Benign paroxysmal positional vertigo (BPPV)

Complaints – BPPV

Simply put, BPPV contains crystals in one of your balance organs, so that balance organ does not work properly.
Because of those crystals you can get very dizzy from head movements such as lying down or turning over in bed, looking back with the head (for example in high kitchen cabinets) or bending down. Vertigo is very intense, but lasts for a short time (usually less than a minute). Sometimes the dizziness is accompanied by a nauseous feeling.


First, the normal functioning of the vestibular system is explained. This way you can better understand what exactly is going on.
Healthy people have two balance organs: left and right. These are in the bone behind your ears. The balance organs send information to the brain when you move your head. They ensure that you stay well-balanced. What not many people know is that the balance organs also allow you to keep seeing sharply during movements (for example, while walking, running, cycling, or driving a car).
Each vestibular system is made up of five parts: 2 sacs and 3 channels (see Figure 1). In the bags there are crystals that are attached to the bottom of the bags. These crystals (also called “pebbles” or “grit”) are needed to properly measure movements of the head. The crystals only belong in the bags and not in the channels. The bags are for recording movements in horizontal and vertical directions. The channels are for determining rotating movements.
In BPPV, the crystals become detached from the bags and end up in a channel (Figure 1). Usually the crystals are in the posterior channel, but they can get into any channel. As a result, with every movement of the head, the nerve cells in that channel are stimulated. You may then feel like you are turning after a movement of the head. Pebbles are heavier than moisture (which is normally only in the canal). The stones will continue to rotate longer after a turn of the head. As a result, the feeling of turning continues while the head is already standing still and the feeling of turning also extinguishes when the stone is still again. Note: BPPV also gives more chance of falls.
What causes the crystals to end up in a channel of the vestibular system is not always possible to say. There are several causes for it, such as aging, a hard blow to the head, prolonged bed rest and previous disease of the vestibular system (for example, inflammation or Meniere’s disease. In most cases, however, no clear cause is demonstrable.



The diagnosis of BPPV can be made by an ENT doctor. This will carry out various tests in the consultation room. With the help of the so-called tipping test (in which the head and upper body are suddenly tipped back from a sitting position and the lateral role (in which the patient quickly turns the head from a lying position) we can induce the dizziness in BPPV. Usually, a typical eye movement is visible that can be recorded during the balance examination.

Possible treatment – of BPPV

The treatment of BPPV consists of a so-called liberation or repositioning maneuver. Examples include the Epley maneuver and the Brandt-Daroff maneuver. By means of these maneuvers (sequence of (head) movements) the loose crystals are moved to the original part of the vestibular organ and can (re)attach there. As a result, the crystals can no longer lead to overstimulation of the sensory cells, so that dizziness no longer occurs. The results of a treatment are generally very good.

Brandt-Daroff home exercises

To remedy remaining dizziness symptoms and to prevent the recurrence of the symptoms, you can perform Brandt-Daroff home exercises. Also in people where the complaints return after some time, the exercises are prescribed. With these exercises it is important that you perform them well. If you get dizzy, stay for a while and then complete the exercises.


Time Exercise Expensive
Morning 5 repetitions 10 minutes
Noon 5 repetitions 10 minutes
Evening 5 repetitions 10 minutes

Position 1 : Sit on the edge of your bed. Before you start, sit quietly for 30 seconds.
Position 2: Turn your head 45 degrees to the left and change from sitting to lying on your right side. Perform this movement quickly, within 2 seconds. Hold this position and also your turned head for 30 seconds.
Position 3: After 30 seconds, sit upright again.
Position 4: Perform the same exercise as in position 2, only with your head to the right and falling on your left side.


How often should you do the Brandt-Daroff exercises?

You perform the Brandt-Daroff exercises for 2 weeks, 3 times a day. From position 1 to position 4 and back to position 1 takes about 2 minutes, each position is maintained for 30 seconds. The entire cycle is repeated 5 times per practice session. This means that you take each position 5 times per practice session. In most cases, the exercises have such an effect within about 10 days that the complaints have (almost) completely disappeared.

Will the dizziness come back?

In 1 in 3 patients, BPPV returns within the first year after treatment. Within 5 years, this is even the case in 50% of patients. If the BPPV returns, contact your ENT doctor again. This will then check whether you have BPPV again at that moment or whether something else is going on. If BPPV is detected again, the ENT doctor will treat you again with the Epley maneuver described above, followed by the home exercises.
BPPV is self-limiting. This means that the symptoms often disappear on their own in the long run. Symptoms tend to come and disappear just as suddenly. Nevertheless, various forms of treatment and exercise therapy have proven their effectiveness.


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