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Meniere's Disease and Benign Paroxysmal Positional Vertigo

Many people come to our Meniere’s disease website searching for an explanation of BPPV. It sounds scarier than necessary because few people know that these letters stand for Benign Paroxysmal Positional Vertigo. Everyone uses the letters BPPV or even BPV (Benign Positional Vertigo, omitting the P for paroxysmal).

My plan is to offer you sites so you can do your own searching. You may also want to know the difference between Meniere’s Disease and BPPV. Later I want to show you how you can think this through a little differently:  the term “paroxysmal” will become important to you.

My goal is for you to be more in control of your health and thus your future. Ultimately it is to remove some of the fear of not knowing how to help yourself.

It is also very important to recognize that any medical practitioner is trained to treat the symptoms with which you show up or “present”. That is why you contacted them in the first place. With that in mind, let’s explore this condition.

What is BPPV? (Benign Paroxysmal Positional Vertigo) (or BPV: these terms are used interchangeably) and How is it Connected with Meniere’s Disease?

It is a condition relating to your balance nerve. In very simplistic terms, your doctor thinks you have crystals or tiny rocks (debris) that may be blocking some drainage areas of your inner ear, thus giving you vertigo or dizziness: vertigo is the unpleasant sensation that your head is spinning versus feeling a little imbalanced.


The reason Benign Paroxysmal Positional Vertigo may be given instead of a Meniere’s disease diagnosis is because the symptoms are very similar.  It can take some time (testing & specialists) to properly diagnose a person with Meniere’s disease and BPPV may be given as an INITIAL diagnosis.

BPPV (or BPV) stands for a set of words that have a very specific medical meaning and are easily recognized by any health care professional.

Benign Paroxysmal Positional Vertigo:

  • Benign” is an assumption that this is not a harmful situation with long range health issues, apart from the inconvenience of lack of balance AT TIMES. "Benign" refers to a condition, or growth that is not cancerous, doesn’t spread to other parts of the body etc. to suggest it is not dangerous or serious.
  • Paroxysmal” means it comes and goes without any regularity: Please keep this term in mind.
  • Positional” means it is most often caused when the head is held a certain way.
  • Vertigo” means that your balance nerve is giving you vertigo, a spinning sensation.

What does the medical community say about BPPV?

I am going to take some important and similar points from 5 mainstream medical facilities. This helps you to see what most doctors are taught. This is the basis of their diagnosis for you.

These sites include the Mayo Clinic, Johns Hopkins, Dizziness And Balance (Dr. Timothy Hain), VEDA, and the House Ear Clinic. At the end of this article there will be some comments and links to each facility because you will probably want to learn more.

What BPPV seems to be:

When you really study all of this information, you come away with a suggestion that something is forming (or resulting in) debris or crystals: that these subsequently block a normal drainage pathway, but not for long.  This sack (sac)-like container (utricle) is suddenly shifted by your body in response to some “incident”. The reason this shift is so influential, is that this is part of your balance and hearing process. So any “malfunction” is serious at that moment.

For some reason, in literature, this is a balance issue. However the hearing nerve, vestibulocochlear n.) is identified as being part of the anatomy. (We get a lot of emails from readers who discuss “cilia” or “hair involvement”. This is where these cilia “are located”.)

Keep in mind what I said earlier: doctors treat symptoms.

Benign Paroxysmal Positional Vertigo Symptoms:

What symptoms do people show up with?  Most people do NOT show up with all of these symptoms.

These are also some of the classic Meniere’s disease symptoms, which may be why Benign Paroxysmal Positional Vertigo can be given as the initial diagnosis

Possible Causes of Benign Paroxysmal Positional Vertigo

From reading what BPPV (BPV) is, it’s pretty obvious that “something” is blocking some sort of drainage canal. The causes can include:

  • Ear rocks or also known as otoconia
  • Gentamicin injections
  • Certain head positions
  • Meniere’s Disease
  • Whiplash
  • Infections
  • Viruses
  • Head injuries
  • Degeneration of the vestibular (balance) system of the inner ear

Treatment - or - Is there a Treatment for Benign Paroxysmal Positional Vertigo?

