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.
Disclaimer
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.
Can this condition occur in both ears at the same time?
Hi Anita,
Yes, BPPV can occur in both ears at the same time.
I have seen three new patients just this week with BPPV in both ears.
That situation will require more total treatments to resolve, but it is still associated with a good outcome if you find a skilled provider who is competent to treat it.
Best wishes,
Kim Bell, DPT
Hi there! I’ve had dizzy spells for three days now. Had to go to the emergency room three days ago because the dizziness was making me vomit over and over. Now that I’ve been home when I move my head a certain way or tilt my head I get very dizzy. Does this sound like what your talking about?
Hi Summer,
Motion activated dizziness is a typical symptom of BPPV.
There are a few other possible root causes that might be at play here, so it is important to get evaluated by a professional who specializes in dizziness.
You can use this blog to search for a vestibular health care provider in your area, like a doctor or physical therapist.
This blog has home remedies that may help.
I always suggest for people to notify their primary doctor as well.
I hope you feel better soon!
Hi, I had so far 4 extremely acute vertigo episodes for the past 3 years. I’m otherwise a healthy 40yo female.
After the 1st episode I had a consultation with an ENT specialist.
He checked my hearing, my nose, and did an MRI of my head.
All came back clear.
Then he did a maneuver to check if it was BPPV, my eye pupils shaked and he showed it to my partner who was in the consultation with me.
My vertigo had passed by itself by the time I managed to see this Dr. But he said he did the Eply maneuvers anyway just in case. I didn’t feel any different.
But then I went onto suffer acute vertigo again every six months more and less until today. I’m mid-episode. 3rd day and counting.
The specialist didn’t have me any treatment long term. 🙁
Hi Virginia,
I am sorry to hear this!
You may need some medication for immediate relief of symptoms, so you can contact your primary doctor, ENT, or go to the emergency room as needed.
You may benefit from some vertigo home remedies, as I share here.
This article can help you search for a vertigo provider in your area.
I hope you get relief soon!
How to find a skilled provider?
Hi Cathy,
I have two online directories to search listed in this blog.
Best wishes,
Dr. Kim Bell, DPT
I read this post from a link where you said that BPPV can be caused by dehydration but you didn’t discuss that here. Can you please expand on that? How does dehydration causes BPPV?
Hi Meredith,
This is a great question.
Sometimes BPPV is associated with head trauma or inner ear infections. In that case, we can attribute a likely cause to the BPPV onset.
Most cases of BPPV are idiopathic, which means no specific known cause.
In that case, there are certain risk factors that are associated with higher likelihood of idiopathic BPPV.
Risk factors for BPPV include high blood pressure, high cholesterol, and tobacco smoking.
Other associated risk factors include osteoporosis, osteopenia, low vitamin D, migraines, and Meniere’s disease. This means people with these conditions are more likely to get idiopathic BPPV than people who do not have one of these conditions.
Dehydration and stress are risk factors that are thought to be associated with a new onset of idiopathic BPPV.
In theory, I suppose the dehydration could affect the physiology of the inner ear and contribute to crystals coming loose.
It is a risk factor, but not everyone who is dehydrated will end up with BPPV.
I hope that helps!
Best wishes,
Kim Bell, DPT
I have the symptoms. I also have Parkinson’s. My right ear manufactures ear wax a lot and my ears hurt often.
Hi
I am suffering from Bppv vertigo from last one year ..
My left ear crystal relocate from their original position ..
With this I got vomittings also ..
I take a lot treatment..
but it’s still on …
Within this one year I suffer from 2 more toblems ..
One is of chronic gastritis associated with h pyloric bacteria , due to this I loose my weight … medication is going on for this ….
I just want to know
With this bppv can I live a good and comfortable life ..
Will I be able to work normally in corporate world as I am doing earlier …
Please guide me what precautions should I take while sleeping ..
And tell me what precautions I should take if I want to restart my job again
Hi Gunjan,
I am sorry to learn that BPPV has taken such a toll on your life and your work!
This blog may help you find a provider in your area who can treat BPPV.
This blog has Vertigo Home Remedies that may help.
This blog talks about Learning to live with vertigo.
This blog describes why the Epley maneuver may not work.
This is my most popular blog on the link between the gut and vertigo. You may be interested in the comments section as well.
If you are in the USA, you can research the Americans with Disabilities Act (ADA) which allows for certain accommodations for people to return to work with debilitating symptoms, within reason. Your doctor can help you write a request for tier employer about any accommodations you may need.
However, many people with chronic BPPV have to switch jobs or remain on disability. Many people are not able to continue to perform their usual job, so it is very important to seek proper care for resolution.
I hope that information is helpful!
I do not have a blog that I can share on Sleeping specifically with vertigo, but I will include that information in my first book – which I am working on now.
You can join my mailing list if you want to be notified when my first book becomes available. I send out about 1-2 emails per month.
In general, propping yourself up on at least two pillows may help with sleeping.
Best wishes,
Kim Bell, DPT
Could prior concussions cause BPPV years later? I have suffered off and on since the late 80’s.
People who have suffered a concussion can certainly get BPPV years later.
You can search for a provider who may be able to help using this article.
This article has vertigo home remedies that may help.