Vestibular Rehabilitation: Exercises for Benign Paroxysmal Positional Vertigo (BPPV)

The Inner Ear and Benign Paroxysmal Positional Vertigo (BPPV)

The vestibular system inside the inner ear consists of the utricle, saccule, and three fluid-filled semicircular canals lined with delicate sensory hair cells that detect angular and linear head movements.

Benign Paroxysmal Positional Vertigo (BPPV) occurs when microscopic calcium carbonate crystals (otoliths or 'ear rocks') dislodge from the utricle and migrate into a semicircular canal (most commonly the posterior canal). Rolling over in bed or looking up triggers brief, violent spinning sensations.

• Sudden spinning vertigo lasting 10 to 60 seconds triggered by specific head position changes.
• Associated nausea, lightheadedness, and characteristic rotational eye nystagmus.
• Positive Dix-Hallpike diagnostic test confirming posterior canal canalithiasis.

Canalith Repositioning Maneuvers: The Definitive Treatment

Medications (such as cinnarizine or betahistine) may dampen nausea, but they cannot reposition displaced calcium crystals. The definitive mechanical solution is canalith repositioning therapy (the Epley or Semont maneuver).

A trained physiotherapist guides the patient through a sequence of four precise head positions held for 30-60 seconds each, using gravity to roll the loose crystals out of the canal back into the utricle where they dissolve harmlessly.

• Epley maneuver achieves an 85-90% success rate within 1 to 2 guided clinical sessions.
• Brandt-Daroff home habituation exercises for residual dizziness and central compensation.
• Post-maneuver guidance: avoiding extreme neck tilting or sleeping flat for the initial day.

Gaze Stabilization Drills and Home Care in Kolkata

For vestibular hypofunction (such as after vestibular neuritis or labyrinthitis), vestibular rehabilitation focuses on gaze stabilization (VOR drills): focusing eyes on a fixed letter while shaking the head side-to-side, retraining the vestibulo-ocular reflex.

CareMotion physiotherapists assess vestibular nystagmus, perform gentle bedside canal repositioning, and guide balance habituation in the safety of your home.

• VOR x1 exercise: Staring at a business card while shaking the head horizontally for 1 minute.
• Turn on nightlights in hallways to avoid waking into complete darkness during dizzy spells.
• Sit on the edge of the bed for 30 seconds before standing up to allow vestibular equilibrium.

Useful next steps

• Balance and coordination training
• Fall prevention programs
• Request a home evaluation

Further reading

• American Academy of Neurology: BPPV Practice Guidelines