What is the patient education for Benign Paroxysmal Positional Vertigo (BPPV)?

Patient Education Handout: Benign Paroxysmal Positional Vertigo (BPPV)

BPPV is a common inner ear disorder that causes brief episodes of vertigo triggered by specific head movements, but it can be effectively treated with simple repositioning maneuvers in most cases. 1

What is BPPV?

• BPPV occurs when tiny calcium crystals (otoconia) become dislodged from their normal location in your inner ear and move into the semicircular canals, causing false signals about head movement 1
• These displaced crystals make you sensitive to position changes, causing brief but intense spinning sensations 1
• BPPV can recover spontaneously in about 20% of patients within 1 month and up to 50% by 3 months 1
• Despite being called "benign," untreated BPPV can significantly impact your quality of life and increase your risk of falls 1

Common Symptoms

• Brief episodes of spinning vertigo lasting 10-20 seconds (occasionally up to 1 minute) when changing head position 2
• Vertigo typically triggered by:
  • Rolling over in bed
  • Getting in or out of bed
  • Bending over and straightening up
  • Looking up (like reaching for something on a high shelf) 1, 3
• Nausea may accompany the vertigo 3
• Some patients experience "nautical vertigo" (feeling like you're on a boat) rather than spinning sensations 4
• Symptoms may come and go over time 1

Diagnosis

• Your healthcare provider can diagnose BPPV using simple positioning tests like the Dix-Hallpike maneuver or supine roll test 5
• These tests reproduce your symptoms and allow your provider to observe specific eye movements (nystagmus) 3, 5
• Expensive tests like MRI or CT scans are usually not needed unless your symptoms are unusual or don't respond to treatment 1, 3

Treatment Options

• The most effective treatment is a canalith repositioning procedure (CRP), such as the Epley maneuver, which moves the displaced crystals back to their proper location 5, 6
• These procedures have a high success rate (80-90%) and often work immediately or after just 1-2 treatments 7
• Your healthcare provider can teach you how to perform these maneuvers at home if needed 5
• Vestibular rehabilitation exercises may help if you have persistent symptoms 5
• Medications like antihistamines or benzodiazepines are generally not recommended for BPPV as they only mask symptoms and may delay recovery 1, 6

What to Expect After Treatment

• You may experience mild dizziness for a short time after the repositioning procedure 7
• Some patients (about 19%) may experience temporary down-beating nystagmus or vertigo after treatment, which typically resolves quickly 7
• No special restrictions are needed after treatment - you don't need to sleep upright or avoid certain positions 5

Important Safety Information

• BPPV increases your risk of falling, so take precautions, especially when getting out of bed 1, 5
• Move your head slowly when changing positions 3
• Ensure good lighting at night if you need to get up 5
• Remove tripping hazards from your home 5

Long-Term Outlook

• BPPV has a significant recurrence rate: 5-13.5% at 6 months, 10-18% at 1 year, and up to 36% over longer periods 1
• Recurrence rates are higher in patients whose BPPV was caused by head trauma 1
• Knowing the signs of recurrence allows you to seek prompt treatment 1

When to Contact Your Healthcare Provider

• If your symptoms don't improve after treatment 1
• If you develop new or different symptoms (hearing loss, persistent headache, double vision, difficulty speaking or walking) 1, 8
• If your vertigo episodes become more frequent or severe 1
• If you experience falls or significant balance problems 1

Additional Resources

• For more information and support, visit www.vestibular.org 1
• Ask your healthcare provider about local support groups 1

Remember that while BPPV can be distressing, it is rarely dangerous and is usually treatable with simple, effective procedures. With proper diagnosis and treatment, most people can achieve significant relief from symptoms.