BPPV — When the World Spins Around You

Dr. D. Mahesh

MBBS, MS

ENT Surgeon
Attapur

When the world starts spinning suddenly, it can be one of the most frightening feelings.
Benign Paroxysmal Positional Vertigo (BPPV) is one of the most common causes of vertigo — a condition where simple head movements can trigger severe dizziness, nausea, and even vomiting.

Epley Maneuver — Treatment for BPPV Vertigo

A story from my practice

Recently, a 60-year-old lady came to the Emergency Room. She complained that “the room spins” whenever she turned her head or lay down on the bed. She was unable to sit or stand up without feeling giddy.

On examination, I noticed nystagmus — small involuntary eye movements that occur due to disturbance in the inner ear.
I performed a Dix-Hallpike test, where the patient’s head is gently turned and lowered to one side to look for typical eye movements.
This confirmed Right-sided BPPV.

Immediately, I performed an Epley’s Maneuver — a simple bedside procedure that repositions tiny calcium crystals (called otoliths) within the inner ear.
Within minutes, her vertigo reduced dramatically. She stood up, smiled, and said, “Doctor, the world has stopped spinning.”

Another case — after knee surgery

Another patient of mine — a gentleman who recently underwent Right ACL (Anterior Cruciate Ligament) reconstruction surgery — developed sudden giddiness a few days after surgery.
He was so afraid of moving his head that he kept it in one fixed position for several days.

This immobility can sometimes cause the small ear balance stones (otoliths) to clump and move into the wrong part of the inner ear — leading to BPPV.
After confirming the diagnosis, Epley’s Maneuver was again performed, and he recovered immediately.

Understanding BPPV in simple terms

Inside each ear, we have a delicate balance system called the labyrinth.
It works like a spirit level — the same tool used to check if a wall is straight or not.
Tiny calcium particles inside the inner ear (called otoconia) shift with head movement and tell the brain about your body’s position.

When these particles accidentally move into the wrong canal, the brain receives false signals of movement, even when you are still — this causes vertigo.

Symptoms and how patients feel

Patients with BPPV often describe:

Sudden spinning sensation when turning in bed or looking up/down
Nausea and vomiting
Sweating and imbalance
Fear of moving the head or walking

During a severe episode, some patients cannot even get up from bed — the burden of vertigo can be both physically and emotionally distressing.

Diagnosis — The Dix-Hallpike Maneuver

The Dix-Hallpike test helps confirm BPPV.
The patient is made to sit upright, then quickly lie down with the head turned to one side.
If vertigo and nystagmus occur, it indicates which ear is affected.
It’s a simple and safe test that can be done in the ENT practice or Emergency Room.

Treatment — Epley’s Maneuver

The Epley’s Maneuver is a quick, non-surgical treatment where the head is moved in specific positions to relocate the displaced ear stones back to their original place.
Relief is often instant or within 24 hours.

Most patients walk out smiling, relieved that their world has finally stopped spinning.

Medications — Vertin and Others

While repositioning maneuvers are the main treatment, medicines can help reduce symptoms:

Vertin (Betahistine): Improves blood flow in the inner ear and reduces dizziness.
Anti-nausea drugs: Like Domperidone or Ondansetron for vomiting.
Short rest: Avoid sudden head movements for a day or two after the procedure.

However, long-term dependence on vertigo tablets is not advised — correcting the root cause gives lasting relief.

Final Thoughts

BPPV is common, easily diagnosable, and completely treatable.
Understanding that your inner ear is your body’s “spirit level” helps patients appreciate how delicate yet powerful the balance system is.

If you or your loved one experiences spinning sensations or dizziness, don’t ignore it —
sometimes, all it takes is a simple Epley’s Maneuver to bring the world back to balance.