The most common treatment is a set of exercises called the Epley Maneuver or the Semont Maneuver. The basic idea is to shift the rocks out of their present blocking position to allow for “natural” fluid flow. Brief head shifts by a qualified medical practitioner are seen to be adequate.

Common sense dictates that this debris needs to be removed: so exercises seem to be the most common way to accomplish this.

Some doctors suggest just waiting: hoping nature will shuffle and reposition the blockage by itself.

For many people, these exercises produce no results or make them feel worse. So you if you have had this diagnosis and did the exercises and still have these symptoms at times, then please go back for more help.

So what does all this mean?

All the sites mentioned Meniere’s disease as a possible cause. Let’s take a moment to explore what Meniere’s disease is seen to be.

The classic Meniere’s disease symptoms include hearing fluctuation, balance symptoms such as dizziness and vertigo, inner ear pressure, and tinnitus. What could be the cause for these symptoms? There have to be some.

OK, as I mentioned above, these are the same symptoms as BPPV, which can lead to the two of them being confused, or why BPPV might be the initial diagnosis.

How could Meniere’s disease be seen as a CAUSE for Benign Paroxysmal Positional Vertigo if they have such similar symptoms?

If you take the balance symptoms from the Meniere’s disease diagnosis and apply them to the Benign Paroxysmal Positional Vertigo balance symptoms, you might find some commonality as to a possible cause(s) for BOTH of these conditions.

Think carefully about this idea. I hear from so many people who have both these diagnoses.

If you have read any of my other articles or the blog posts, you know I am trying to teach you to always look for a cause, ESPECIALLY for your Meniere’s disease symptoms. (Absolutely nothing ever happens in our bodies without one) As previously stated, doctors treat symptoms. They are doing their assigned job. Their testing rules out other causes/problems. (It is why you want other testing done.)

Could there be another way to look at the Causes of Benign Paroxysmal Positional Vertigo (and therefore also) Meniere’s Disease?

OK Instead of - Could there be another way to look at all of this?

In exploring current medical information, I think one very important part is left out of all of this discussion.  You need to realize that doctors are trained to treat the SYMPTOMS. It is why you seek medical help. There are also the ones who can “order” tests. And you do want these tests because they will show up any other problems.

However, if we look at the explanations for the Benign Paroxysmal Positional Vertigo (BPPV) symptoms (and in fact for Meniere’s disease as well), medical sites are very general: ear rocks, certain head positions, whiplash, viruses, head injuries, degeneration of the vestibular (balance) system of the inner ear.

Can you see my way of thinking? SOMETHING has to cause these ear rocks (otoliths) or suggested blocks in the first place, at THAT particular time, not all the time.

  • If you have had one episode or just a few, yet you had whiplash years ago, how would that set these symptoms off now?
  • If you have degeneration of the balance nerve system, why only have symptoms occasionally, why not all the time as this is your “natural” state now?
  • If your head injury was a while back, why not have these symptoms all the time? What could be causing these “ear rocks” that block the drainage channels right now?
  • If you have an infection, would you not now have these symptoms as long as you have the infection?

What could the cause of Benign Paroxysmal Positional Vertigo possibly be?

And more importantly what can you do to prevent this from happening again? Could there be something else causing your balance symptoms, not just a term called “ear” rocks?


For some readers, these basic descriptions will be adequate. They will understand that BPPV relates to balance symptoms and are not seemed to be harmful (benign).

They may or may not already have had a diagnosis of Meniere’s disease. They are happy with a diagnosis, know there could be a treatment plan for Meniere's disease to live by, and are resigned to occasional upheavals in their lives. They are not happy with the symptoms or that possibility, but they accept this as an unchangeable and brief inevitable interruption in their life.

Then there are those readers who want the symptoms to go away and not return: they are prepared to search for the underlying cause and fix that. If you are the second type of reader, I would love to support you in your search. Please let me know if you would like our PDF email called our “observations”. It is a great point at which to begin. You have been given the medical world opinion. Could there be other possible causes?

