Traditional BPPV typically causes spinning vertigo symptoms and robust nystagmus during BPPV testing. However, I see a lot of patients who have not gotten answers or relief with traditional vertigo health care.

BPPV without Spinning

In many so-called atypical vertigo cases that have failed to resolve with traditional vestibular health care, I frequently find mild intensity, widespread BPPV in multiple canals within both ears with corresponding weak nystagmus of short duration.

That means multiple canals in both ears appear to have BPPV crystals during testing, but the positional symptoms are mild such as transient dizziness, blurry vision, falling sensation, or nausea, not the typical intense spinning sensation characteristic of BPPV.

Weak, brief nystagmus is present during BPPV testing, but is not obvious, vigorous, or robust.

Typical BPPV vertigo produces a burst of robust positional nystagmus that correlates with the spinning feeling.

Since the classic robust burst of nystagmus and complaint of spinning during BPPV testing are not present in these cases, this type of atypical vertigo often goes undetected and unaddressed.

Atypical Vertigo Cases: What are Some Examples?

You may be wondering, “How can this happen?” I will share my observations for these atypical vertigo cases.

In some atypical vertigo cases, I have observed the presentation of mild, widespread BPPV in both ears may occur in patients who have been living with vertigo for years while trying to maintain an active lifestyle such as surfing, yoga, martial arts, volleyball, pickleball, and other sports or recreational activities.

I also find mild, widespread BPPV in patients who have experienced multiple onsets of vertigo over a multi-year period and thought the vertigo may have “gone away on its own” each time, so they have never sought professional help.

Effects of Mild, Widespread BPPV in Both Ears

For patients with mild, widespread BPPV in both ears, it appears as if someone took a leafblower to the inside of their inner ears spreading the BPPV particles all over the place throughout the vestibular labyrinth on each side. Essentially, it’s a pervasive mess that needs to be cleaned up methodically, similar to coming home from the beach and tracking sand through multiple rooms in your house.

Now you may understand why I advocate for consulting a vestibular professional instead of learning to live with vertigo.

I also sometimes explain to my patients that the ultimate effect of this condition on their neurological system is as if someone set up multiple radios all around them, playing different music continuously and simultaneously. In such atypical vertigo cases, the multiple conflicting errors in sensory input from the BPPV crystals spread throughout their vestibular system can overwhelm and stress their central nervous system, similar to listening to multiple songs at the same time.

Mild, widespread BPPV in multiple canals within both ears can cause significant daily distress and disability and may persist without a satisfactory diagnosis, even after consultation with traditional medical specialists.

This presentation of BPPV often co-occurs with significant fatigue, which is worse at the end of the day and gradually improves as the patient recovers.

Some of these patients require a higher than average number of visits to completely resolve the symptoms step by step. Patients who are willing and able to perform a home exercise program usually recover more quickly than patients who are unable or unwilling to do exercises as instructed at home.

With proper care, these patients can have a full recovery.

Even after the resolution of these atypical vertigo cases and successful relief of mild, widespread BPPV with particle repositioning maneuvers, some patients may still have lingering, residual dizziness for up to two weeks. That feeling usually dissipates as their brain recovers and recalibrates, especially with daily movement and good quality sleep.

Learn More About Other Atypical Types of BPPV

In addition to mild, widespread BPPV in multiple canals within both ears, there are other types of atypical vertigo cases which we did not discuss in this article.

For more information on another atypical presentation of BPPV called Type 2 BPPV, click here.

For a detailed discussion specifically on posterior canal BPPV variants, click here.

Click here for examples of atypical types of vertigo that present with symptoms worse on the unaffected side.

I hope this blog on atypical vertigo was helpful on your healing journey.

Updated January 16, 2026 by Dr. Kim Bell, PT, DPT