BPPV · Dubai Hills
You turn over in bed and the room spins. It lasts under a minute, then stops. It happens again when you tip your head back to reach a high shelf.
That pattern has a name, and a treatment that works in the room, on the same day. BPPV is the most common cause of vertigo. At Kinetika in Dubai Hills we test which ear and which canal is involved, then treat it by hand with a repositioning manoeuvre. Most people need 1 to 3 sessions, and BPPV itself requires no scan, no medication and no surgery.
Senior Physiotherapist, vestibular and balance lead
BPPV stands for benign paroxysmal positional vertigo, and the name describes itself once you separate the words. Benign means it is not dangerous and it does not damage your hearing. Paroxysmal means it arrives in short bursts rather than lasting all day. Positional means a change in head position triggers it. Vertigo means a false sense that you or the room is moving.
So BPPV is short attacks of spinning, triggered by head movement, from a cause that will not harm you. Most attacks run for a few seconds to under a minute, then fade. Many people describe the fear more clearly than the spin, and that caution settles once the cause is treated.
Inside each ear sits a small organ called the utricle. It holds thousands of tiny calcium carbonate crystals (otoconia) that tell your brain about gravity and straight-line movement, such as a car accelerating. Beside it sit 3 fluid-filled loops, the semicircular canals, which detect rotation. In a healthy ear the crystals stay in the utricle.
BPPV begins when some crystals break loose and drift into one of those canals. Now, whenever you move your head, they slide through the fluid and press on the motion sensor at the base of that canal. That ear reports a spin that is not happening, your other ear correctly reports none, and the conflict is what makes the room turn.
When people search for crystals in my ear, this is precisely what they mean. The phrase is accurate. There really are crystals, and they really have moved into the wrong place.
Crystals break loose with age, because the membrane holding them starts to weaken after 50. They also break loose after head injury, long periods lying flat, and inflammation of the balance nerve. Often we find no cause, which changes nothing about the treatment.
BPPV has a recognisable pattern. These movements provoke it most often.
Four features point strongly towards BPPV. Movement triggers it, and it does not begin while you sit still. It is brief, seconds rather than hours. There is a delay, and the spin usually starts 1 to 5 seconds after you move. It repeats, though often a little less strongly each time.
BPPV does not cause hearing loss, ear discharge or new tinnitus, which is ringing in the ear. Nor does it cause headache, double vision, slurred speech or limb weakness. Tell us if you have any of those, because they point elsewhere.
The Dix-Hallpike test confirms BPPV in the posterior canal, involved in roughly 8 of every 10 cases.
You sit on the plinth. Your physiotherapist turns your head 45 degrees to one side, then lies you back quickly so your head hangs slightly below the plinth. She watches your eyes for about 30 seconds, then sits you up and repeats on the other side.
We are watching for nystagmus, a brief involuntary flicking of the eyes that shows a canal is being stimulated. Its direction tells us which canal holds the crystals. Its timing tells us whether they float freely or stick to the sensor, because those need different manoeuvres. If it is negative and we still suspect BPPV, a supine roll test checks the horizontal canal.
This is where our equipment earns its place. Nystagmus can be faint, and you suppress it without meaning to whenever you fix your eyes on something. We use videonystagmoscopy (VNS), infrared goggles that record your eyes in darkness at high magnification. We also use video head impulse testing (vHIT) and skull vibration testing, and optokinetic stimulation for retraining where visual dependence is part of the picture.
All of it answers one question. Which ear, and which canal, so the manoeuvre is performed correctly the first time.
Your assessment is with Nour Salman, our vestibular and balance physiotherapist. Nour has 8 years of experience, trained at Saint Joseph University of Beirut, and worked previously at Cleveland Clinic Abu Dhabi.
The Epley manoeuvre uses gravity to move the crystals out of the canal and back into the utricle. It takes about 5 minutes. Here is the sequence for right-sided posterior canal BPPV.
For left-sided BPPV, every direction reverses. For horizontal canal BPPV we use a different manoeuvre. Depending on the case, that may be the Lempert roll or the Gufoni manoeuvre. This is why assessment comes first.
We retest with the Dix-Hallpike straight afterwards. If the nystagmus has gone, the manoeuvre worked. If it persists, we repeat it in the same session.
Expect the manoeuvre to provoke your vertigo. That is normal, and it is a useful sign, because it means we found the right canal and the crystals are moving. The spinning in each position lasts 10 to 30 seconds, and some people feel nausea. You can stop at any point.
Afterwards, some people feel unsteady or foggy for the rest of the day. Your brain spent weeks adapting to false signals from one ear, and it now readjusts to accurate ones. That is recalibration, not a setback, and moving normally, within the precautions we give you, speeds it. You leave with a sheet of dos and don'ts for the days after the manoeuvre, and we go through it with you before you go.
BPPV has a very high treatment success rate when the affected canal and BPPV subtype are accurately identified and the appropriate repositioning maneuver is performed. Recent evidence suggests that most single-canal cases resolve within 1-3 treatment sessions, with approximately 77% resolving after the first session, 92% after two sessions and 98% after three sessions. Resolution rates can be lower and treatment may require more sessions in bilateral and multiple-canal BPPV.
