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Benign paroxysmal positional vertigo (BPPV)


Disease: Benign paroxysmal positional vertigo (BPPV) Benign paroxysmal positional vertigo (BPPV)
Category: Ear, nose, larynx diseases
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Disease Definition:

Benign paroxysmal positional vertigo (BPPV) is one of the most common disorders that can cause vertigo.
A person's sudden sensation of unsteadiness or that their surroundings are moving is called vertigo.

One of the characteristics of this disease is brief episodes of mild to intense dizziness associated with specific changes in the position of the head. Usually, this sensation occurs when a person sits up in the morning, turn over in bed, move their head in a certain direction, lie down from an upright position, or when they move their head to look up or down. Additionally, a person might feel out of balance when walking or standing.

Despite the fact that it can be quite bothersome, benign paroxysmal positional vertigo is rarely serious except when it increases the chance of falls. Treatment for this disease can be received during a doctor’s office visit.

Work Group:

Prepared by: Scientific Section

Symptoms, Causes


Some of the signs and symptoms of this disease are:

  • Unsteadiness
  • Dizziness
  • A loss of balance
  • Lightheadedness
  • Blurred vision associated with the sensation of vertigo
  • A sense that the person or their surroundings are spinning or moving.
  • Nausea
  • Vomiting

Episodes of benign paroxysmal positional vertigo and other forms of vertigo can disappear for some time and then come back; however, these signs and symptoms come and go, usually lasting less than one minute.

Even though the activities that cause the signs and symptoms of benign paroxysmal positional vertigo are always brought on by a change in the position of the head, but they can vary from one person to another.

Usually, the signs and symptoms of BPPV are accompanied by abnormal rhythmic eye movements (nystagmus). It is also possible to have BPPV in both ears (bilateral BPPV), but this condition is very rare.


The vestibular labyrinth is a small organ in the ear, which has loop-shaped structures (semicircular canals) that contain fluid and fine, hair-like sensors monitoring the rotation of the head. The head’s position and the movements of the head are monitored by other structures in the ear called otolith organs, which contain crystals that make a person sensitive to movement. These crystals can become dislodged because of many factors, and when they do, they can move into one of the semicircular canals, particularly while the person is lying down, causing the semicircular canal to become sensitive to head position changes that it normally wouldn’t respond to. As a result, the person will feel dizzy.

Usually, this disease develops in people older than 60 years. However, it can also occur after a minor to severe blow to the head. Damage that occurs during ear surgery, prolonged positioning on the back (supine), or disorders that damage the inner ear are some of the less common causes of BPPV.

To determine the cause of BPPV, a person needs a consultation with an ear, nose and throat (ENT) specialist, or a doctor who specializes in the brain and nervous system (neurologist). However, in most cases, the cause of BPPV can never be determined.



This disease rarely causes any complications despite the fact that it is uncomfortable. Severe BPPV can cause frequent vomiting, which increases a person's risk of dehydration.


The patient may be treated by a doctor, audiologist or physical therapist with a series of movements known as the canalith repositioning procedure, in order to help relieve BPPV.
This procedure is usually effective after one or two treatments. It consists of several simple and slow maneuvers for positioning the head, which can be performed in the doctor’s office.

The goal of this treatment is moving the particles from the fluid-filled semicircular canals of the inner ear into a tiny bag-like open area (vestibule) that contains one of the otolith organs (utricle) in the ear where these particles are more easily reabsorbed and won’t cause any trouble. After any symptoms or abnormal eye movements stop, each position is held for about 30 seconds.

A person should avoid lying flat or placing the treated ear below shoulder level after this procedure, and during the night, the person should elevate his/her head on a few pillows when sleeping, which will allow time for the particles that are floating in the labyrinth to settle into their vestibule and be reabsorbed by the fluids in the inner ear.

The doctor will teach the patient how to perform the procedure on themselves so that they can do it at home before returning to the doctor’s office for a recheck, because they will have to perform this procedure several times over the course of several days.

In some rare cases, a person may be recommended a surgical procedure if the canalith repositioning procedure is not effective. During this procedure, the doctor will use a bone plug in order to block the portion of the inner ear that is causing dizziness. The semicircular canal in the ear can be prevented from responding to particle movements or head movements in general. Although less than 5% of people undergoing this procedure experience long-term hearing loss, however, about 90% of the canal plugging surgeries are successful.


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Consultants Corner

Dr. Faisal Dibsi

Dr. Faisal Dibsi Specialist of Otolaryngology - Head and Neck Surgery

Dr . Dirar Abboud

Dr . Dirar Abboud Hepatologist – Gastroenterologist

Dr. Talal Sabouni


Dr. Samer Al-Jneidy

Dr. Samer Al-Jneidy Pediatrician

Dr. Hani Najjar

Dr. Hani Najjar Pediatrics, Neurology

Dr. Tahsin Martini

Dr. Tahsin Martini Degree status: M.D. in Ophthalmology

Yaser Habrawi , F.R.C.S.Ed

Yaser Habrawi , F.R.C.S.Ed Consultant Ophthalmologist

Samir Moussa M.D.

Samir Moussa M.D. ENT Specialist

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