Helpful Resources

One of the most common inquiries we get, as well as one of the greatest sources of patient confusion, is surrounding a condition called Benign Paroxysmal Positional Vertigo (BPPV), commonly referred to as something along the lines of “loose ear crystals”. While it is certainly very common, and relatively easy to treat with simple maneuvers, it is by no means the only source of dizziness/vertigo-type symptoms. Unfortunately, it seems to be a sort of “blanket diagnosis” for many practitioners as soon as a person reports any sort of dizzy symptoms at all. Since opening our clinic we have literally seen hundreds of patients who have been definitively MISdiagnosed with BPPV when the actual source of their vertigo/dizziness/imbalance symptoms was something entirely different, which could not be corrected with simple maneuvers. There seems to be a profound lack of understanding and awareness surrounding the wide range of vestibular disorders that can cause dizziness/vertigo-like symptoms, and how to differentiate them from BPPV. “Vertigo” is NOT a diagnosis – it is a symptom, and BPPV is just one potential cause for the symptom of vertigo. Because BPPV is quite easy to treat with simple maneuvers, and many people have been told they have it (or possibly even received a formal “diagnosis”), they don’t see why they need to have an assessment and just want a quick appointment to “fix their crystals”. We did previously have a short duration appointment just for BPPV, however, due to the clear confusion surrounding this condition we no longer offer those “quick fix” appointments, even if you’ve been “diagnosed” with BPPV by a doctor or other health care provider. We know they are absolutely well-intentioned, but our experience as a dedicated vestibular clinic is that the vast majority of patients who have been referred to us for a quick BPPV fix, do not actually have BPPV. Or, it is not the sole underlying cause of their symptoms, and is actually a secondary complication of a larger underlying issue. In any case, the point of this extensive explanation is that even if you believe you just have BPPV (or have even been “diagnosed” with it), you still need to book an Initial Consult so that we can properly assess you and ensure that is in fact what you’re dealing with. If it is, that’s fantastic news and we will absolutely perform the necessary corrective maneuvers to resolve it as part of that appointment. The added benefit is that you will also receive peace of mind that you have been thoroughly assessed by a dedicated vestibular specialist for any other potential underlying problems. 

Having said all of that, see below for some key information on BPPV that may help you determine if it is likely what you have. If so, you may even be able to resolve it on your own at home by attempting some common repositioning maneuvers, for which there are countless instructional YouTube videos. If, however, you would like a professional assessment by a dedicated vestibular specialist, we would be happy to help.

BPPV has 3 very distinct characteristics:

1. 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.
2. It causes true rotational vertigo: True vertigo, as we define it clinically, is the hallucination of movement. BPPV causes extreme rotational vertigo, typically a violent spinning or tumbling sensation (it is NOT subtle). There are countless forms of what we call “non-vertiginous dizziness” (ex. light-headedness, unsteadiness, imbalance, disequilibrium, floating/rocking/swaying sensations, wooziness, nausea, brain fog, distorted vision etc.) but those are not considered true vertigo, clinically speaking. 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 do NOT have BPPV.   
3. It is short duration: The acute vertigo doesn’t last long (usually less than 30 sec). BPPV is caused by the physical movement of inner-ear “crystals” in response to a specific change in head position. It is governed by gravity. The vertigo can only occur as long as the “crystals” are physically moving – once they stop, so does the vertigo. It typically takes less than 30 seconds for the crystals to settle if you remain still. It is not physiologically possible for BPPV to cause prolonged/sustained acute vertigo lasting several hours or days. If you have/had prolonged acute vertigo lasting hours without stopping, it is NOT BPPV.  It is possible to have multiple episodes, which occur each time you move in a specific way, but each one should not last any longer than a minute if it is BPPV. 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.

Additional Information:

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:

1. • 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 does not cause pressure/fullness in your ear.
   • You cannot physically feel or hear inner-ear crystals. Any odd physical sensations, pain, or sounds within your ears is not being caused by crystals. Full stop. There are, of course, numeorus things that may be causing that, but inner-ear crystals is not one of them.
   • Crystals are not visible under any circumstance by someone looking in your ears. Full stop. Any visible abnormalities in the ear canal are absolutely, categerocially NOT the inner-ear crystals that cause BPPV.
   • Recurrent BPPV: BPPV is something that many people will likely experience once or twice in their lifetime. Once treated with appropriate repositioning 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’s time to have a more thorough assessment by a dedicated vestibular specialist.
   • 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