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Benign Positional Paroxysmal Vertigo (BPPV)

Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of vertigo — the sudden sensation that you’re spinning or that the inside of your head is spinning. BPPV causes brief episodes of mild to intense dizziness. It is usually triggered by specific changes in your head’s position.

  • Benign as although it can be quite disabling, it is not due to serious disease
  • Paroxysmal because it occurs in short bursts of up to one minute
  • Positional as it is provoked specifically by movement to or from certain positions
  • Vertigo – dizziness defined as an illusion of movement.


Often there is no cause of BPPV, but you can be more at risk following a head injury, being over 50 or female or having experienced it before.

Symptoms are caused by the dislodging of Otolith (calcium carbonate structures) within the inner ear system. This leads to them settling in the canals of the ear and leading to dizziness when the head is moved into certain position.

Unfortunately, patients often have to wait a long time to be correctly diagnosed and treated for BPPV, with the average time being 70 months!!

On average, patients visited hospitals more than eight times before the final diagnosis due to initial visits to inappropriate departments (Wang et al 2014).



Signs and Symptoms

  • Symptoms typically last less than one minute
  • Episodes can disappear for some time and then reoccur
  • Usually when changing head position, typically rolling over in bed
  • Dizziness
  • Spinning
  • Unsteadiness
  • Nausea/Vomiting
  • Usually occurs in people aged 50 and older.

Diagnosis and treatment

BPPV is diagnosed by health professionals through a combination of identifying the symptoms and then performing a manoeuvre depending which of the inner-ear canals is affected.

It can then be successfully treated through specific techniques designed to filter the Otolith out of the canal to be reabsorbed and stop symptoms of dizziness.

In 91% of cases, the Epley’s manoeuvre can successfully eradicate symptoms of posterior canal BPPV in just 1 to 2 sessions if performed correctly (Power, Murray and Szmulewicz 2020).

BPPV can affect different canals of the inner ear though, so it is important that you have an accurate diagnosis before performing the procedure.

These techniques are performed by highly trained professionals so seek specialist support before trying to perform these yourself as if performed incorrectly it can lead to a worsening of your symptoms.

Here at Hallamshire Physiotherapy Clinic we have multiple staff trained in diagnosing and successfully treating conditions such as BPPV.

Call us on 0114 267 1233 to book an appointment with one of our specialist clinicians.


Specific treatments available

BPPV- Posterior canal – Epley manoeuvre

BPPV- Lateral canal – 360° BBQ roll

BPPV- Anterior canal – Deep Head Hanging Manoeuvre


The Epley Manoeuvre for BPPV

The following video (click image) shows how we would perform the Epley manoeuvre in clinic. It is not recommended to perform on your own due to the risk of increasing symptoms if performed incorrectly or if the problem is in a different canal to the posterior canal.


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