What is Benign Paroxysmal Positional Vertigo (BPPV)?

BPPV (Benign Paroxysmal Positional Vertigo) is a common and treatable condition that affects the inner ear, leading to episodes of vertigo, dizziness, and disorientation. If you're experiencing these symptoms, it's important to understand what BPPV is, how it's diagnosed, and what treatment options are available.

At our clinic, we provide a comprehensive guide to BPPV, including its causes, symptoms, and treatment options. Our expert team of healthcare professionals have years of experience diagnosing and treating BPPV, and we're here to help you understand your condition and develop a personalized treatment plan that works for you.

If you're dealing with vertigo, dizziness, or other symptoms of BPPV, don't wait to seek help. Call us today to learn more about this condition and how we can help you get back to feeling your best.

BPPV is a condition characterized by episodes of vertigo exacerbated by changes in head position such as going to lie down in bed, rolling over in bed, or looking up or down. The episodes typically last for seconds to minutes and are better with keeping the head still in neutral position.

The term “loose crystals” is used frequently to describe the calcium carbonate crystals or otoliths that have broken loose from an area of the inner ear called the utricle or saccule. These crystals are attached to the utricle and help us sense gravity in a linear fashion (i.e. moving forward or backwards).

The crystals attached to the saccule help us sense gravity and linear acceleration predominantly in a vertical direction. Head trauma, a current or old inner ear infection, autoimmune/inflammatory disorders, migraine, or other inner ear disorders such as Meniere’s disease may cause the crystals to break off from the utricle or saccule. If the crystals migrate into the semicircular canals it can cause positional related vertigo or “gravity-dependent” vertigo.

There are three strategically placed hair cell bundles that sit at the end of three semicircular canals (three in each ear, six total). Imagine a snow globe representing your head position and then turn it upside down. Even though your head is still, the “loose crystals” are still moving and stimulating the cupula by driving endolymphatic fluid flow, thus telling your brain that you are rotating in space. This visual-vestibular mismatch causes the vertigo sensation and may also lead to nausea and vomiting.

Anatomy/Physiology of the Inner Ear

The anatomy of the inner ear is composed of both the cochlea (the sensory organ required for hearing) and the vestibular apparatus (which provides sensation for orientation and balance).Both of these systems, considered the labyrinth of the inner ear, are encased in the temporal bone. The vestibular apparatus is the structure in the inner ear that contributes to the sensation of equilibrium, the coordination of head positioning, and the vestibulo-ocular reflexes. The system consists of the vestibule and the semicircular canals. The patient will normally have two equally functioning vestibular apparati, one for each ear, that are bathed in endolymphatic fluid. The fluid generally has the same consistency and components as cerebrospinal fluid, with the exception of slightly different potassium levels found in endolymph. This system is innervated by the eighth cranial nerve (vestibulocochlear), particularly the vestibular division of that nerve. The vestibule pertains to the two otolith organs called the utricle and the saccule. These organs respond to linear accelerations. Each of these organs has a structure called the macula, which is a single patch of sensory hair cells, on to which the otoliths attach by a “jelly” like viscous matrix. In the utricle, the macula lies in a horizontal plane, whereas in the saccule, the macula lies in a vertical plane. Thus, the utricle senses gravity predominantly in a linear horizontal direction, while the saccule distinguishes predominantly vertical linear movements. The organs do this because the otoliths (also known as otoconia “crystals”) are calcium carbonate structures that are heavier than their surroundings and deflect the kinocilium hair cells of the maculae toward the vector of linear acceleration (or gravity). Deflecting the kinocilium repolarizes the hair cells and results in sensory information transmitting to the brain stem where balance and eye movement reflexes are generated. The semicircular canals refer to the structures of three looping canals found in each ear. The canals in each ear sit at approximately right orthogonal angles to each other and detect rotational head movements (angular accelerations). The canals include bilateral horizontal (lateral), anterior, and posterior semicircular canals. When the head moves, there is a corresponding movement of fluid (endolymph) within the canals that push on a structure called the cupula, found in each canal. The cupula is an accessory structure that rides on top of the crista ampullaris and deflects the kinocilium of the hair cells when endolymph passes over it. Similarly, a deflected kinocilium depolarizes hair cells in the crista and sends sensory information to the brainstem to generate compensatory balance and eye movements. The lateral canals correspond to yaw like rotation of the head. The anterior and posterior canals correspond to head movements in the pitch and roll axes, similar to those described with orientation of airplane movements. The canals work in tandem to provide a complementary signal for the brain. For example, with left horizontal canal excitation with head rotation to the left, there must also be right horizontal canal inhibition. The anterior and posterior canals are set up in a cross fashion. This means that when an anterior canal is excited, the contralateral (on the opposite side) posterior canal is inhibited. Pathology of the balance portion of the inner ear often presents in a variety of forms and can include vertigo, disequilibrium, and imbalance.