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
My plan is to offer you sites so you can do your own
searching. You may also want to know the
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
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
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
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
- Ear rocks or also known as otoconia
- Gentamicin injections
- Certain head positions
- Meniere’s Disease
- Head injuries
- Degeneration of the vestibular (balance) system of the
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
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
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
Think carefully about
this idea. I hear from so many people who have both these
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
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
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
- 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
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
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
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
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”
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. http://info.nsf.org/Certified/BWPI
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
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
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 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
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.