Vestibular Rehabilitation
What Is BPPV?
Benign paroxysmal positional vertigo — BPPV — is the most common cause of vertigo. If you have ever had a sudden, brief spinning sensation when you roll over in bed, tilt your head back, or look down, BPPV is very likely the cause.
Inside your inner ear are tiny calcium carbonate crystals called otoconia (sometimes called “ear rocks” or “ear crystals”). These normally sit in a small chamber that senses linear movement. In BPPV, one or more of these crystals become dislodged and migrate into one of the semicircular canals — the fluid-filled tubes that sense rotation. When you move your head, the loose crystal shifts inside the canal and sends a false signal to the brain: you feel as though you are spinning even though you are still.
The word benign is important: BPPV is not dangerous. It does not mean anything is wrong with your brain. But it feels horrible, and — left untreated — can really get in the way of day to day life, and is a risk factor for falls.
What Does It Feel Like?
The classic signs of BPPV:
- A brief but intense spinning sensation (vertigo) lasting seconds to a minute, triggered by specific head positions
- Nausea during or after the episode
- A sense of imbalance or unsteadiness that lingers after the spinning stops
- Symptoms most noticeable when lying down/getting up, rolling over in bed, looking up, or bending forward
The Epley Manoeuvre
The Epley manoeuvre is a highly effective, non-invasive treatment for BPPV. It is a sequence of carefully guided head and body positions, performed over a few minutes, designed to move the displaced crystal out of the semicircular canal and back to where it cannot cause symptoms.
When performed correctly, the Epley manoeuvre resolves BPPV in the majority of cases — often in a single treatment session. Research consistently shows it to be more effective than doing nothing or simply waiting for symptoms to resolve on their own.
We are trained in performing the Epley manoeuvre and the full clinical assessment that determines which canal is affected and in which direction — this matters, because the correct variant of the repositioning manoeuvre depends on which canal is involved.
Other Causes of Dizziness and Vertigo
Not all dizziness is BPPV. Vestibular rehabilitation also addresses:
- Vestibular neuritis and labyrinthitis — inflammation of the vestibular nerve or inner ear, often following a viral illness, causing prolonged unsteadiness
- Cervicogenic dizziness — dizziness arising from the neck rather than the inner ear
- General vestibular hypofunction — reduced function in one or both inner ears, causing persistent imbalance
A thorough assessment will identify the source of your symptoms before any treatment begins.
How We Can Help
A vestibular assessment typically involves:
- A detailed history of your symptoms — when they started, what triggers them, how long they last
- Clinical tests to identify which structure is involved (Dix-Hallpike test, head impulse test, roll test)
- Treatment in the same session where appropriate — for BPPV, this is usually the case (some people do feel quite affected after the treatment, so having someone on call to drive you home is useful - it may not be neccesary - some people feel great after the treatment).
- A home exercise programme to support recovery and reduce the risk of recurrence
Most patients with BPPV notice a significant improvement within one or two sessions.
Any Questions?
Contact us or book an appointment and we can assess whether vestibular rehabilitation is right for you.