What causes BPPV? 

Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause of spinning dizziness, which is related to the ear. This kind of spinning dizziness is called vertigo. In BPPV, the organ of balance in the inner ear malfunctions. The ear normally uses small crystals called “otoconia” to determine the direction of gravity. In a disease state these crystals come loose and float around inside the inner ear. These crystal particles cause the sensation of vertigo (spinning) every time they are disturbed by head motion.


BPPV has characteristic features such as:

  • Intense vertigo (room spinning)
  • Nausea, but rarely vomiting
  • Can be brought on by certain positions
  • Short duration (minutes)
  • Characteristic eye movements called Nystagmus

People with BPPV typically have symptoms when looking up, rolling over in bed, or bending under things. In some cases it is possible for people to identify the ear causing the symptoms. This condition affects roughly 10% of the population over 60. BPPV is likely under diagnosed and often treated with medications instead of the more effective particle-repositioning maneuver.

What is Vertigo?

There are many diseases that can cause vertigo and many types of dizziness, which are not vertigo. Different terms can be applied to these other symptoms. The term dizziness is a very general term for a collection of sensations such as being off balance (disequilibrium), spinning (vertigo) or being light headed (pre-syncope). Each of these sensations can, in turn, have a number of causes. Common culprits include heart disease, certain type of drugs and medications, and brain disorders.

In general terms the causes of vertigo can be thought of as either central, related to the brain, or peripheral, related to the organ of hearing.

Peripheral Vertigo

There are a number of other relatively common peripheral causes of vertigo, which include; Meniere’s Disease, Recurrent Vestibulopathy and Vestibular Neuronitis, and BPPV. In each of these peripheral causes of vertigo something has gone wrong with the balance organ in the ear called the vestibular apparatus.

Central Vertigo

Central causes can be related to a problem with the brain itself such a tumor or stroke or are related to outside conditions which affect the brain indirectly like drugs such as alcohol. Other disorders that affect the brain indirectly include heart disease and rhythm abnormalities, which interrupt the supply of oxygen to the brain and can cause dizziness. This is similar to the common experience of feeling lightheaded when standing too quickly.

Frequently Asked Questions about BPPV

What Causes BPPV?

The ear normally uses small crystals called “otoconia” to determine the direction of gravity. In a disease state these crystals come loose and float around inside the inner ear. These crystal particles cause the sensation of vertigo (spinning) every time they are disturbed by head motion.

How did I get BPPV?

There are three main reasons for BPPV:

  1. Increasing age predisposes you to get loose particles in the inner ear.
  2. Infections of the ear often cause these particles to come loose.
  3. Head trauma and car accidents are the main cause of BPPV in young people.

How long will an episode of BPPV last?

The episodes themselves can last up to several minutes each over a period of several months. Most people get better spontaneously after months or years. However, people who have a single episode of BPPV will likely have further episodes in their lifetime.

Is this very common?

Yes. BPPV is the most common cause of dizziness related to the ear. Approximately 3 million new people are diagnosed with BPPV per year in the United States.

Will it come back?

Unfortunately this is very likely. The recurrence rate is somewhere between 20% and 60%. Fortunately a good treatment exists.

Why does it recur?

The maneuvers to treat BPPV do not permanently remove the particles which cause dizziness. These maneuvers simply relocate the particles to an area of the inner ear which does not cause vertigo. However, after several months or years these particles can find their way back into areas of the inner ear which are problematic.

How can I reduce the chance of having it again?

There is very little which effects the recurrence rate of BPPV.

Will flying or swimming worsen my BPPV?

No. Flying can affect certain ear conditions which are pressure related. BPPV is not one of them.

Is there anything which makes BPPV worse or better?

Yes. Stress, and lack of sleep both make the symptoms worse. Some people think a poor diet and alcohol intake also make the symptoms worse.

What are the crystals made of?

The “otoconia” crystals are primarily made up of calcium. Although they are a normal part of the inner ear, they are not supposed to be free floating.

Is there a treatment for dizziness and vertigo caused by BPPV?

Yes. DizzyFIX is an effective and natural treatment for vertigo and dizziness due to BPPV. The DizzyFIX interactively guides you through a particle repositioning maneuver. This maneuver helps you treat the most common cause of vertigo called Benign Paroxysmal Positional Vertigo or “BPPV”. The maneuver cures vertigo and dizziness in 88% of patients with just 1 treatment.

What else can I do?

Medications like sedatives, antihistamines and anti-nauseants do help to a certain degree Visit your family doctor to rule out other causes of dizziness.

Time often helps patients cope with dizziness. BPPV resolves spontaneously in most people after a period of between 3 months to 2 years.

There is a surgical procedure for BPPV called ‘Posterior Semi-cirular Canal Occlusion’ but it involves drilling into the mastoid bone, which is the very thick bone behind the ear. It has certain risks associated with it and should be considered akin to brain surgery. Unless the symptoms are very severe this is not a reasonable option for most people.

Complementary therapy has been tried by many patients. Acupuncture, Chiropractic and Naturopathic treatments may have benefit but this has yet to be quantified scientifically.

Is it possible to have two types of dizziness at the same time? Both BPPV and Labyrinthitis?

Yes. One of the major causes of BPPV are viral inner ear infections or Labyrinthitis. This type of BPPV is often called “Post Viral BPPV”. Labyrinthitis is a viral infection of the vestibular nerve (the nerve of balance). Typically characterized by a week of spinning vertigo and nausea which goes away by itself. It can leave the person with little or no balance function and can cause BPPV. The virus causes the nerve to swell and stop functioning. It sometimes dies. Sometimes doctors will treat with either steroids or antiviral agents during the acute episode in hopes of lessening the effect. Typically the virus is just a normal cold virus.

How can you get Labrinthitis diagnosed?

Labyrinthitis is typically a clinical diagnosis made on history and physical exam. Some specific balance tests may help confirm the diagnosis. An ENG (Electro-nystagmo-gram) which can be done at any Neuro-otologists office (Subspeciality ENT) will tell you, in most cases, what the problem is, or at least if it is related to the ear.