Doing more research on Benign Paroxysmal Positional Vertigo (BPPV) and Meniere’s disease symptoms

One good place to start is the fluids you “manage” for your body. The idea of ear rocks in the inner ear, to which you have no direct access should be of interest to you.

What is an ear rock?

What could be causing your body to make “ear rocks” (otoliths)? If you can’t reach your inner ear from the outside to cause this to happen, what could be going inside your body to contribute to this formation? Why not explore this a little more as your interest is piqued?

Study the term “homeostasis”. This is all about your body shifting fluids in and out of cells, to make sure EACH area is well served.

Are you taking any medical “actions” to dry up any excess fluids, to shift this fluid need?

Are you eating diets that do not allow your body to BE healthy? Salt is very necessary to your fluid needs. In Meniere’s disease, it is recommended to cut it lower. Study this idea more for yourself.

Could your blood pressure be sluggish and not provide adequate flow?

Are there any things you do to help yourself If You Have Benign Paroxysmal Positional Vertigo or Meniere’s Disease?

I believe so. I believe you have the KEY in front of you in these letters “BPPV” (or BPV)

Let me share my ideas with you: it’s like unraveling a puzzle.

Just for now, ignore the “benign” word: in very simplistic terms, it means this is harmless, non cancerous, not getting larger.
Ignore the word “vertigo”: you KNOW how that feels.

  • Pay close attention to the word “Positional
  • Pay close attention to the “Paroxysmal” word

Paroxysmal means “occasionally” no routine, unexpected.

So when was the last “unexpected balance problem” for your episode? Recall the date, the place, the time. Now you can get a much clearer picture of what to look for as a cause.

Knowing this only happens in a certain position, gives you a huge clue as well.

This is all about the balance nerve “being bothered” somehow.

Knowing the date of the latest episode(s) now allows you to look very carefully at your activities on that particular date. Why that particular date? Why not other dates as well? Think about this: your trauma was the same, your Meniere’s disease the same (or was it?) the degeneration of your balance system would be consistent from one day to the next.

What was different on this one day from all the other days you feel fine. Or well balanced?

You had to be doing something different. Was any other part of your body involved?

As you know, your balance nerve is in your inner ear, above your neck, away from your heart which is the center of your body. Your heart pumps blood carrying all sorts of vital elements required for life.

Could anything be blocking this very important task?  If so, what? We are talking about positions (positional) on a CERTAIN day (paroxysmal: not all the time/every day). Could there be a way for you to innocently hold your head block this natural blood flow?

I have already mentioned fluids above. Ask yourself if you are drinking enough fluids. Crystals and ear rocks suggest a deficit of fluids, right? Make sure these fluids are healthy ones. All bottled waters are not alike: check yours with the NSF site.

Also ask yourself if you are doing anything to dry up our body: drugs can do that. Certain ones are meant to do that. Low salt diets may not allow for enough salt in your body: study what electrolytes are all about.


Benign Paroxysmal Positional Vertigo (BPPV or BPV) involves the balance nerve. It alludes to unexpected times when your head is held a certain wayand your body has formed ear rocks or crystals (otoliths). Just as an aside, if you showed up with any hearing symptoms, you would now most likely been seen as having Meniere’s disease. So the very same questioning has to be part of your thinking. Why now, why not al the time?

Can you see how you can look at your own situation symptom by symptom and time and position? Can you see that by looking at things a little differently, how you can now be more actively involved in your own health?  These observations apply whether it is your Meniere’s disease symptoms coming back, or if they are BPPV related.  It is important to observe and note this information so that you can refer back to it and possibly identify what triggered the attack or reaction.

This is YOUR body: not your doctor’s. Only you know how awful and unsettling it feels to be faced with unexpected episodes over which you have no control. Well, not any longer. Now you can do a few things to manage your body. This is all about becoming aware of your body, how it functions and what you can do to help it along.

