Most of us have experienced dizziness at some point in our lives, be it from getting up too quickly, dehydration or even spinning rapidly in an office chair. However, there may come a time when dizziness isn’t as easily explained and the symptoms persist for a much greater length of time. This could indicate a form of dizziness known as vertigo, where the spinning sensation isn’t necessarily just within the head but the room appears to be moving instead.

Vertigo can be due to numerous reasons, but one of the most typical causes is Benign Paroxysmal Positional Vertigo (BPPV) which is an inner ear disorder¹. To help determine if BPPV is the leading factor of a patient’s symptoms, a physiotherapist or health care practitioner trained in vestibular therapy may perform various maneuvers which will provoke symptoms if positive. A confirmation of BPPV can then be treated by the vestibular physiotherapist. Typically the majority of individuals experiencing BPPV are aided by treatment, as studies have shown usually one third of patients will be fully recovered by 3 weeks². Despite recovery, it is not uncommon for BPPV to reoccur months, even years later.

Risk Factors

In the majority of cases, there is no known cause of BPPV, as 50-70% of cases are idiopathic². There are some risk factors for the condition, but in general these risk factors cannot be controlled. Risk factors include: increasing age, genetics, female gendered, head trauma, osteoporosis, vitamin D deficiency in post-menopausal women, prolonged bed rest, chronic headache and neck pain, diabetes mellitus with high blood pressure, hyperlipidemia, thyroid disorders, hearing loss, pigmentation disorders such as vitiligo, multiple sclerosis and Parkinson’s disease². Generally the occurrence of BPPV is often spontaneous in those aged 50-70 years. The most common cause in younger individuals is due to a head injury, but it could still occur from a spontaneous onset³.

There are some types of dizziness that may mimic BPPV, but there are often other identifying characteristics for these conditions. For instance, the type of vertigo due to Meniere’s disease may also present with fluctuating hearing loss and tinnitus². Meniere’s is typically treated with medications, however for true cases of BPPV medications tend to not significantly affect symptoms and repositioning procedures are by far the superior method of treatment¹. Thus it is important to be properly diagnosed before entering any form of treatment.

Cause of BPPV

So what makes the room spin with BPPV? The cause is due to small calcium crystals that end up entering one of our three semicircular canals⁴. These little crystals/rocks are meant to be present in our ears, but they are supposed to be located just outside the canals within a gelatinous fluid filled cup (the utricle). The utricle is one of the components that helps us with our balance. The three semicircular canals that are present in each ear should just be filled with fluid (endolymph) with no crystals present; when we turn our head to one direction, the fluid in our ears will move which then cause little hairs at the end of the canal to move. These tiny hairs then send a signal to our brain letting us know which position our head is in. Our eyes will also send a signal to the brain telling us which way we are positioned. As both signals match, our brains create a semblance of balance.



However, should the crystals end up getting into one (or multiple) canals of our ears, when we turn our head a certain direction the fluid in the canal may hit against the crystal/rock and a backflow will be created. This backflow of fluid causes the hairs at the end of our canal to move in a different direction. Our brain will then receive the signal from our ears that our head is facing a different direction compared to the signal coming from the eyes. Having these mixed messages is what causes the room to spin. In order to fix this spinning, various positioning maneuvers can be done to relocate the crystals out of our ear canals and back to the utricle they came from.