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A drawing of a disoriented girl with a spinning  head and seeing stars
Head spinning

What is balance?

Balance is a complex process of sensory information that comes into our central nervous system coordinating with motor processes to maintain upright posture. We use visual (our eyes), somatosensory (nerve receptors from our muscles and joints), and vestibular (inner ear) systems to achieve good balance. BPPV is a disruption of the vestibular system.

Vestibular System:

This system uses coordination of the body, head, and eye movements to keep upright posture. The vestibular system is comprised of 3 semi-circular canals in your inner ear that gives your brain information (via the vestibulo-cochlear nerve) about the coordination of head and eye movement. There is a jelly-like substance (endolymph) as well as calcium carbonate crystals (otoconia) that live in the canals. Disruption of these crystals to float freely in the canals increases neural input sending abnormal signals that results in dizziness.

Who gets BPPV?

Trauma or head injuries are the most common causes of BPPV for individuals under the age of 50, however BPPV is most common between the ages of 50-70 – due to degeneration/aging. Other causes of BPPV are due to prolonged positioning (such as during a surgery) or viral (an infection within the system).

Signs and Symptoms of BPPV?

The most common complaints of BPPV are feeling very dizzy and nauseous when rolling in bed, with quick head turns, or bending over. Some individuals with have imbalance with walking or a sense of floating.


Fortunately there is treatment for BPPV. A skilled clinician will take a thorough history and exam to determine if you actually have BPPV. If BPPV is positive, the exam will ascertain which canal is involved. This is important as the involved canal will determine which treatment position is recommended. Your physical therapist will teach you how to do these exercises on your own. Treatment benefits are often immediate!!!