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Vertigo, a sensation of movement where the individual or the individual’s environment appear to spin and whirl, can be a rather unpleasant experience. Vertigo can affect balance, contributing to falls that can be serious among older adults, and may be accompanied by dizziness, a feeling that you’re spinning or falling, and in severe instances migraines, vomiting, nausea, an inability to see properly (nystagmus), and even fainting.

Vertigo has several causes, but one of them is connected to your sense of hearing – benign paroxysmal positional vertigo, abbreviated BPPV. BPPV occurs as the result of calcium crystals that form naturally known as otoconia or otoliths, which generally cause no problems. In individuals who suffer from benign paroxysmal positional vertigo, however, these crystals become dislodged from their normal location and travel into one of the semicircular canals of the inner ear which govern our sense of balance. When this happens, and the individual with BPPV reorients their head relative to gravity, these crystals move around, resulting in an abnormal displacement of endolymph fluid, which results in vertigo.

Benign paroxysmal positional vertigo can be brought on by such common actions as tilting or turning your head, looking up and down, and rolling over in bed, and is characterized by the brief (paroxysmal) nature of the attacks. These symptoms can be worsened by lack of sleep, stress, or changes in barometric pressure, such as before rain or snow. The disorder can manifest itself at any age, but it typically appears in people over 60 years of age. It’s difficult to pinpoint the specific cause of benign paroxysmal positional vertigo for any given individual, but it commonly occurs following accidents in which the person receives a blow to the head.

BPPV is differentiated from other types of dizziness or vertigo in that it is practically always prompted by head movements, and in that its symptoms usually decrease in in under a minute. Diagnosing benign paroxysmal positional vertigo generally involves a straightforward test where the patient lies on an exam table and tilts their head to the side or over the edge. Additional tests that can be used to diagnose BPPV include videonystagmography (VNG) or electronystagmography (ENG), which test for abnormal eye movement, and magnetic resonance imaging (MRI), primarily to eliminate other potential causes, such as brain tumors or brain abnormalities.

There is no complete cure for BPPV, but it can be successfully treated using canalith repositioning (either the Semont maneuver or the Epley maneuver), both of which use physical movements to shift the crystals to an area in which they no longer cause problems.In approximately 10 percent of cases, surgery may be recommended if these therapies don’t provide satisfactory outcomes. If you’ve experienced unexplained dizziness or vertigo that lasts for more than a week, see your health care provider.