İşitmeAtölyesiAt a glance
Short positional dizziness from displacement of tiny calcium crystals (otoconia) that have entered the balance canals (semicircular canals), moving with head motion.
Seconds-long severe spinning attacks triggered by turning in bed, lying down/getting up, or raising/bending the head.
Benign; if hearing loss/tinnitus/headache accompanies it, another cause should be considered.
The main treatment is not medication but canalith repositioning manoeuvres (Epley, Semont, barbecue).
Medical disclaimer. This content is for informational purposes only and does not replace a physician’s examination, diagnosis or treatment; it should not be used as medical advice. For your complaints or personal situation, always consult an ear, nose and throat physician and an audiologist.
If you have seconds-long severe dizziness triggered by turning in bed, lying down and getting up, or raising your head, consult a specialist. Although BPPV is benign, if the dizziness is accompanied by hearing loss, tinnitus or headache, other causes should be investigated. Do not try manoeuvres at home without determining the correct canal.
Definition and epidemiology
Benign paroxysmal positional vertigo (BPPV) is a short positional dizziness that occurs when tiny calcium crystals (otoconia) that have entered the balance canals (semicircular canals) in the inner ear are displaced by head movement.
BPPV is the most common cause of dizziness in the community. Its frequency increases with age and it is more common in women (Bhattacharyya et al., 2017).
When the otoconia move freely in the canal it is called ‘canalithiasis’; when they adhere to the canal’s sensory organ it is called ‘cupulolithiasis.’ The posterior canal is most often involved.
Symptoms and signs
Typically there are seconds-long severe spinning attacks triggered by movements such as turning in bed, lying down/getting up, raising the head or bending forward. The attacks are short but can cause intense nausea and imbalance.
Features that distinguish BPPV from other causes are: positional triggering, short latency (starting a few seconds after the movement), fatiguability (decreasing with repetition) and usually settling on its own within 60 seconds.
Hearing loss, tinnitus or headache are not typical findings of BPPV; if present, other causes should be considered.
Causes and risk factors
BPPV is mostly idiopathic (no cause found). Known causes include head trauma, prolonged bed rest and other inner-ear diseases.
Traumatic BPPV can be more stubborn than the idiopathic form, may involve more than one canal and recur more often. Advanced age and vitamin D deficiency are among the factors that increase the risk of recurrence.
There is growing evidence that vitamin D supplementation may reduce recurrence in patients with vitamin D deficiency and frequent recurrences.
Audiological and clinical assessment
Diagnosis is largely made with positional tests; additional imaging is often unnecessary. The aim is to identify the involved canal and side.
- Dix-Hallpike test: the gold standard for posterior-canal BPPV; the triggered typical nystagmus makes the diagnosis.
- Supine roll test: assesses horizontal (lateral) canal BPPV.
- Direction and character of the nystagmus: show the involved canal and the canalithiasis/cupulolithiasis distinction.
- Pure-tone audiometry: normal in BPPV; done for differential diagnosis if there is a hearing symptom.
Determining the correct side and canal is critical for choosing the appropriate treatment manoeuvre.
| Canal | Diagnostic test | Typical manoeuvre |
|---|---|---|
| Posterior | Dix-Hallpike | Epley, Semont |
| Horizontal (lateral) | Supine roll | Barbecue (Lempert), Gufoni |
| Residual imbalance | — | Brandt-Daroff (home exercise) |
Treatment and audiological rehabilitation
The main treatment of BPPV is not medication but canalith repositioning manoeuvres. These manoeuvres send the displaced crystals back to a harmless area with the help of gravity.
In posterior-canal BPPV, the Epley and Semont manoeuvres achieve high success. In horizontal-canal BPPV, the barbecue (Lempert) and Gufoni manoeuvres are preferred. Manoeuvres should be performed by an experienced specialist (Bhattacharyya et al., 2017).