Ref: Alfarghal M, Singh NK, Algarni MA, Jagadish N, Raveendran RK. Treatment efficacy of repositioning maneuvers in multiple canal benign paroxysmal positional vertigo: a systematic review and meta-analysis. Front Neurol. 2023 Nov 6;14:1288150. doi: 10.3389/fneur.2023.1288150. PMID: 38020643; PMCID: PMC10658715.
Those figures are unusually high for any physiotherapy treatment, and the reason is mechanical. BPPV is not a disease that needs to heal. It is loose material in the wrong compartment, so moving it back stops the symptom.
We see you twice a week until the Dix-Hallpike test is negative. If symptoms persist after 3 sessions, we reconsider the diagnosis rather than repeat the manoeuvre.
Here is an honest answer rather than a protective one.
The Epley manoeuvre is safe for most people, and self-administered versions genuinely help. We teach the home version to many of our own patients, because BPPV recurs and you should be able to manage that yourself.
The problem with starting at home is accuracy, not safety. The manoeuvre is side-specific. Performed for the wrong ear, it can move crystals further into the canal, and you may feel worse for a day or 2. It is also canal-specific. The Epley treats the posterior canal only, and roughly 1 in 5 cases involve a different canal.
Identifying the side without goggles is hard. Most people cannot tell which ear is affected from symptoms alone, and online guides ask you to guess from whichever side provokes more spinning. That guess is wrong often enough to matter.
So the honest position is this. Have it diagnosed once and treated correctly, then learn the manoeuvre for your own side and canal. Treating a recurrence at home is then reasonable.
Ask us first if you have significant neck disease or severe neck stiffness, recent neck or spinal surgery, unstable heart disease, a detached retina or carotid artery disease.
Brandt-Daroff exercises take a different approach. Rather than repositioning the crystals in one sequence, they disperse them and reduce your brain's response to the false signal.
You sit on the edge of the bed, then lie quickly onto one side with your head turned 45 degrees upwards. Hold for 30 seconds, or until the spinning stops. Return to sitting for 30 seconds, then repeat to the other side. That is 1 repetition, and a typical programme is 5 repetitions, 3 times a day, for 2 weeks.
They are less effective than a correctly targeted Epley manoeuvre, and the research favours repositioning. We use them when the affected side stays unclear, or as a home programme for someone whose BPPV recurs often.
BPPV can come back, and a return within the following few years is not unusual. Recurrence is more likely with increasing age, after head injury, with migraine, and in people with low vitamin D.
Recurrence does not mean the first treatment failed. The manoeuvre moved the crystals successfully, then new crystals broke loose, or the same ones returned to the canal.
If your familiar pattern returns, contact us. We retest, confirm the side and canal, and repeat the appropriate manoeuvre. Second episodes usually resolve as quickly as the first. As a preventive measure, ask your doctor to check your vitamin D level, since correcting a deficiency is associated with fewer episodes.
Vertigo is a symptom, not a diagnosis, and repositioning will not help these other causes.
Seek urgent medical care rather than booking physiotherapy if your dizziness comes with sudden severe headache, double vision, slurred speech, facial or limb weakness, numbness, difficulty walking or loss of consciousness.
Kinetika is a DHA licensed clinic in Dubai Hills. In most cases we assess and treat BPPV in one visit. Most insurances accepted.
Common questions
Brief spinning, triggered by rolling over, lying down, sitting up or looking up, starting a second or two after the movement and settling within a minute, is the classic pattern. Only a positional test with the eyes recorded confirms it.
No. It is unpleasant and it can make you fall, but it does not damage your hearing or your brain. The danger with any vertigo is missing a different cause, which is why we screen for warning signs before treating.
It uses a sequence of held head and body positions to move the loose crystals out of the semicircular canal and back into the utricle, where they belong.
No. It provokes short spinning in each position, and some nausea, but it is not painful. You can stop at any point.
Most people need 1 to 3. We see you twice a week until the Dix-Hallpike test is negative. If symptoms persist after 3 sessions, we look again at the diagnosis.
In most cases, yes. If the positional test confirms which ear and canal are involved, we perform the manoeuvre in the same appointment.
You leave with a sheet of dos and don'ts for the days that follow, and we go through it with you before you go. Moving normally within those precautions helps your brain recalibrate.
Arrange a lift for your first appointment. After a manoeuvre, take care for the rest of the day and follow the precautions on your sheet.
Once we have confirmed your side and canal and shown you the manoeuvre, yes, and we teach it to many patients for recurrences. Starting at home without a diagnosis risks treating the wrong side or the wrong canal.
New crystals can break loose, or the same ones can drift back into the canal. Recurrence is more common with age, after head injury, with migraine and with low vitamin D. A repeat manoeuvre usually settles it as quickly as the first time.
No. BPPV is diagnosed by positional testing with the eyes recorded. An MRI cannot show the crystals. A scan is only useful when the pattern points to a different cause.
Related vestibular care
Dubai Hills
Allow 60 minutes for your first appointment. Unit 403, Floor 4, Park Heights Square 1, Al Khail Road, Dubai Hills.