Benign Paroxysmal Positional Vertigo (BPPV) is a mechanical problem in the inner ear that causes brief but intense episodes of dizziness or spinning sensations (vertigo) triggered by specific head movements. The condition occurs when tiny calcium carbonate crystals called otoconia become dislodged from their normal location and migrate into the semicircular canals of your inner ear, where they don’t belong. These displaced crystals interfere with the normal fluid movement that your inner ear uses to sense head motion, sending false signals to your brain about your body’s position. BPPV affects the population, with higher prevalence among older adults. While the term “benign” indicates the condition isn’t life-threatening, the sudden and unpredictable nature of vertigo attacks can impact your safety, independence, and psychological well-being.
BPPV Treatment in Singapore
Benign Paroxysmal Positional Vertigo (BPPV) can affect daily activities, causing sudden spinning sensations that may disrupt work, sleep, and overall quality of life. If you’re experiencing recurring episodes of dizziness triggered by head movements, BPPV is a common cause of vertigo. Our ENT specialist offers comprehensive BPPV treatment in Singapore using diagnostic techniques and evidence-based therapies. With proper medical evaluation and targeted treatment, patients may experience improvement in their symptoms and can aim to return to their normal activities.
*Individual results and timelines may vary.*
Dr Gan Eng Cern
MBBS
MRCS (Edin)
mmed (orl)
FAMS
What is BPPV?
Types of Meniere’s Disease
BPPV can affect different semicircular canals in your inner ear, and understanding the specific type helps determine the appropriate treatment approach.
Posterior Canal BPPV
This is the most common form of BPPV. The calcium crystals settle in the posterior semicircular canal, causing intense vertigo when you move from lying down to sitting up, look up or down, or roll over in bed. Symptoms typically last less than one minute but can be severe enough to cause nausea and imbalance.
Horizontal Canal BPPV
This type involves crystals in the horizontal semicircular canal. It causes intense horizontal spinning sensations when turning your head from side to side while lying down. The vertigo episodes tend to be severe but shorter in duration compared to posterior canal BPPV.
Anterior Canal BPPV
The least common form, anterior canal BPPV, causes vertigo with head movements in the sagittal plane, such as nodding. Due to the anatomical position of the anterior canal, crystals rarely settle here, and symptoms may be less typical, making diagnosis more challenging.
Causes & Risk Factors
Causes
- Head trauma: Head injuries can dislodge otoconia from their proper location
- Inner ear disorders: Vestibular neuritis or labyrinthitis can damage structures holding crystals in place
- Degeneration: Age-related changes in the inner ear’s structural integrity
- Prolonged bed rest: Extended periods lying down can allow crystals to accumulate in canals
- Inner ear surgery: Procedures affecting the ear can inadvertently displace otoconia
- Migraines: Associated with a higher incidence of BPPV, though the mechanism is unclear
Risk Factors
- Age: Risk increases after age 50
- Gender: Women are more likely to develop BPPV, possibly due to hormonal factors
- Osteoporosis: Low bone density correlates with increased BPPV risk
- Vitamin D deficiency: Correlation with recurrent BPPV episodes
- Previous BPPV: Patients may experience recurrence
- Family history: Genetic predisposition may play a role in some cases
- Sedentary lifestyle: Reduced physical activity may increase susceptibility
Signs & Symptoms
During Vertigo Episodes
- Room-spinning sensation
- Dizziness triggered by specific head positions
- Nausea or vomiting during severe episodes
- Unsteadiness after vertigo subsides
- Involuntary eye movements (nystagmus)
- Feeling of being pulled to one side
- Difficulty focusing vision during attacks
Between Episodes
- General sense of imbalance or floating
- Mild residual dizziness
- Neck stiffness from avoiding triggering positions
- Anxiety about future episodes
- Fatigue from constant vigilance
- Mild headaches or pressure sensation
Progressive Symptoms
- Hearing changes are NOT typical of BPPV
- Tinnitus (ear ringing) suggests a different diagnosis
- Severe headaches warrant further investigation
- Weakness or numbness requires immediate evaluation
BPPV symptoms typically appear suddenly upon waking or with position changes throughout the day. The intensity often varies, with morning episodes frequently being more severe due to overnight crystal accumulation.
