Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause of vertigo, which is a symptom of the condition. Though not fully understood, BPPV is thought to arise due to the displacement of otoconia (small crystals of calcium carbonate) from the maculae of the inner ear into the fluid-filled semicircular canals.

  • Benign means it’s not very serious. Your life is not in danger.
  • Paroxysmal means that it hits suddenly and lasts a short time.
  • Positional means you trigger the vertigo with certain postures or movements.


Dizziness, including vertigo, affects 15% to 20% of adults yearly based on population studies. The lifetime prevalence of BPPV specifically was found to be 2.9%, and incidence increases with age due to age-related degeneration of the otolithic membrane. Additionally, BPPV is about two to three times more common in women versus men.


With BPPV, otoconia (also known as “otoliths” or “canaliths”) dislodge and settle within the endolymph of the semicircular canals. When the head remains static, there is no stimulus causing the hair cells to fire. With motion, however, the displaced otoconia shift within the fluid, and the subsequent stimulus is unbalanced with respect to the opposite ear, inappropriately causing symptoms of dizziness, spinning, and/or swaying. Hence, symptoms of BPPV are profound with movement but classically lessen with rest.



The maneuver begins with the patient seated and head turned 45 degrees to the side being tested so as to isolate and vertically orient that side's posterior canal. The patient is then laid back into a supine position with the tested ear down .Classic teaching suggests hanging the head back over the edge of the bed, but this is not necessary when performing the Dix‐Hallpike test alone. Overextension of the neck may even elicit a false positive response from the contralateral side. Clinicians should also be cautious of patients with neck, back, abdominal, and hip problems as this may require special care during the diagnostic maneuver


Unfortunately, BPPV is a condition that can re-occur periodically with long-term recurrence rates as high as 50% within 5 years, especially in those whose BPPV is related to trauma. If it seems to always reoccur in the same canal and if deemed safe, your therapist may teach you to perform a specific treatment maneuver on yourself.

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