We have been successfully evaluating and treating patients with BPPV for decades.

Benign paroxysmal positional vertigo (BPPV) is a common inner ear disorder that affects balance. In the event of trauma, as a result of virus or with age, naturally existing crystal otoliths (calcium carbonate) in the ear become dislodged. The overriding symptom of BPPV is brief vertigo, lasting less than one minute. Paroxysmal means it happens suddenly. Positional refers to the fact that it is brought on when head or body position is changed, as when looking upwards, rolling over in bed, lying flat, sitting up in bed or getting out of bed.

Besides vertigo, other symptoms include:

  • "Brain fog"
  • Headache
  • Imbalance
  • Lightheadedness/dizziness between vertigo spells
  • Nausea/vomiting



Diagnosis

Medical history and a physical examination are used to diagnose BPPV. Observing eye movement when the patient is placed in various positions helps to determine the condition. To better understand and treat patients, an OSU Wexner Medical Center physician or advance practice provider may test for other specific causes of BPPV, including labyrinthitis or Meniere’s disease.

The Department of Otolaryngology -- Head and Neck Surgery at The Ohio State University Wexner Medical Center has a staff dedicated to perform the most advanced testing. That helps ensure you are properly diagnosed so that your treatment can be as effective as possible and that you can get faster results.

Treatment

BPPV is treated by putting the patient in various physical positions, called Epley maneuvers, to move the displaced otoliths. These head and body movements take about five minutes and often deliver immediate results. However, in some cases, it can take 24-72 hours to be symptom-free. If you have a relapse, you can be successfully treated again. There is relatively little risk to this procedure.

Why Choose Ohio State?

The Department of Otolaryngology–Head and Neck Surgery at OSU Wexner Medical Center has been successfully evaluating and treating patients with ear-related issues for decades. Many of our patients are referred to us by local ENTs due to our outstanding reputation.

A dedicated testing staff: We have a vestibular technician who is highly trained to recognize vestibular disorders through vestibular testing.

Trained specialists: Among our physicians are a group of neurotologists who are highly skilled in treating all diseases of the ear, medically or surgically. Many of the neurotologists in the state of Ohio are found here.

Nationally recognized: OSU Wexner Medical Center is recognized by U.S.News & World Report one of the nation’s best hospitals for care of the ear, nose and throat.

Frequently Asked Questions

What is BPPV and how did I get it?

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.


What are the symptoms?

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.”


How do I know if I have BPPV?

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.


How is it treated?

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.


What if I have BPPV in both ears?

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.


Will I feel better immediately after the Epley maneuver?

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


What do I do when I leave the office?

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.


Is there a medication or surgery that will cure this instead?

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


Can I do this maneuver at home?

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.


Will it come back?

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.


What if the Epley maneuver does not work for me?

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.


Will I need to make another appointment?

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.




Dr. Aaron Moberly explains Ohio State's expertise in treating BPPV, a common source of vertigo.

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