Diagnosis and Treatment of Benign Paroxysmal Positional Vertigo

Benign paroxysmal positional vertigo (BPPV) is a peripheral vestibular disorder that can negatively affect quality of life and daily functioning and increase the risk of falls. BPPV is caused by dislodged otolith particles that become trapped in any of the 3 inner ear semicircular canals (anterior, posterior, or horizontal), but most commonly affects the posterior canal. Due to the posterior canal’s anatomical orientation with vertical alignment and curvature, particles in this canal tend to settle in the lowest portion and are less likely to exit with natural head movements compared with the other canals. When the head moves in the plane of the involved canal, these tiny calcium particles move in response to gravitational forces, generating fluid motion within the inner ear that displaces the cupula, the vestibular system’s main sensory structure. This temporary displacement of the cupula alters vestibular signaling, which causes involuntary eye deviation resulting in the characteristic transient nystagmus and dizziness typically described as vertigo.