Benign Paroxysmal Positional Vertigo (BPPV)
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BPPV (Benign Paroxysmal Positional Vertigo)
What is it?
BPPV is a common inner-ear cause of brief spinning vertigo triggered by head position changes. Tiny calcium crystals (otoconia) shed from the utricle and drift into a semicircular canal, where they mislead the balance sensors when you roll over, look up, or bend.
Attacks last 45-60 seconds, and present without hearing loss, head pain, or other neurological symtpoms. Diagnosis is confirmed by positional tests like Dix-Hallpike that provoke nystagmus. It’s very treatable with canalith repositioning maneuvers (e.g., Epley), which move crystals back to where they belong.
What are the symptoms?
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Brief positional vertigo
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Positional nystagmus
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Nausea and vomiting are potentials during treatment.
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Sometimes unsteadiness, which should clear after treatment.
Is it treatable?
Yes. BPPV is highly treatable. Canalith Repositioning Maneuvers, like the Epley maneuver, can move the crystals back where they belong. If it is stubborn or recurrent, there are other things you can do to help. Preventative Canalith Repositioning Maneuvers, are not recommended. Here is a podcast to help.
Vestibular Migraine
What is it?
Vestibular migraine is a migraine variant where the main symptom is vertigo or dizziness, with or without headache. The brain’s sensory networks misprocess motion and visual input, causing spontaneous or positional vertigo, imbalance, motion sensitivity, and visual discomfort.
Episodes last minutes to hours and may be linked to typical migraine features: light/sound sensitivity, nausea, or aura. Triggers include stress, sleep changes, hormones, and certain foods. Diagnosis is clinical after ruling out inner-ear disease; management uses migraine lifestyle, preventives, and rescue meds.
What are the symptoms?
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Episodic (or chronic) symptoms of vestibular nature
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Neurological & migraine symptoms like light and sound sensitivity
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Light / sound sensitivity, headache is NOT required
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Nausea, imbalance, anxiety, dizziness, vertigo, quick spins, and more
Is it treatable?
Yes, Vestibular migraine is very manageable with lifestyle changes, toolkits, sometimes medications, supplements, and more! Here’s a podcast to learn more!
Ménière’s Disease
What is it?
Ménière’s disease is an inner-ear disorder marked by recurrent spells of vertigo with fluctuating hearing loss, tinnitus, and a feeling of ear fullness. It’s thought to involve excess inner-ear fluid (endolymphatic hydrops) that distorts the balance and hearing organs.
Attacks usually last 20 minutes to several hours and can leave fatigue and imbalance afterward. Over time, hearing may decline, often at low frequencies first. Diagnosis is clinical and audiogram-based; management uses salt restriction, diuretics, vestibular suppressants during attacks, and targeted ear treatments if needed.
What are the symptoms?
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Recurrent vertigo
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Fluctuating hearing loss
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Tinnitus, roaring
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Aural fullness
Is it treatable?
Often. Symptoms can be controlled: low-salt diet, diuretics, and rescue meds for attacks; intratympanic steroids or gentamicin for refractory cases. Hearing support and vestibular rehab help. Surgery is a last resort. Many achieve fewer, milder spells.
Labyrinthitis / Vestibular Neuritis
What is it?
Vestibular neuritis and labyrinthitis are acute inflammations of the vestibular nerve or vestibular system. Neuritis involves the vestibular branch of the nerve only. Both cause sudden and severe vertigo with nausea, nystagmus, and other symptoms.
Hearing is typically impaired only in vestibular labyrinthitis, but not neuritis. Symptoms peak over the first 24-72 hours but improve over days to weeks. this is NOT a recurrent problem, and the acute phase with vertigo and the worse symptoms typically only occurs one time on a persons life. If it is diagnosed in the first 72 hours, a steroid taper can often be prescribed, and after vestibular rehabilitation therapy should be done to treat the remaining symptoms. The prognosis is excellent.
What are the symptoms?
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Sudden continuous vertigo for 24-72 hours
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Often occurs after having been sick
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Nausea, vomiting, severe imbalance for 24-72 hours
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Hearing loss in the cases of labyrinthitis
Is it treatable?
Yes. After ruling out stroke, short courses of vestibular suppressants and sometimes steroids ease the acute phase. Early vestibular rehabilitation promotes central and peripheral compensation. Most recover over weeks to months, and residual symptoms should continue to improve.
Vestibular Neuritis
Navigating the Maze of Vestibular Disorders: Understanding Neuritis and Labyrinthitis
PPPD (Persistent Postural‑Perceptual Dizziness)
What is it?
PPPD is a chronic functional condition that is secondary to another vestibular or medical condition. PPPD is diagnosed after 90 days of symptoms, and has specific diagnostic criteria.
Typically symptoms are worse when you’re upright, moving, in a busy environment, or during a vestibular flare.
Hearing tests and imaging will come back normal, this is a clinical diagnosis. Treatment should consist of cognitive therapy (like acceptance and commitment therapy), vestibular rehab therapy, lifestyle change, treating the underlying condition, and more.
What are the symptoms?
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Chronic (but can wax and wane) rocking & swaying sensations.
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Typically, worse when upright
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Motion-provoked symptoms
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Visual pattern intolerance
Is it treatable?
Yes. PPPD responds to combined care: vestibular and visual-motion therapy, graded return to activity, cognitive-behavioral strategies, and SSRIs/SNRIs to reduce hypervigilance. It’s not degenerative, and many patients steadily regain comfort and function.
The Best Steps to Treating PPPD (Persistent Postural Perceptual Dizziness)
5 Habits to help vertigo and dizziness: A guide towards relief
Bilateral Vestibular Hypofunction (BVH)
What is it?
BVH is reduced function of both inner-ear balance organs. Instead of spinning attacks, people feel chronic unsteadiness, especially on uneven ground or in the dark, and may have oscillopsia—blurred, bouncing vision with head movement. Falls risk is elevated.
Causes include ototoxic antibiotics (e.g., gentamicin), meningitis, autoimmune disease, genetic or age-related loss. Diagnosis relies on vestibular tests like vHIT, calorics, and rotary chair. Treatment centers on vestibular rehabilitation, vision and proprioception cues, assistive balance tools, and avoiding further ototoxins.
What are the symptoms?
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Chronic imbalance
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Oscillopsia (gaze instability) with motion
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Unsteady wide- based gait
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Worse in the darkness or on uneven surfaces
Is it treatable?
Binocular Vestibular Hypofunction is not curable, but it can be managed with the right set of tools. Targeted vestibular rehabilitation is a great place to start, and then using tools like a walking stick, flatter shoes, nightlights, and more can help you feel more balanced throughout life!
Where Do I Go?
Other Diagnoses
- Acoustic Neuroma – A benign tumor on the balance nerve
- Superior Canal Dehiscence – A hole in the bone above the inner ear canal
- Perilymph Fistula – A tear between the middle and inner ear
- Cervicogenic Dizziness – Dizziness related to neck issues
Not Sure Where to Start?
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