In this blog, I will answer the question I frequently hear from my patients: Is BPPV always worse on the affected side?
Here is an example to explain this question. You roll over to the left side in bed and spin really bad but not much on the other side. Does that mean you have BPPV in the left inner ear? Does that mean the left ear is the “affected” side?
As a contrasting example, say you feel more dizzy or nauseous rolling over to the right side. Does that mean your right inner ear is affected by BPPV?
Keep in mind that other health conditions can cause symptoms with rolling in bed, but this blog is focused on a discussion of BPPV.
How to Tell Which Inner Ear is Affected by BPPV
Many of my patients tell me that before we met, they watched videos on YouTube trying to figure out how to determine which ear has BPPV. The plan was to figure out the affected ear on their own and then attempt self-treatment for BPPV.
Many of the videos my patients watched taught them to lie down and turn their head both ways. Then choose the “affected side” based on which side has the worst symptoms or the worst eye movement, aka “jittery eyes.”
Although that may be correct in many cases, it is not always accurate.
Nystagmus Must Be Observed
The problem with that strategy is that no one is looking at your eyes to see which way they’re going!
The direction of the eye movement or nystagmus is diagnostic to determine which ear is affected.
Therefore, the eye movement either needs to be filmed or observed by a professional.
Only by observing the eye movement can you determine the affected ear.
Two Examples of BPPV with Symptoms Worse on the Unaffected Side
To make my point, I want to tell you about two types of BPPV that are actually worse on the unaffected side.
Horizontal Canal BPPV, Cupulolithiasis Type
In cases of horizontal canal cupulolithiasis, the symptoms are less severe and the involuntary eye movement (nystagmus) is not as strong on the affected side.
In the diagnostic process for horizontal canal cupulolithiasis BPPV, the affected side is the one with less severe symptoms and less robust nystagmus. This example is completely opposite of the instructions given on most YouTube videos my patients watched.
This type of BPPV is an example of why the answer to this FAQ is:
No, BPPV is not always worse on the affected side.
Apogeotropic Posterior Canal BPPV
Apogeotropic posterior canal BPPV is another example of a BPPV variant that can sometimes produce symptoms that are more severe on the uninvolved side. The nystagmus in these cases is the inverse of what you would expect for a posterior canal BPPV so it can show up worse on the uninvolved side and masquerade as anterior canal BPPV.
The apogeotropic variant of posterior canal BPPV is another example of why the answer to this FAQ is:
No, BPPV is not always worse on the affected side.
For a deeper discussion on 5 reasons why the Epley Maneuver does not always work, click here.
Disclaimer
This blog is provided for informational and educational 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.
I’ve been dealing with supposed bppv for the last month. Its started off only affecting my right side, as in when I lay down with head turned on right side, spinning occured. It got slightly better after 2 days and I thought it went away completely, then one night I tried to turn over to my left side and now the spinning happened on that side. It got better over a few days, then it has just been repeating the same situation over a month, with a different side causing spinning and other side is unaffected. Right , left, right, left, right left. And currently it’s been stuck on my left side for 2 weeks straight.
Hi Tony,
I am sorry to hear this! I encourage you to seek treatment with a vestibular professional who can examine your eyes during BPPV testing.
In this blog, I talk about BPPV variants that are worse on the unaffected side. Therefore, you really need a professional to assess you to figure out what type of BPPV you have.
They must observe your nystagmus – which way are your eyes jumping?
Also, if it is truly right AND left BPPV that keeps recurring, then it is important to dig deeper into the potential root cause. There may be a deeper root cause you can address.
For example, chronic stress, chronic viral activity, poor posture/ forward head, improper ergonomics, upper cervical subluxation, etc can cause BPPV recurrences.
I wrote blogs on all those topics on this blog site and on my second blog at BetterBalanceInLife.com. You may be able to do some detective work on your own!
I also wrote a book talking about all these concepts. You can find it here.
I hope you find answers and get relief.
Is it likely BPPV if the dizziness comes on with quick side to side movements rather than up and down ones?
That’s possible. It can also be cervical dizziness.
A professional evaluation is beneficial to determine the root cause. You can have more than one concurrently.
I talk in more detail about both of these root causes in my book.
I had a vibrating tool by my neck during an adjustment and had vertigo days later. Was confirmed left side horizontal bvvp. Had bbq roll done and felt worse! Started finally getting better a couple weeks later but have had residual dizziness since. In the last few days I now cannot roll to either side without spinning. Now I’m locked on my back to sleep and my neck has been strained and hurting. Did position testing today and PT said negative but I’m getting full spins now on either side. Help!
This blog may help.
Ultimately you may need care from an experienced vestibular health care professional.
I hope you feel better soon!