A few tiny crystals in the inner ear can make a person feel as if the room is spinning when they sit up, tilt their head or lie down. At Mayo Clinic in Minnesota, audiologist Neil Shepard, Ph.D., says this sensation has a name: vertigo—and it is not the same as ordinary dizziness.
Dizziness usually means feeling lightheaded or unsteady, Shepard explains. Vertigo is the false sense that you or the things around you are moving. The difference matters because vertigo can point to a problem with the inner ear, which helps people sense movement and keep their balance. A first episode can be unnerving, but one common cause can often be treated with a series of guided head movements.
That cause is benign paroxysmal positional vertigo, or BPPV. With BPPV, certain changes in head position bring on the spinning feeling. Shepard says tiny crystals in the inner ear normally stay in place within a jellylike membrane. They help the body respond to gravity. If the ear is damaged, often by a blow to the head, the crystals can move to another part of the ear. There, ordinary shifts in position can trigger vertigo. In some cases, especially among older adults, doctors cannot identify what caused the crystals to move.
To check for BPPV, a doctor may use the Dix-Hallpike test. The patient is moved into a position that tends to trigger symptoms, and the doctor looks for a particular involuntary eye movement. That response usually confirms BPPV. If the test is unclear, a person's history and intermittent symptoms may lead to other tests, including checks for eye movements and balance. Physical therapy or additional diagnostic tests may also be needed.
Treatment is often simple: a clinician slowly guides the patient through specific head movements to return the crystals to a place where they no longer cause symptoms. For most people with BPPV, vertigo goes away after one repositioning treatment. Still, symptoms can return. About 50% of people who are successfully treated have vertigo again within a year. A doctor may teach patients how to repeat the movements at home; if the problem remains after a couple of days, follow-up treatment may be needed.
BPPV is not the only cause. Vestibular neuritis and labyrinthitis involve inner-ear damage, usually from an infection. Meniere's disease, a rare inner-ear disorder with an unclear underlying cause, can also bring on vertigo. These conditions can be harder to treat than BPPV, but their symptoms can often be managed so they do not disrupt daily life.
Shepard recommends seeing a doctor as soon as possible after an episode, even though vertigo is not usually a medical emergency. Finding the cause helps guide treatment—and for many people with BPPV, a carefully guided change in head position can bring the world back to stillness.