We were recently asked, “Why does BPPV go away and come back?”. To understand the treatment and natural history of BPPV it helps to understand how it happens in the first place.
Lets imagine that the inner ear is akin to a tiny snow globe inside the head. In a healthy person the snow inside this globe is actually stuck down but with age the snow comes loose and begins to fly around when disturbed. Now lets imagine there is a house inside the snow globe. Inside the house are the very sensitive balance organs of the inner ear. There are, of course, windows in the house and sometimes flying snow comes in through those windows. When that happens you get BPPV.
Every time the snow globe is disturbed, by rolling over or looking up, the snow inside the house causes the balance organs to be confused and the sensation of vertigo results. The snow can fall out of the windows of the house as well but this only happens sometimes when you are in just the right position. The treatment maneuver for BPPV carefully guides these particles out. You can have your doctor do the maneuver or do it yourself with a BPPV treatment device.
Without treatment BPPV often lasts 2 weeks until the particles inside the house (which is actually called the posterior semi-circular canal) fall out or somehow breakup. However, more snow can come in and usually does in about 60% of people.