Benign Paroxysmal Positional Vertigo (BPPV)

Evaluation and Treatment for

Positional Vertigo​

 

If you experience brief episodes of dizziness or a spinning sensation when rolling over in bed, getting out of bed, looking up, bending over, or changing positions, you may have Benign Paroxysmal Positional Vertigo (BPPV)—the most common cause of vertigo. Although BPPV is not life-threatening, it can significantly impact your confidence, balance, daily activities, and quality of life. Fortunately, BPPV is highly treatable with specialized vestibular physical therapy.

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What Is BPPV?

BPPV occurs when tiny calcium carbonate crystals (otoconia) that normally help detect movement become displaced from their usual location within the inner ear and migrate into one of the semicircular canals. When you change the position of your head, these loose crystals move within the canal, sending incorrect signals to your brain about your body's position. This creates the sensation that you or the room is spinning, even though you are not moving. Symptoms are typically brief, lasting seconds to less than a minute, but they can be intense and unsettling.

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Common Symptoms of BPPV

• Brief episodes of spinning vertigo when changing head position

• Dizziness when rolling over in bed or getting into or out of bed

• Symptoms when lying flat

• Dizziness when looking up or bending over

• Feeling off balance or unsteady after an episode

• Nausea during episodes of vertigo

• Increased fear of falling or avoiding certain movements

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Comprehensive Vestibular Assessment and Treatment

 

Not all dizziness is caused by BPPV. During your evaluation, your physical therapist will perform a detailed examination to determine whether your symptoms are coming from the inner ear, vision, nervous system, neck, or another source.

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Specialized Infrared Video Goggles

Pure Movement utilizes specialized infrared video goggles to observe your eye movements during vestibular testing.

These goggles allow your therapist to identify nystagmus—the involuntary eye movements that occur with vestibular disorders—which helps determine:

• Whether BPPV is present

• Which ear is affected

• Which semicircular canal is involved

• Whether another vestibular condition may be causing your symptoms

Using infrared goggles improves diagnostic accuracy by allowing subtle eye movements to be observed even in complete darkness, where visual fixation no longer suppresses nystagmus.

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Evidence-Based Treatment

Once the affected canal has been identified, treatment typically involves a series of precise repositioning maneuvers designed to guide the displaced crystals back to their proper location within the inner ear.

Depending on the type of BPPV, treatment may include:

• Epley Maneuver

• Semont Maneuver

• Barbecue Roll (Lempert Maneuver)

• Gufoni Maneuver

• Deep Head Hanging Maneuver

• Brandt-Daroff home exercises when appropriate

Many patients experience significant improvement after just one or two treatment sessions, although some cases require additional visits depending on the canal involved and the duration of symptoms.​