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Benign Paroxysmal Positional Vertigo (BPPV) dizziness is generally thought to be due to debris described as "ear rocks", formally known as "otoconia".  When there has been damage to the inner ear either by head injury, infection, or advanced age, the ear rocks float through the ear canal stimulating small hair follicles that send signals of imbalance to the brain.  About 50% of all dizziness in older people is due to BPPV. The most common cause of BPPV in people under age 50 is head injury.  In half of all cases, BPPV is called "idiopathic," which means it occurs for no known reason. 

Symptoms of BPPV include dizziness/vertigo, lightheadedness, loss of balance, migraine and nausea.  Symptoms are usually intermittent and also may present for a few weeks, then stop, then come back again. Most symptoms are triggered from a change of position of the head with respect to gravity. Examples would include getting out of bed or rolling over in bed, use of shampoo bowls in beauty parlors, bending forward or even the Yoga posture called the "down dog can sometimes be the trigger. ). While rarely encountered, BPPV is also common in persons who have been treated with medications that are toxic to the inner ear such as gentamicin (Black et al, 2004).


Diagnosis can be made by a physical therapist with history and physical examination alone including testing called the Dix-Hallpike test. A positive Dix-Hallpike tests consists of a burst of nystagmus (jumping of the eyes) and most times nausea is associated with the testing.


The Epley Maneuvers

The treatment for BPPV is very effective, with roughly an 80% cure rate, (Herdman et al, 1993; Helminski et al, 2010). The Epley maneuver, also called the particle repositioning or canalith repositioning procedure, is intended to move debris or "ear rocks" out of the sensitive part of the ear (posterior canal) to a less sensitive location. The maneuver takes about 15 minutes to complete. After either of these maneuvers, you will be provided instructions in how to modify activities and allow the "ear rocks" to settle into and maintain their position.

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