These are some Benign Paroxysmal Positional Vertigo websites that you may find useful:


Dr. Timothy Hain writes: In Benign Paroxysmal Positional Vertigo (BPPV) dizziness is generally thought to be due to debris which has collected within a part of the inner ear. This debris can be thought of as "ear rocks"........they are not able to migrate into the canal system. The utricle (a sac may have been damaged by head injury, infection, or other disorder of the inner ear, or may have degenerated because of advanced age”

Dr. Timothy Hain: “While gentamicin toxicity is rarely encountered, BPPV is common in persons who have been treated with ototoxic medications such as gentamicin (Black et al, 2004). In half of all cases, BPPV is called "idiopathic," which means it occurs for no known reason.” “The utricle may have been damaged by head injury, infection, or other disorder of the inner ear, or may have degenerated because of advanced age” .... Read the rest of Dr. Hain’s comments on his website.

Johns Hopkins (Medical) describes Benign Paroxysmal Positional Vertigo this way: Benign Paroxysmal Positional Vertigo (BPPV) is the most common of vestibular disorders and the most easily treated. In most patients, it can be cured with a simple physical therapy maneuver. BPPV can affect people of all ages, although it is most common in folks over the age of 60.

BPPV occurs when small, microsized calcium crystals called otoconia become dislodged from their normal location on the utricle, one of the inner ear sensory organs...... Please read this important description on their website.

“In many patients, especially the elderly, there is no specific inciting event. As we get older, the otoconia are probably more easily sheared off from their normal positions stuck on the utricle. All of us certainly have a few of these microscopic stones floating around in our semicircular canals, but usually there are not enough of them to cause symptoms. Only when a large clump falls into one of the semicircular canals do the stones create their mischief.”

House Ear Clinic describes BPPV much the same: BPPV: One of the most common causes of dizziness is BPPV (benign paroxysmal positional vertigo). This type of dizziness is associated with a brief spinning sensation that is triggered by head movements that occur when rolling out of bed or getting your hair washed. Most cases can be resolved in one office visit with repositioning maneuvers like the Epley maneuver..... Please visit the House Ear Clinic for more information.

Mayo Clinic describes Benign Paroxysmal Positional Vertigo this way: Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of vertigo — the sudden sensation that you're spinning or that the inside of your head is spinning.

Benign paroxysmal positional vertigo is characterized by brief episodes of mild to intense dizziness. Symptoms of benign paroxysmal positional vertigo are triggered by specific changes in the position of your head, such as tipping your head up or down, and by lying down, turning over or sitting up in bed. You may also feel out of balance when standing or walking.

Although benign paroxysmal positional vertigo can be a bothersome problem, it's rarely serious except when it increases the chance of falls. You can receive effective treatment for benign paroxysmal positional vertigo during a doctor's office visit.

Here is what VEDA offers: Benign paroxysmal positional vertigo (BPPV) is the most common disorder of the inner ear’s vestibular system, which is a vital part of maintaining balance. BPPV is benign, meaning that it is not life-threatening nor generally progressive. BPPV produces a sensation of spinning called vertigo that is both paroxysmal and positional, meaning it occurs suddenly and with a change in head position.

Another description of BPPV on VEDA:  “Benign paroxysmal positional vertigo (BPPV) is a condition resulting from loose debris (otoconia) that collect within a part of the inner ear. In addition to head injury, BPPV can occur due to the degeneration of inner-ear hair cells during the natural process of aging”

All of the above medical sites have a version of the Epley Maneuver. Here are a few more choices via MedlinePlus.


The Epley Maneuver: MedlinePlus

Epley Maneuver or Semont Maneuver for Vertigo: The Epley and Semont maneuvers are exercises used to treat benign paroxysmal positional vertigo (BPPV). They are done with the assistance of a doctor or physical therapist. A single 10- to 15-minute session usually is all that is needed.

I thought I should add the definition of Benign because the meaning can sometimes get confused.  "Benign" refers to a condition, tumor, or growth that is not cancerous. This means that it does not spread to other parts of the body. It does not change or destroy nearby tissue. Sometimes, a condition is called benign to suggest it is not dangerous or serious.


By Karin Henderson - Nurse, Retired.



Additional Resources


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