Published on July 15, 2018

Balance & Dizziness Therapy

Cause of dizziness, vertigo could be in your ears: BPPV

By Roseanne Smith, Lawrence Memorial Hospital

Martha woke up one morning, sat up and became so dizzy she almost fell off her bed. She hung onto the side of her bed and headboard until the room stopped spinning. She finally was able to stand and begin her day. Off and on for the rest of the day, she felt dizzy or nauseated – and sometimes both. She discovered that if she moved much she had vertigo, so she spent most of the day sitting in her chair trying to remain as still as possible.

Unfortunately, there are many causes for dizziness or vertigo such as the type Martha has. If you are so dizzy you can’t get up, you should dial 911 and go to the emergency room. Otherwise, a good place to begin looking for help is your doctor’s office, where your physician can:

  • Review your medications to see if that could be the cause.
  • Examine you for the possibility of significant medical problems, such as stroke or a tumor that could cause vertigo.
  • Check for blood pressure changes, an inner ear problem or a variety of other medical issues.

The most common cause of intermittent dizziness has a long name: benign paroxysmal positional vertigo, which often is referred to as BPPV. According to research, this type of vertigo accounts for up to 40 percent of dizziness caused by inner ear problems.

If you have BPPV, you become dizzy if you move. But that dizziness usually lasts for less than a minute – until you move again. The dizziness most often is associated with head movement. People can become nauseated and throw up, particularly in the first few days. Some people have this problem only once in their lives. For others, this problem occurs once every few days. It usually lasts for one to two weeks, but the duration can vary significantly from one person to another.

BPPV is sort of a mechanical problem. Your inner ear contains the vestibular labyrinth, which is how you orient yourself to gravity and to motion. A couple of areas in your inner ear contain calcium carbonate crystals that are attached to tiny hair cells – at least they should be. The crystals’ weight pulls on the hair cells, which sends a signal to your brain and causes you to orient your head to gravity.

If you shed too many crystals, or fall and hit your head and knock a whole lot off, you are more likely to have BPPV. The crystals then can roll into the semicircular canals, which often occurs at night when you are sleeping on your side. Once in the canals, the crystals create havoc with your normal perception of how fast or how far you have moved your head.

Part of the concern about BPPV is that it also can affect your balance. When you have BPPV, the labyrinth for one ear usually is affected, and basically is relaying bad information to your brain. Your brain coordinates information from your vestibular system, vision and sensation from your body to keep you oriented well in space. If one of these systems is malfunctioning it can affect your balance and lead to falls. Recent statistics show that about 10 percent of people older than 65 who are having difficulty with balance have BPPV. If the BPPV is treated, their balance also improves.

If you see an otolaryngologist, someone in their office will treat you by performing an Epley maneuver, which is undertaken to reposition crystals in your inner ear.

In Lawrence, we also have several physical therapists who can perform a detailed evaluation and treat the BPPV with the positioning maneuver. If you have had BPPV for some time, it is likely that some of your visual reflexes also have been affected, and the physical therapist will give you exercises for that. Physical therapists are well-trained in evaluating balance and gait problems and helping you also improve those.

Roseanne Smith is a physical therapist at LMH Therapy Services. She can be reached at


Cause of dizziness, vertigo could be in your ears: BPPV

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