Vestibular Condition
Benign Paroxysmal Positional Vertigo (BPPV)
BPPV is the most common cause of recurrent, episodic vertigo. It occurs when calcium carbonate crystals (otoconia) become displaced in the inner ear, triggering intense spinning sensations with certain head movements — and it’s highly treatable.
What causes BPPV?
Small crystals migrate from the utricle into one of the three semicircular canals. When you move your head, these displaced crystals shift and send false movement signals to the brain.
How it happens
Otoconia (calcium carbonate crystals) become displaced and migrate into the posterior, horizontal, or anterior semicircular canal, disrupting normal fluid signals.
Why it matters
Beyond the spinning, BPPV often causes lingering imbalance or lightheadedness that can last hours or days — and a significant fall risk, especially in older adults.
Common Triggers and Signs
Episodes typically last less than one minute and are brought on by specific head position changes.
Positional triggers
- Rolling over in bed or lying down
- Bending over to tie shoes or pick something up
- Looking up toward a high shelf ("top-shelf vertigo")
- Getting out of bed in the morning
What you may feel
- Brief, intense spinning sensation (usually <1 minute)
- Rapid, uncontrollable eye movements (nystagmus)
- Nausea during or following an episode
- Lingering imbalance or lightheadedness for hours after
How we identify your BPPV
Accurate diagnosis is essential — each affected canal requires a different treatment technique. Our certified vestibular therapists use infrared video technology to track nystagmus for the most precise results.
Dix-Hallpike Test
Identifies the most common form — posterior canal BPPV. The therapist guides the patient into specific positions while monitoring eye movements.
Supine roll test
Used specifically to detect horizontal canal BPPV by rolling the patient's head to each side while lying flat.
Side-lying test
An alternative for patients who have difficulty with neck extension or lying fully on their back.
Bow and lean test
A supplemental test used to pinpoint the exact side of involvement in tricky horizontal canal cases.
Canalith Repositioning Procedures
These are not exercises — they are precise maneuvers performed by a trained therapist to guide displaced crystals out of the canal and back into the utricle. Most cases resolve in 1–2 sessions.
Epley maneuver
The gold-standard treatment for posterior canal BPPV. A specific sequence of head and body rotations uses gravity to move displaced particles back into the utricle.
Semont (Liberatory) maneuver
Rapid shifts from side to side. Particularly effective for cupulolithiasis — where crystals are stuck to the canal's sensor rather than floating freely.
Bar-B-Que roll
Involves rolling the patient in a full 360° or 270° arc while lying flat to clear the horizontal canal.
Gufoni (Appiani) maneuver
A newer, highly effective alternative for horizontal canal variants. Often more comfortable for patients who cannot tolerate the full rolling motion of the Bar-B-Que technique.
Brandt-Daroff exercises
Home habituation exercises prescribed for mild residual symptoms or high recurrence risk. Designed to reduce sensitivity to the triggering movements over time.
Expert vestibular care
We don't just stop the spin. Our approach covers accurate diagnosis, effective repositioning, and full balance retraining to restore your confidence in daily life.
90%+
Resolution rate
Research-backed success — the majority of BPPV cases resolve completely in just one or two treatment sessions.
Advanced
Certified therapists
All vestibular therapists hold advanced certification in vestibular rehabilitation and use infrared video nystagmography for precise diagnosis.
Full
Recovery support
Beyond the maneuver — we provide balance retraining and follow-up care to help you return to full activity with confidence.
Don't live with the spin.
Serving Mississauga, Etobicoke, and Clarkson GO. Book today and get back on steady ground.
