Vertigo, Benign Paroxysmal Positional (BPPV)



  • Benign paroxysmal positional vertigo (BPPV) is a mechanical disorder of the inner ear characterized by a brief period of vertigo experienced when the position of the patient’s head is changed relative to gravity.
  • Vertigo results from the mismatch of the perception of movement by the visual, vestibular, and proprioceptive symptoms when none exist.
  • The brief period of vertigo is caused by abnormal stimulation of ≥1 of the 3 semicircular canals of the inner ear, with the posterior canal most commonly affected.
  • BPPV is the single most common cause of vertigo.


  • Age of onset is typically between the 5th and 7th decades of life.
  • Incidence increases with each decade of life.
  • Prevalent sex: female > male
  • BPPV affects the quality of life of elderly patients and is associated with reduced activities of daily living scores, falls, and depression.

1-year incidence 0.6%

Lifetime prevalence 2.4%

Etiology and Pathophysiology

  • In BPPV, calcite particles (otoconia) that normally weigh the sensory membrane of the maculae become dislodged and settle into the semicircular canal, changing the dynamics of the canal. Reorientation of the canal relative to gravity causes the otoconia to move to the lowest part of the canal, causing displacement of the endolymph, deflection of the cupula, and activation of the primary afferent. This results in the generation of nystagmus and the associated sensation of vertigo.
  • BPPV may be idiopathic, posttraumatic, or associated with viral neurolabyrinthitis.

Risk Factors

Female gender, vitamin D deficiency, osteoporosis, migraine, head trauma, and high total cholesterol level (1)

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