What is BPPV?
Benign Paroxysmal Positional Vertigo (BPPV) is one of the most common causes of dizziness and vertigo, yet it can feel extremely alarming when it first occurs. Many people describe it as a sudden spinning sensation that happens when they move their head in certain positions, such as rolling over in bed, looking up, or bending down. Although BPPV is usually not serious, the symptoms can significantly affect confidence, balance and day-to-day activities.
The term itself can sound complicated, but it breaks down quite simply:
- Benign = not life-threatening
- Paroxysmal = sudden and brief
- Positional = triggered by head movement
- Vertigo = a spinning sensation
BPPV occurs when tiny calcium carbonate crystals, often called ‘ear crystals’ or otoconia, become dislodged from their normal position within the inner ear. These crystals then move into the semi-circular canals – the part of the inner ear responsible for balance. When the head changes position, the crystals move incorrectly within the fluid of the canal, sending false signals to the brain that create the sensation of spinning.
Common signs and symptoms of BPPV include:
- Brief episodes of vertigo lasting seconds to minutes
- Dizziness triggered by specific head movements
- Feeling unsteady or off balance
- Nausea or motion sickness
- Difficulty focusing during an episode
- Symptoms when rolling in bed or getting up quickly
Importantly, BPPV does not usually cause hearing loss, ringing in the ears (tinnitus), or significant ongoing dizziness between episodes. If these symptoms are present, another condition may be responsible.
Treating BPPV: The Epley Manoeuvre
One of the most effective treatments for BPPV is the Epley manoeuvre. This is a series of carefully guided head and body movements designed to reposition the displaced crystals back to their correct location in the inner ear where they no longer trigger vertigo symptoms. The manoeuvre is often highly effective and in many cases, symptoms improve dramatically after just one or two treatments.
During an Epley manoeuvre, the practitioner moves the patient through several positions while monitoring symptoms and eye movements. Some temporary dizziness during the procedure is normal, as the crystals are being repositioned. Many patients report immediate improvement afterwards, although some may feel slightly “off” for a short period as the brain readjusts.
Osteopaths can play an important role in helping patients with BPPV. Osteopaths are trained healthcare professionals with expertise in musculoskeletal health, balance, movement and whole-person care.
Following a thorough assessment, an osteopath may:
- Identify whether symptoms are consistent with BPPV
- Screen for other causes of dizziness that may require medical referral
- Perform or guide repositioning techniques such as the Epley manoeuvre
- Help improve neck mobility and posture, which can sometimes contribute to dizziness symptoms
- Provide reassurance, advice, and exercises to improve confidence and balance
As dizziness can have many potential causes, it is important that symptoms are assessed properly rather than self-diagnosed.
BPPV vs Labyrinthitis: What’s the Difference?
BPPV is often confused with labyrinthitis, but the two conditions are quite different.
Labyrinthitis is an inflammation or infection of the inner ear, often following a viral illness such as a cold or flu.
Unlike BPPV, labyrinthitis usually causes:
- Persistent dizziness lasting days rather than seconds
- Continuous vertigo rather than movement-triggered episodes
- Hearing loss or muffled hearing
- Tinnitus (ringing in the ears)
- General unwellness or fatigue
People with labyrinthitis often feel severely dizzy even when sitting still, whereas BPPV symptoms are usually brief and specifically triggered by movement. Labyrinthitis typically improves gradually over time, although some people may require medication, vestibular rehabilitation, or further medical assessment.
Although both conditions affect the inner ear and balance system, recognising the difference is important so the correct treatment can be provided. If dizziness is accompanied by severe headache, double vision, facial weakness, difficulty speaking, chest pain, or neurological symptoms, urgent medical assessment should always be sought.
The good news is that BPPV is highly treatable and many people experience significant relief with appropriate assessment and treatment. With expert guidance, reassurance and targeted management, patients can often return quickly to normal activities and regain confidence in their balance and movement.
If you are experiencing dizziness and would like assessing please do get in touch with us at Walnut Grove to see how we can help.
