This document discusses benign paroxysmal positioning vertigo (BPPV), a common cause of dizziness. BPPV occurs when small crystals in the inner ear become dislodged and migrate to areas where they interfere with balance. This can cause brief but intense spinning sensations when the head is moved into certain positions. While uncomfortable, BPPV is treatable through physical therapy maneuvers that reposition the crystals. Most patients find relief after one or two treatment sessions.

1. Do You Have Rocks Loose In Your Head?
There are several different reasons why you might
experience spinning sensations or what is more
often called “dizziness” or “vertigo.” One form of
dizziness in particular can occur at any age to
anyone, although it seems to occur more often to
those over 60. The good news is that it can be
treated quite successfully.
This relatively common balance error occurs when a
person puts his or her head in a particular position,
which sets in motion a series of events that to some, can have quite
debilitating results. It can occur with just lying down in bed, turning in
bed from one side to the other, lying back in the dentist’s chair or at
the hair salon for a shampoo. The vertigo can make you very
nauseated and if you happen to be standing, it can cause you to fall
and hurt yourself.
When a person’s head is in the “trigger position” for a short period of
time, a quick spinning sensation occurs that can come on quite
violently or if you’re lucky, only mildly. This lasts for 10-20 seconds as
long as the position is maintained. If the person changes position, the
dizziness will begin to subside but returns again when turning back to
the offending position. The clinical name for the disturbance is,
“Benign Paroxysmal Positioning Vertigo” or BPPV. It can also be
described as, “having rocks loose in your head”! This is true because
the error that occurs in the balance system is produced by small
crystals landing in areas of the inner ear where they shouldn’t be.
The inner ear balance system or vestibular system is a matched pair,
one in each ear and is made up of two different sensory mechanisms.
One system is made up of 3 semi-circular canals that are full of fluid
with a gate at the end of each canal. It gives your brain information
about the direction your head is moving. As your head moves, the fluid
in the semi-circular canals moves as well. This causes the gates to
swing open triggering a signal that is then transmitted to your brain.
The brain responds by sending a signal to the muscles in your eyes to

2. make a corrective eye movement in concert with the head movement.
This is an automatic response and cannot be voluntarily shut down.
Another system located in your inner ear is called the otolith organ and
it can be simply described as a bed of jello with small calcium
carbonate crystals embedded into it. At the base of this jello-like
material are sensory trigger cells. This system tells your brain about
the speed of your head movement in space. Each system works to tell
your brain and then your eyes about the direction and speed of your
head movements. They work at a very high speed and are sensitive to
miniscule body movements.
The problem comes when the crystals are disturbed and begin to
slough off in great numbers. The crystals then migrate over time and
end up piling up against one of the gates in the semi-circular canals.
This is where the fun begins. When these rocks are in the wrong spot
and you happen to put your head in the “trigger position,” the crystals
hold the gate open too long and tell your brain that you are still
moving when in fact, you’ve stopped. The brain believes your
vestibular system over everything else and tells your eyes to make a
corrective movement based upon bad information. This causes the
eyes to keep moving and therefore create a spinning sensation. This
can create quite a stir, literally, as 80% of sufferers report
experiencing nausea and disorientation.
The good news is that this disturbance can be fixed by performing a
very specific physical therapy maneuver. Research tells us that 75% of
patients report no further symptoms after one treatment. Of those
who continue to have spinning sensations after the first treatment,
85% are cured after the second treatment. It is rare that BPPV cannot
be cured by physical therapy.
If you think that you or a loved one might be experiencing BPPV, we
can help! A simple test in our office can identify which canal is causing
the problem and then we will refer you for treatment. Call our office if
you have questions about this or other balance disturbances.
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