

To treat BPPV it is essential to determine which ear is affected. It can be either ear or both ears affected. Most people are aware which side is affected cause they get dizzy when they lie down on a certain side. If it’s unclear do the following test.

  1. Sit on the bed and turn the head to one side.
  2. Lie down as fast as you can, and keep your head turned to that side. If possible hang your head over the edge of the bed.
  3. Wait for 30 seconds.
  4. If you get spinning dizziness your affected ear is the left ear.
  5. If this doesn’t cause dizziness try the same manoeuvre with the other side.

Treatment of BPPV

The only non-surgical help for BPPV is a “Particle Repositioning Maneuver”. This is a specific sequence of rolling movements of the head and body that guide the loose particles through the inner ear and out of the semicircular canals.

One form of a particle repositioning maneuver was developed in 1992 by Dr. Epley. This maneuver helps to treat the most common cause of vertigo. The maneuver cures vertigo and dizziness in 88% of patients with just 1 treatment. After several months or years otoconia can find their way back into the semicircular canals. The recurrence rate is somewhere between 20% and 60%. In this case a repeated particle repositioning maneuver is necessary.

Many people initially take various kinds of medication such as sedatives, antihistamines and anti-nausea drugs to help with their symptoms. However medications can’t cure BPPV and only mask the symptoms.

Very few people with BPPV are ever treated surgically. However, a number of options are available. Some of these operations carry the risk of deafness and injury to the vestibular balance system. Surgical treatment is reserved for people with highly recurrent and symptomatic disease. [1]



[1] Clearwater Clinical. (n.d.). The Natural Treatment for Vertigo and Dizziness. Retrieved from

[2] Nordqvist C. (2009). What is Vertigo? What Causes Vertigo? Retrieved from