Understanding Vertigo and BPPV

March 20th, 2024

There are likely very few people in this world that enjoy being dizzy - in fact the only people I can think of are children that think it is hilarious when they fall down. As we get older, getting dizzy when we are trying to stand up, or roll over in bed, or reach down to pick up up a pen off the floor can be scary and uncomfortable. That room-spinning sensation when our body changes positions is a hall mark sign of Benign Paroxysmal Positional Vertigo, or BPPV. However, not all feelings of dizziness are true vertigo and have vastly different treatment plans and means of diagnosis and causes.

When discussing true vertigo or BPPV, this is a mechanical issue, meaning it is caused by something being out of place as opposed to a neurological issue that has to do with the eyes and the brain. This mechanical issue is a result of crystals in our inner ear. Our inner ear houses our vestibular system, or our balance organ, and it is about the size of a baby’s pinky bone. It is actually our first sensory structure to develop at 7weeks inside the womb; it is what we need to orient ourselves in space. We need our vestibular system to know if we are upside down or right-side up, rotated left or rotated right. There are 3 canals that are a part of this inner ear called the semi circular canals and positioned in different planes (like that toy that you would trace beads on).

These crystals (made of calcium bicarbonate) found within our inner ear inside what’s called the saccule and utricle. Picture ice in a cup of water - when you go to take a drink, the ice hopefully stays in place, however, some times that ice spills onto your face and it is quite alarming! This is essentially what happens with BPPV or vertigo - the ice becomes dislodged and the change in our head position (the cup) causes greater movement than expected.

So going back to our toy beads, the way to get those crystals back into their home is to trace and move our head along the path. This series of head and body maneuvers should only be done by a trained therapist due to the risk of these crystals being dumped into the wrong canal - the ice getting put into a different cup which could make your symptoms worse. When done correctly, BPPV takes an average of 1.2 visits to resolve completely - that means days, weeks, or months of dizziness could be cured within 2 sessions!