BPPV crystals (Benign Paroxysmal Positional Vertigo crystals) cause dizziness, vertigo, falls and mild cognitive problems. Many people with BPPV crystals do not even know it! Unfortunately, it often goes undetected by healthcare providers as well, leading to unnecessary suffering for months to years.

BPPV: What is it?

When someone has “BPPV,” this means that calcium carbonate crystals in their inner ear, or vestibular system, are typically floating around in an inner ear semi-circular canal (SCC) which is only supposed to contain fluid.

The technical term for BPPV crystals is “otoconia” and they are free-floating in most BPPV cases. In rare BPPV cases, the BPPV crystals can be adhered – or stuck like glue – to a certain area within the inner ear canal.

Therefore, two types of BPPV are the free-floating type, which is called canalithiasis, or the stuck-like-glue type, which is called cupulolithiasis. Just to give you an idea, I have treated and consulted with thousands of people with BPPV and only seen three cases of cupulolithiasis, so it is very rare.

Those little BPPV crystals break free from the membrane where they belong in the inner ear organs and travel into the semi-circular canal(s) for a variety of reasons. Some common reasons include normal aging of the vestibular system, bumping the head, and hormonal changes like puberty, pregnancy or menopause.

These common causes of BPPV, along with other causes of BPPV, trigger the crystals to flake off or break off of the membrane where they are supposed to be in the inner ear. The BPPV crystals basically go running away from home and float into a canal in the inner ear where they are not supposed to be.

These BPPV crystals actually have a very important job.

Untreated BPPV Causes Problems

Most people with BPPV feel “spinny” in certain positions like lying down or get dizzy with certain motions like bending over or looking up.

Many people who have BPPV crystals also have mild cognitive impairment that comes as a result of the neurological error caused by the BPPV crystals.

The BPPV crystals cause a conflict in the information that the inner ear balance system is sending to the brain because now the right side inner ear doesn’t match the left side inner ear. That conflict in sensory information is so dramatic for people that it causes cognitive impairment because people can’t concentrate or think clearly. This is because their brain is working so hard just to help them sit up straight and not fall off of their chair, or to be able to walk and get around safely.

It has been a miracle for me when I have seen people that I thought had mild onset of dementia, or their families thought they had mild cognitive impairment, and they were having chronic falls. A skilled assessment identified that they had BPPV crystals in their inner ear, and we fixed the BPPV crystals through Vestibular Rehab.

After BPPV crystals are cleared up, the person often stops falling and/or the cognitive impairment disappears.

Good News: BPPV Resolves with the Correct Treatment

For most people, BPPV can be fixed in one or two sessions if it is the most simple type, where the crystals are free-floating in just one canal. Once BPPV is resolved, then the dizziness triggered by certain positions and motions is gone!

All of a sudden, the appearance of a sort of temporary or a false cognitive impairment is immediately gone. The person says “Oh my gosh, the fog that I have been living in for years is gone!”

Sometimes the falls and balance problems disappear immediately also. In other cases, a 4-6 week course of Vestibular Rehab Physical Therapy for balance training and muscle strengthening is needed for a full recovery.

You may be suffering from BPPV if you are constantly feeling cognitively challenged, unsteady with walking and/ or experience dizziness or vertigo when you lie down or roll over in bed. Talk to a Vestibular Expert to get a root cause evaluation to find the underlying problems.

To learn more about BPPV symptoms, click here.


This blog is provided for informational purposes only. The content and any comments by Dr. Kim Bell, DPT are not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. The details of any case mentioned in this post represent a typical patient that Dr. Bell might see and do not describe the circumstances of a specific individual.

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