What are the symptoms of BPPV?

Benign paroxysmal positional vertigo (BPPV, often described as “loose ear crystals”) shows itself as a sudden spinning sensation lasting from seconds to a few minutes, usually when turning over in bed, getting out of bed or moving the head up and down. It is caused by the small calcium crystals in the inner ear that contribute to our sense of balance coming loose and slipping into the wrong canal — the brain receives a false signal that you are moving.

How is the diagnosis made at the examination?

The diagnosis is made with a specific examination manoeuvre called the Dix–Hallpike test — I turn your head to a particular angle, lay you back quickly and watch for the typical involuntary eye movement (nystagmus). This test clarifies both whether it is BPPV and which ear is affected — the second point matters because it determines on which side the Epley manoeuvre is performed.

What is the Epley manoeuvre, and can it be done at home?

The Epley manoeuvre is a head-positioning technique that uses gravity to return the displaced crystals to where they belong — in most patients it brings marked relief in a single session. Once the examination has shown which ear is affected, I teach you the steps to repeat at home.

An important warning: trying the manoeuvre by yourself, deciding on the side without a doctor’s examination, is not recommended — a manoeuvre done on the wrong side does not help.

Which dizziness is an emergency?

If any of the following accompanies the dizziness, urgent assessment is essential before trying any manoeuvre at home: severe headache, blurred or double vision, slurred speech, weakness in the face or on one side of the body, dizziness that lasts more than a few days or keeps getting worse, or loss of balance with confusion or a risk of falling. These symptoms may point to a neurological cause rather than BPPV.