Experiencing these symptoms? Don’t wait for them to worsen.
Schedule a consultation with our ENT specialist for an accurate diagnosis and personalised treatment plan.
When to See a Doctor
Seek immediate medical attention if you experience vertigo accompanied by severe headache, fever, vision changes, hearing loss, difficulty speaking, arm or leg weakness, or loss of consciousness, as these symptoms suggest conditions beyond BPPV. Schedule a consultation with an ENT specialist if you have recurring positional vertigo lasting more than a few days, dizziness affecting your ability to work or drive safely, or episodes becoming more frequent or severe. Early professional evaluation is important because many conditions can mimic BPPV, including vestibular migraine, Meniere’s disease, and central nervous system disorders.
During your first consultation, our ENT specialist will conduct a thorough medical history review, focusing on your symptom patterns, triggers, and any associated factors. The examination includes specialised positional testing performed in a controlled environment with safety measures in place. Patients may find relief knowing their symptoms have a definable cause and that treatment options exist. The specialist will explain your specific BPPV type and discuss the appropriate treatment approach based on your individual presentation.
Diagnosis & Testing Methods
Accurate diagnosis of BPPV requires specialised vestibular testing performed by an experienced ENT specialist.
Dix-Hallpike Test
The Dix-Hallpike test remains the standard for diagnosing posterior canal BPPV, involving specific head and body positioning while observing for characteristic eye movements (nystagmus) and vertigo symptoms. The test takes about 5-10 minutes and can reproduce your typical symptoms, confirming the diagnosis. For horizontal canal BPPV, the supine roll test (also called the Pagnini-McClure test) involves turning your head side to side while lying down, observing for horizontal nystagmus and vertigo.
Video-nystagmography (VNG)
Video-nystagmography (VNG) uses specialised goggles with infrared cameras to record and analyse eye movements during positional testing, providing objective documentation of BPPV and helping differentiate between canal types.
video Head Impulse Test (vHIT)
The video head impulse test (vHIT) evaluates the vestibulo-ocular reflex, helping to identify if other vestibular problems are present alongside BPPV. Some cases may require audiometry (hearing tests) to rule out Meniere’s disease or other inner ear conditions.
MRI Imaging
MRI imaging is rarely needed unless symptoms suggest central nervous system involvement or when BPPV treatments fail to provide relief. Diagnostic procedures require no special preparation, though you should avoid vestibular suppressant medications 48 hours before testing for accurate results.
Treatment Options Overview
BPPV treatment focuses on repositioning displaced crystals and managing symptoms. Our ENT specialist will determine the suitable approach based on your specific canal involvement and symptom severity.
Canalith Repositioning Procedures
These specialised physical manoeuvres are the primary treatment for BPPV. The Epley manoeuvre treats posterior canal BPPV through a series of specific head and body positions that guide displaced crystals back to their proper location. The procedure takes about 15 minutes and may cause temporary vertigo during treatment. Patients may experience improvement after one to three sessions, though some require additional treatments.
*Individual results and timelines may vary.*
Barbecue Roll Manoeuvre
Specifically designed for horizontal canal BPPV, this treatment involves sequential 90-degree body rotations while lying down, effectively “rolling” the crystals out of the affected canal. The procedure may need repetition over several days for optimal results. Patients typically perform modified versions at home between clinical sessions to maintain treatment benefits.
Vestibular Rehabilitation Therapy
Customised exercise programmes help your brain compensate for inner ear dysfunction and reduce residual dizziness after repositioning treatments. These exercises include gaze stabilisation techniques, balance training, and habituation movements designed to decrease motion sensitivity. Regular practice over 4-6 weeks may improve balance confidence and reduce fall risk, particularly beneficial for older adults or those with persistent imbalance.