There is no strong evidence that strict post-manoeuvre position restrictions (high pillow, neck collar) provide added benefit. For residual mild imbalance, home exercises such as Brandt-Daroff and vestibular rehabilitation speed recovery. Drugs are used only briefly to ease nausea.
Epley manoeuvre — step by step
Important: This illustration is for information only. The Epley manoeuvre should be performed by an experienced clinician after the correct canal and side have been identified; do not attempt it on your own. Incorrect performance can worsen symptoms.
Start seated. Your head is turned 45° toward the affected ear.
You are quickly laid flat on your back; the head stays turned 45° and slightly extended. Wait until the vertigo settles.
The head is slowly turned 90° to the opposite side (about 90° total). Wait again briefly.
The body is turned onto its side in the direction the head faces; the face looks down. Then you slowly sit up.
In posterior-canal BPPV it uses gravity to move the displaced crystals back to a harmless area. Each position is usually held for 30–60 seconds.
Impact on quality of life and advice
Although short, sudden attacks can create fear of falling and anxiety; they can increase fall risk, especially in older adults. Fortunately, BPPV usually resolves quickly with the correct manoeuvre.
There may be mild unsteadiness for a few days after the manoeuvre; this is the system re-calibrating and usually passes on its own. If symptoms recur, it is recommended to see a specialist for correct canal identification rather than trying manoeuvres on your own.
If you used this review, you can cite it as follows (APA 7):
İşitme Atölyesi. (2026). Benign Paroxysmal Positional Vertigo (BPPV). Hearing & Balance Health Guide. https://www.isitmeatolyesi.com/en/guncel-haberler/categories/isitme-sagligi-rehberi/benign-paroksismal-pozisyonel-vertigo/Permanent link: isitmeatolyesi.com/en/guncel-haberler/categories/isitme-sagligi-rehberi/benign-paroksismal-pozisyonel-vertigo/ · Last reviewed: July 2026 · License: CC BY-NC-ND 4.0
References
- Bhattacharyya, N., Gubbels, S. P., Schwartz, S. R., et al. (2017). Clinical practice guideline: Benign paroxysmal positional vertigo (update). Otolaryngology-Head and Neck Surgery, 156(3_suppl), S1-S47.
- Hilton, M. P., & Pinder, D. K. (2014). The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo. Cochrane Database of Systematic Reviews, 12, CD003162.
- von Brevern, M., Bertholon, P., Brandt, T., et al. (2015). Benign paroxysmal positional vertigo: Diagnostic criteria. Journal of Vestibular Research, 25(3-4), 105-117.
Frequently asked questions
Is BPPV dangerous?
As the ‘benign’ in its name shows, BPPV is not a dangerous disease and does not point to a serious brain problem. Although uncomfortable, it is usually treated quickly with simple manoeuvres. Still, assessment is important to confirm the diagnosis.
I still feel mild unsteadiness after the manoeuvre; is that normal?
Yes, this is quite common. Even after the crystals settle, your balance system may take a few days to re-calibrate; this ‘residual unsteadiness’ usually passes on its own. If severe spinning attacks recur, re-assessment may be needed.
Do drugs cure BPPV?
Dizziness drugs only temporarily reduce nausea and the severe spinning sensation; they cannot put the crystals back in place. The main and lasting treatment of BPPV is the repositioning manoeuvres that solve the mechanical problem.
Does BPPV recur?
Yes, BPPV can recur in some patients; recurrence is more frequent, especially in those with a history of head trauma and at older ages. In people with vitamin D deficiency, supplementation may help reduce recurrences. When it recurs, the manoeuvre is usually effective again.
Can I do the manoeuvre myself at home?
Manoeuvres done without determining the correct canal and side can be ineffective or even increase symptoms. It is safest to see a specialist for the initial diagnosis and treatment, then perform the home exercises the specialist teaches you.
Scales that can be used to monitor the daily impact of dizziness and balance confidence: