Helpful Resources

A lof of people inquire about booking our “BPPV Assess & Treat” appointment because it is so much shorter and less expensive than a comprehensive assessment. The reason you aren’t able to book it online is that there seems to be a lot of confusion about what BPPV is, and what it is not. Many people have been told that they have BPPV when a few simple screening questions would have determined that they most definitely do not. We are more than happy to assess and treat BPPV. In fact, we love it! It is incredibly rewarding to be able to immediately resolve something that is so debilitating with a few simple maneuvers. Unfortunately, not all dizziness is a result of BPPV though, and there’s no point in wasting your time and money on an unnecessary additional appointment when it may have been obvious from the start that your symptoms were not consistent with BPPV. We cannot deduct the cost of a BPPV Assess & Treat from a susbsequent comprehensive assessment if you decide to book it just because it is shorter, even though your symptoms aren’t consistent with it. We still have to book the same amount of clinic time for a comprehensive assessment if that’s ultimately what you end up needing, whether you’ve had a previous BPPV assessment or not, so it may end up costing you more in the long run. Please don’t take that to mean we don’t want to see you if you think you have BPPV – we absolutely do. We just really want to clarify what seems to be a lot of confusion surrounding BPPV. Please read the following information, and if it does in fact seem that you may have BPPV, please give us a call or send us an email letting us know you’ve read the BPPV screening information and we will be more than happy to book you in immediately. Thank you kindly for your understanding. 

Benign Paroxysmal Positional Vertigo (BPPV) is a common peripheral vestibular condition that most people have heard referred to as something along the lines of “loose crystals” in the ears. While BPPV is certainly common, it is by no means the only source of dizziness and vertigo symptoms and is very frequently erroneously diagnosed. I.e. people are often immediately diagnosed with BPPV as soon as they report any sort of dizziness/vertigo symptoms at all, or mistakenly self-diagnose because it’s the first thing that comes up in a Google search of “vertigo” or “dizzy” symptoms. If you do indeed have BPPV, that’s actually good news, believe it or not! BPPV is the one vestibular disorder that has an immediate corrective solution. Once we determine exactly where the “loose crystals” are located, we can physically manipulate them back into their correct location with specific maneuvers. That’s why we have the option of a much shorter duration “BPPV Assess & Treat” appointment. Before booking that though, we need to figure out if you are likley experiencing BPPV or not.

BPPV has 3 very distinct characteristics:

• It is positionally provoked: It only occurs in response to specific changes in head position, most commonly rear head pitch/looking up/laying back with your head turned to one side, or rolling horizontally from one side to the other. Deep forward bending/forward head pitch may also provoke a response at times. If you experience spontaneous vertigo with no change in head position at all (ex. sitting or standing still and upright) it is not BPPV.
• It produces an intense rotational spinning or tumbling sensation (I.e. True vertigo): True vertigo, as we define it clinically, is the hallucination of rotational movement. BPPV causes severe vertigo, typcially a violent spinning or tumbling sensation (it is NOT subtle). There are endless forms of what we call “non-vertiginous” dizziness (ex. light-headedness, unsteadiness, disequilibrium/wooziness, brain fog, rocking/tilting/swaying etc.) but those are not considered true vertigo. You may feel non-vertiginous dizziness after having had a true vertigo attack, but if you didn’t experience any intense rotational spinning/tumbling in the first place, you don’t have BPPV.   
• It is short duration (usually less than 30 sec): BPPV is caused by the physical movement of inner-ear crystals through a slightly viscous fluid in response to a specific change in head position. It is a slave to gravity. The vertigo can only occur as long as the crystals are moving – once they settle, so does the vertigo. It typcially takes less than 30 seconds for the crystals to settle if you remain still. There is a less common variant of BPPV that can produce more prolonged vertigo lasting up to 1 min, but rarely any longer than that. Prolonged/sustained vertigo lasting several hours is NOT BPPV.
• BPPV can also occur as a secondary result of something else that is going on in your inner-ears. If you have all the symptoms of BPPV but are experiencing additional symptoms, you may need more thorough examination, and sometimes even urgent medical care. Some things to look out for are:
  • Sudden hearing loss in one or both ears (BPPV does not cause hearing loss – sudden loss of hearing is an emergency and should be assessed immediately – depending on the cause, there may be a very narrow window in which pharmacologic intervention can prevent permanent loss)
  • Aural fullness: If one of your ears suddenly felt like it became very plugged or full around the same time as your vertigo, this also needs to be assessed more urgently and thoroughly. BPPV doesn’t cause aural fullness.
  • Recurrent BPPV: BPPV is something that many people will likley experience once or twice in their lifetime. Once treated with appropriate repositoining maneuvers it usually doesn’t recur very frequently (if ever), unless there is some underlying risk factor or condition that is causing it. If you suffer from chronic recurrence of BPPV episodes even after you get it resolved with repositioning maneuvers each time, it might be time to have a more thorough assessment. 
  • Always be aware of signs of stroke (F.A.S.T): 
    • Face drooping (especially on one side)
    • Arm weakness (raise arms. is one side weak?)
    • Speech (Is it slurred/difficult to speak?)
    • Time to call 911

If you would like to read some more detailed information on BPPV, here are two excellent articles: 

• BPPV_BDC
• BPPV_VeDA