BPPV

How it works

The inner ear has two small organs that sense gravity and straight-line movement. Each holds a bed of calcium carbonate crystals, the otoconia, resting on hair cells³. Next to them are three fluid-filled loops, the semicircular canals, which sense rotation¹. Sometimes crystals break loose and drift into a canal, most often the rear one¹. Now, when you tilt your head, the crystals sink through the fluid and push on the rotation sensor. The brain gets a signal that you are spinning, while your eyes say you are still. The mismatch produces vertigo, flicking eye movements called nystagmus, and nausea¹.

Each episode usually lasts less than a minute¹. Triggers are rolling over in bed, lying down, sitting up, looking up at a shelf, and bending forward¹. Between episodes there is often a mild unsteadiness.

BPPV is the most common cause of vertigo⁵. It can happen at any age and sometimes follows a knock to the head¹.

How common it is

The 2.4% lifetime figure comes from a telephone survey of the general adult population in Germany⁶. It is most often seen in people over 60, and it usually starts between 50 and 70¹. Women are affected more often than men¹.

Is it a problem?

BPPV itself is not dangerous. It does not affect hearing and does not damage the ear. It often clears on its own within weeks. The real risk is a fall during an episode.

Get it checked because it is easy to fix. A doctor confirms BPPV with the Dix-Hallpike test, which tilts your head and watches your eyes⁴. The treatment is the Epley manoeuvre, a sequence of head positions that rolls the crystals back out of the canal². It takes a few minutes and is safe and effective². BPPV comes back in about a third of cases². Do not copy the manoeuvre from a video before a diagnosis, because other causes of vertigo need different care.

See a doctor promptly if vertigo comes with:

• hearing loss,
• double vision,
• weakness,
• trouble speaking,
• a severe headache.

Also see a doctor promptly if it lasts for hours. Numbness or weakness can point to a more serious cause, such as a stroke¹.

History and culture

The Epley manoeuvre is named after John Epley, an American ear surgeon who first described it in 1980². Many doctors mocked it at first, because he also used a heavy vibrator on the bone behind the ear⁵.