Medications
While medications don’t cure BPPV, they may provide temporary symptom relief during severe episodes. Anti-vertigo medications like betahistine can reduce spinning sensations, while anti-nausea drugs help manage associated symptoms. Vestibular suppressants should be used sparingly as they may delay central compensation. Our ENT specialist prescribes medications judiciously, focusing on repositioning procedures as the primary treatment.
Brandt-Daroff Exercises
These home exercises serve as both treatment and prevention for BPPV, involving repeated movements from sitting to side-lying positions with specific head turns. Performed twice daily for two weeks, they help disperse crystals and reduce position sensitivity. While less effective than office-based repositioning procedures, they’re valuable for patients with frequent recurrences or those unable to access immediate clinical treatment.
Every patient’s condition is unique.
Our ENT specialist will assess your specific situation and recommend the most suitable treatment approach for you.
Complications if Left Untreated
Untreated BPPV can impact quality of life beyond the immediate vertigo episodes. Persistent symptoms may lead to anxiety and depression in patients, as the unpredictability of attacks creates apprehension. The fear of triggering vertigo causes many to restrict head movements, which may result in neck stiffness, headaches, and muscle tension. Falls represent a concern, particularly for elderly patients.
Prolonged BPPV can affect cognitive function and work productivity, as the brain continuously compensates for conflicting sensory inputs, which may lead to mental fatigue and difficulty concentrating. Social isolation often develops as patients avoid activities where vertigo might occur, including driving, exercise, or social gatherings. Sleep quality may deteriorate when patients fear rolling over in bed, creating a cycle of fatigue that can worsen balance problems. Some patients develop persistent postural-perceptual dizziness (PPPD), a chronic dizziness disorder that may persist even after BPPV resolution. Early treatment can help prevent these effects and aims to maintain normal daily functioning.
Prevention
While not all BPPV cases are preventable, certain measures may reduce your risk of initial episodes or recurrence. Maintaining adequate vitamin D levels through sun exposure or supplementation may decrease BPPV risk. Regular physical activity, particularly exercises involving head movements, helps maintain vestibular system health and may help prevent crystal accumulation. Proper management of migraines, if present, may reduce associated BPPV risk through preventive medications and trigger avoidance.
Head injury prevention remains important – wearing appropriate protective equipment during sports, using proper lifting techniques, and maintaining a safe home environment to prevent falls. For those with previous BPPV, sleeping with your head slightly elevated (about 45 degrees) may help prevent crystal migration. Avoid prolonged periods in positions that previously triggered symptoms, though complete avoidance of head movements is counterproductive. Stay hydrated and maintain good overall health, as dehydration and systemic illness may increase susceptibility. If you’ve had BPPV before, learning and performing maintenance exercises can help prevent recurrence.
Medisave & Insurance Shield Plan approved
Your ENT procedure may be eligible for Medisave claims, with the claimable amount varying based on the procedure’s complexity. For additional options, including the use of your insurance or Integrated Shield Plan, reach out to our friendly clinic staff today for assistance.
Frequently Asked Questions (FAQ)
How long does BPPV treatment take to work?
Patients may experience improvement after canalith repositioning procedures. Some individuals require 2-3 treatment sessions over several weeks for symptom resolution. Residual mild imbalance may persist for several days to weeks as your brain readjusts, but the intense spinning episodes typically stop after treatment. The speed of recovery depends on factors including the specific canal affected, duration of symptoms before treatment, and individual healing responses.
*Individual results and timelines may vary.*
Can BPPV go away on its own without treatment?
While BPPV can occasionally resolve spontaneously as crystals dissolve or relocate naturally, this may take weeks to months. Without treatment, symptoms may persist in many patients. Professional treatment can shorten recovery time and help prevent the development of compensatory behaviours that can cause chronic dizziness. Early intervention also reduces anxiety and fall risk associated with prolonged symptoms.
