Before we talk about BPPV causes, you may want to look at Part 1 of our BPPV overview to get yourself up-to-speed on on what BPPV is as well as Part 3. We also previously published another related blog on BPPV Causes.

BPPV (Benign Paroxysmal Positional Vertigo) is the most common vestibular disorder, or inner ear condition.  

Benign” means it is not related to any disease process or pathology. This can be misleading because the effects of injuries caused by unresolved BPPV can be severe, and are far from benign.

Paroxysmal” means it comes and goes, not constant.

Positional” means it is related to certain positions.

“Vertigo” means a false sense of spinning, translating or tilting movement while the person is at rest or a distorted perception during otherwise normal head motion.

What are BPPV Causes?

BPPV causes generally include a bio-mechanical problem in the inner ear that occurs when one or more otoconia, or crystals, dislodge from the inner ear organ called the utricle and travel via shared endolymphatic fluid into one or more of the semi-circular canals.

There are two types of BPPV causes. The more common type is when the BPPV crystals are free-floating in the endolymphatic fluid in the semi-circular canal. This is called “canalithiasis” or “canalolithiasis.” The direct translation from medical terminology to plain English is “abnormal condition of a stone in the canal.”

The less common of the two BPPV causes is “cupulolithiasis,” which occurs when the BPPV crystal(s) adhere to the specific sensory apparatus inside the semi-circular canal, called the cupula. The direct translation from medical terminology to plain English is “abnormal condition of a stone on the cupula.”

Both of these BPPV causes can occur in any combination of six total semi-circular canals in the inner ear, or vestibular system, so a skilled assessment is recommended.

It gets even more complicated in the case of “canalolithiasis,” or the free-floating stones or crystals, because there are multiple locations inside the semi-circular canal where the crystals can settle, such as the long arm, the short arm or the common crus. The location of the free-floating crystals will dictate the symptoms of BPPV that the person experiences and the signs of BPPV detected upon testing.

There are three fluid-filled semi-circular canals in the inner ear on each side of the head. In order to be certain that a patient does not have BPPV, all six canals must be screened and cleared.

Good News: If properly assessed, simple BPPV in one canal can be successfully treated in 1-2 sessions 85-90% of the time.

So why are patients suffering with BPPV for months to years, or never being treated properly?

Because the most common treatment, the Epley maneuver was invented in 1992. Many healthcare providers in practice today graduated from school in the 80’s or early 90’s before this type of treatment for BPPV was developed.

Vestibular Rehabilitation, which includes BPPV treatment, is an emerging field and not widely known or practiced in modern medicine.

Many providers who know something about BPPV, and dabble in treating occasionally, only know how to test and treat the most common location crystals settle, which is in the long arm of the posterior canal. They are not aware of the other BPPV causes, or how to assess and treat them.

My goals are to empower patients to understand what causes BPPV by providing information to seek appropriate care and to provide all healthcare providers with the knowledge, skills and confidence to to understand BPPV causes as well as recognize it and make appropriate referrals to specialty providers.


This blog is provided for informational purposes only. The content and any comments by Dr. Kim Bell, DPT are not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. The details of any case mentioned in this post represent a typical patient that Dr. Bell might see and do not describe the circumstances of a specific individual.

Accessibility Toolbar

Pin It on Pinterest

Share This

Share this post with your friends!