Benign Paroxysmal Positional Vertigo (BPPV)

BPPV is a medical abbreviation for Benign Paroxysmal Positional Vertigo. It is a form of vertigo that is thought to be caused by calcium deposits within the inner ear. The medical term for these deposits is otoconia. Otoconia normally reside in two parts of the ear called the utricle and saccule but when they abnormally make their way into the portion of the inner ear called the semicircular canals they can cause vertigo. BPPV usually occurs in one ear at a time and not bilaterally.

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There are a few causes of BPPV, according to John Hopkins Medicine. It can come from head trauma, inner ear disease (ischemic, inflammatory, infectious), placing the head in a position for a long time (dentist chair, bed rest), high intensity aerobics, bike riding on rough trails, and the breakdown of the utricle over time. It can also be caused by congenital disorders of the inner ear. Occasionally BPPV has been associated with a history of small strokes or Meniere's disease.


Symptoms of BPPV can sometimes lessen in severity or go away after about six months. Symptoms of BPPV appear with changes in your position such as standing up from lying down or turning in bed. They may vary slightly among individuals but common symptoms include:

  • Dizziness
  • Being light-headed or passing out
  • Imbalance which may make walking difficult
  • Nausea
  • Headache


BPPV is diagnosed using a combination of medical tests including patient history and a physical examination. BPPV is usually accompanied by nystagmus, a subtle "jumping" of the eyes which can sometimes be seen by an observer or by using a test called electronystagmography (ENG). An MRI may be done to rule other disorders that can be considered including a stroke or tumor.​


Anti-nausea medications such as ondansetron or medications used for motion sickness may be helpful in treating nausea associated with BPPV. Otherwise, medications do not seem very beneficial in treating the disorder. BPPV can be treated using treatments called the Epley and Semont Maneuvers and Brandt-Daroff exercises.

The Epley Maneuver

The Epley Maneuver must be performed by a qualified physician in a doctor's office. It takes about 15 minutes to complete and is intended as a means to get the otoconia (calcium deposits) into a different part of the ear where they will be less likely to cause symptoms. The Epley Maneuver may also be called the particle repositioning, canalith repositioning procedure or the modified liberatory maneuver. The exercise consists of four different head positions which are maintained for 30 seconds each. Caution should be taken if trying to perform this method at home.

The Semont Maneuver

During the Semont maneuver, the doctor will tilt your head in different directions while you are in a seated position. Finally, he will tilt your head and gradually assist you until you are lying down on the unaffected ear with your nose pointed down. You will remain in this position for 3 minutes. Then the doctor will gradually help you back into a seated position.

There is about an 80 percent chance of both the Epley and Semont maneuvers working and a chance that symptoms of BPPV will reoccur. Your doctor may give you instructions on exercises or positions you should avoid after having these maneuvers done.

Brandt-Daroff Exercises

Brandt-Daroff Exercises may be performed at home after instruction by a medical professional. They are usually reserved for individuals in which the Epley or Semont Maneuvers have been ineffective. The exercises are more rigorous in that they must be performed in 3 sets per day for 2 weeks. Brandt-Daroff Exercises are successful in about 95 percent of BPPV cases.

Surgical Treatment

Surgical treatment for BPPV is controversial and in general not performed.

While BPPV can be difficult to cope with and will certainly require you to modify your daily life, most patients are treated successfully.

3 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Lundberg YW, Xu Y, Thiessen KD, Kramer KL. Mechanisms of otoconia and otolith development: mechanisms of otoconia and otolith development. Dev Dyn. 2015;244(3):239-253. doi. 10.1002/dvdy.24195.

  2. Nguyen C-T, Basso M. Epley maneuver. In: StatPearls. StatPearls. PMID. 33085434.

  3. Oh S-Y, Kim J-S, Choi K-D, et al. Switch to Semont maneuver is no better than repetition of Epley maneuver in treating refractory BPPV. J Neurol. 2017;264(9):1892-1898. doi. 10.1007/s00415-017-8580-2.

Additional Reading
  • Zalewski, Chris MA, CCC-A. What is Benign Paroxysmal Positional Vertigo (BPPV)?. ASHA

By Kristin Hayes, RN
Kristin Hayes, RN, is a registered nurse specializing in ear, nose, and throat disorders for both adults and children.