What is Benign Paroxysmal Positional Vertigo (BPPV)
Benign Paroxysmal Positional Vertigo (BPPV)is a specific type of dizziness or vertigo. It is a problem in the balance portion of one or both inner ears (the labyrinths).

The labyrinth is part of the coordinated system that maintains your balance. The labyrinth has three fluid filled semicircular canals. The semicircular canals detect motion and direction, and send that information to the brain.

Small pieces of the labyrinth, called canaliths, can break off and float into the semicircular canals. When they settle in the semicircular canals, a change in the position of the head stimulates the semicircular canals and can cause a spinning sensation.

The spinning usually lasts less than 30 seconds, but is often very strong. It can cause nausea and imbalance that may last for hours.

What are the various treatment options for BPPV?
Epley Maneuvers (EM) or Canalith repositioning.
This procedure is a painless, low-risk treatment, which usually has an immediate, positive effect. It utilizes a series of gentle changes in the position of the head and body to move the canaliths to an area in the labyrinth where their presence will not upset the balance system. Think of a process similar to moving a marble through a maze.

Vestibular rehabilitation therapy. Certain exercises may be helpful for some people. The exercises can cause dizziness or nausea. Improvement takes place gradually over several weeks. Our clinic may use these exercises in conjunction with Epley Maneuvers for some patients.

Surgery. A semicircular canal in the problem ear can be plugged. Surgery is a treatment of last resort and should be used when all other methods have failed.

Do nothing and wait. The condition of BPPV may clear up without treatment after weeks, months or years.

The Epley Maneuvers:
Your physician's stated diagnosis of BPPV is required prior to referral for Epley maneuvers.

BPPV is diagnosed by positioning the patient in a specific pattern to provoke the spinning or dizziness in a controlled manner. Abnormal eye movements accompany the spinning and dizziness. These abnormal eye movements are evaluated and allow for appropriate diagnosis and treatment.

Epley maneuvers have a success rate of better than 90% in relieving dizziness due to BPPV. The procedure is painless.

First, the eye movements (nystagmus) that occur with the spinning are observed, analyzed, and the target ear is identified.

Next, the series of head and body position changes are completed. The patient will lie down on an examining table, roll over, and move the head as directed. The movements are slow and gentle and the patient is assisted and supervised constantly during the positioning.

These movements cause the canaliths to move out of the semicircular canal to an area where balance will not be disturbed. Frequently a vibrator is used to help the particles move through the fluid filled semicircular canal.

The Epley maneuvers may take from 15 to 30 minutes. Follow-up will be scheduled in one week. The maneuvers may need to be repeated to be sure that all the canaliths have been moved to the proper place in the labyrinth. There is a range of two to four visits.

Sometimes the canaliths float back to the semicircular canals after months or years and symptoms of dizziness can recur. If that happens, the canalith repositioning procedures can be repeated