BPPV is caused by otoliths, or calcium carbonate crystals, being out of alignment in one or both of your inner ear balance canals. These otoliths, which we frequently call “crystals” or “stones,” are a normal part of your inner ear anatomy. It is only when they get out of place that the problem occurs. This can happen for a number of reasons, but often develops after a head or whiplash injury, inflammation or infection in the inner ear, aging or a sedentary lifestyle. It frequently occurs without any apparent reason.

Regardless of why the condition exists, the symptoms are essentially the same. Classic BPPV typically causes brief spells of true vertigo lasting less than a minute, triggered by certain head and body movements. The most common trigger movements include rolling over in bed, lying back in bed, sitting up on the side of the bed, bending over, looking over one shoulder or looking up. The condition might cause you to awaken during the night with vertigo if you rolled over while sleeping. Although the vertigo is usually very brief, you might feel off balance for minutes or even several hours after this abnormal response is triggered. Between spells you may feel the sensation that your balance is slightly altered or “off.”

We perform a Dix-Hallpike maneuver to test you for this condition. This simply means we have you lie back in a chair or flat on a table and allow your head to hang toward the floor while it is held to the right or left. While you are in this position, we observe your eyes for an electrical movement called rotatory nystagmus. If we see this abnormal movement of your eyes during this maneuver, it means the crystals are out of place in the ear facing toward the ground and that you have a “positive” or abnormal Hallpike.

The Epley maneuver is a treatment for BPPV. The Epley maneuver is designed to dislodge the crystals. During the maneuver, your BPPV is treated by turning your head to specific angles and then having you roll over to lie on your side and shoulder with your head still angled off the end of the table. We then ask you to sit up on the side of the table. It is encouraging if you experience dizziness throughout the Epley maneuver, as this means the crystals are being moved during the treatment. Sometimes the Epley maneuver is performed more than once during your visit.

You will still be treated with an Epley maneuver, but only one side can be treated at a time. The second ear will need to be treated another day.

Some people feel better immediately. Some people may take up to 72 hours to feel better. Both are normal.

If you do not feel like driving, you will be asked to wait in our lobby until you feel better. Some people feel more comfortable having someone else drive them home. We ask that you take it easy for the rest of the day. We do not want you to bend over a lot or perform work above your head the day of treatment. Other than that, there are no special instructions. Some sources suggest that you do not lie flat for 48 hours or that you should wear a neck brace for several days. Our office does not ask this of you, as it is our experience that such measures do not change the outcome of the Epley maneuver.

There is no medication that will cure this condition. In rare cases, a surgery may need to be performed to control the condition.

We prefer that you don’t, as maneuvers performed incorrectly can make the problem much worse. However, on occasion we do instruct some patients to perform a self-Epley maneuver.

Although the Epley maneuver is quite successful in treating BPPV, symptoms can develop again weeks, months or even years down the road, requiring another course of treatment.

Fortunately, the Epley maneuver treats BPPV successfully up to 85 percent of the time. However, there are some different versions of BPPV where the crystals are out of place in a different canal that requires a different type of maneuver. This will be taken into account during your visit. Additional testing may be required, including an MRI or formal balance testing called a VNG (videonystagmography). We may also consider having you participate in a course of balance rehab physical therapy.

You can schedule a follow-up appointment with us the day of your treatment. If you no longer have symptoms, it is acceptable to cancel your follow-up appointment. Or you can wait a week or two and call us if you think you need to schedule another Epley maneuver. Either way is fine with us. We typically wait at least a week between maneuvers.