What triggers BPPV episodes?
BPPV episodes are triggered by specific head movements that cause displaced crystals to move within the semicircular canals. Common triggers include getting out of bed, rolling over while sleeping, looking up (such as reaching for high shelves), bending forward, and quick head turns. Some patients notice increased symptoms with weather changes or during allergy seasons, though these are indirect associations. Understanding your specific triggers helps with symptom management and guides treatment approaches.
Is BPPV treatment painful?
Canalith repositioning procedures are not painful, though they deliberately provoke temporary vertigo to achieve crystal relocation. The vertigo during treatment typically lasts and is managed with careful monitoring and support from our specialist. Some patients experience mild nausea during or shortly after treatment, which resolves quickly. The brief discomfort during treatment is outweighed by the relief achieved, and our ENT specialist aims to ensure your comfort throughout the procedure.
Can BPPV recur after treatment?
BPPV recurrence can occur in some patients. Factors that may increase recurrence risk include age over 65, history of head trauma, and underlying vestibular disorders. Regular performance of preventive exercises, maintaining vitamin D levels, and prompt treatment of new episodes help manage recurrences. Recurrent episodes typically respond well to repeated repositioning treatments.
Are there any restrictions after BPPV treatment?
Post-treatment recommendations vary depending on the specific procedure performed and individual response. Some specialists recommend avoiding lying flat for 24-48 hours after treatment, though recent studies show this may not be necessary for all patients. You should avoid sudden head movements and strenuous activities for a few days while your balance system stabilises. Our ENT specialist will provide personalised post-treatment instructions based on your specific situation and response to treatment.
Conclusion
BPPV, while distressing and disruptive to daily life, is a treatable condition when properly diagnosed and managed. Understanding that your vertigo has a mechanical cause – displaced crystals in your inner ear – often provides psychological relief and hope for recovery. With appropriate canalith repositioning procedures performed by our experienced ENT specialist, patients may achieve symptom resolution within one to three treatment sessions. The approach to management lies in accurate diagnosis of the affected canal, proper execution of repositioning manoeuvres, and addressing any residual balance issues through targeted rehabilitation.
*Individual results and timelines may vary.*
Take the First Step Towards Better Health
Living with BPPV can be challenging, but you don’t have to face it alone. Our ENT specialist has experience diagnosing and treating BPPV using evidence-based approaches.
Dr Gan Eng Cern
MBBS
MRCS (Edin)
mmed (orl)
FAMS
With over 15 years of experience, Dr Gan specialises in the comprehensive management of a broad range of conditions related to the ear, nose and throat (ENT), and head and neck.
Dr. Gan has contributed to the academic field as a Senior Clinical Lecturer at the Yong Loo Lin School of Medicine, National University of Singapore. He is recognised for his extensive research work, with numerous contributions to reputable international ENT journals. Dr Gan is also highly sought after as a speaker and has shared his surgical knowledge as a surgical dissection teacher at various prominent ENT conferences and courses.
- 2020 – Reader’s Choice Gold Award for Best ENT Specialist (Expat Living Singapore)
- 2016 – Best Educator Award (Eastern Health Alliance)
- 2016 – “Wow” Award (Patient Compliment)
- 2014 – Eastern Health Alliance Caring Award – Silver
- 2014 – 19th Yahya Cohen Memorial Lectureship (awarded by the College of Surgeons, Academy of Medicine Singapore for best scientific surgical paper)
- 2012 – Human Manpower Development Award (Ministry of Health, Singapore)
- 2007 – Singhealth Best Doctor Award
Qualifications
- MBBS – Bachelor of Science, Bachelor of Medicine, Bachelor of Surgery (University of New South Wales, Sydney, Australia)
- MRCS (Edin) – Member of the Royal College of Surgeons Edinburgh, United Kingdom
- MMed (ORL) – Master of Medicine in ENT (National University of Singapore)
- FAMS – Fellow of the Academy of Medicine Singapore
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