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Conditions We Treat: Benign Paroxysmal Positional Vertigo (BPPV)

Benign paroxysmal positional vertigo (BPPV) is the most common of the vestibular disorders and is easily treated. This condition can affect people of all ages, but is most common in people over the age of 60. BPPV symptoms include episodic vertigo when your head is tilted up, or when you are turning over in bed or maneuvering out of bed. 

Benign Paroxysmal Positional Vertigo: Why Choose Johns Hopkins

Doctor examining patient
  • Johns Hopkins neurologists have treated many people with BPPV, and use techniques that can help relieve symptoms during an in-office appointment.

  • At Johns Hopkins, you benefit from the expertise of physicians trained in the Epley maneuver – a physical therapy maneuver that uses gravity to dislodge calcium crystals in the inner ear that are causing your vertigo.

  • Johns Hopkins developed the widely known “HINTS” (Head, Impulse, Nystagmus and Test of Skew) three-step ocular motion examination for rapid identification between peripheral (such as BPPV) and other central disorders that can cause your symptoms. 

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BPPV Treatments

Once you get a diagnosis of BPPV, your specialist may treat you with the Epley maneuver, a simple physical therapy procedure. The Epley maneuver addresses the root cause of BPPV – calcium crystals in a chamber of the inner ear, called the semicircular canals, which are responsible for balance and perception.

The Epley maneuver uses gravity to move the calcium crystals out of the chambers of your ear. Afterward, the crystals are harmlessly absorbed by the body over several days to weeks. Sometimes the crystals fall back into the semicircular canal and get stuck again before the body has time to reabsorb them. If this happens, your doctor can repeat the Epley maneuver or recommend that you perform the Epley maneuver at home.

The Epley maneuver consists of several choreographed moves:

  1. First, while sitting up, your head is turned about 45 degrees toward the side that normally aggravates the vertigo.
  2. Next, the doctor helps you lie down backwards with your head just over the edge of the examining table. This position usually provokes strong vertigo.
  3. You stay in this position for about 30 seconds and then the doctor turns you 90 degrees to the opposite side.
  4. After another 30 seconds, your head and body are turned together in the same direction so that your body is pointing towards the side, and your head is pointing down toward the ground at a 45–degree angle.
  5. After 30 seconds in this position, you’re brought upright again.
  6. This is repeated as many as five or six times until the vertigo and nystagmus are relieved when your head is positioned with the bad ear facing down.

In some cases, the doctor may apply a hand-held vibrator to the bone behind the bad ear to help dislodge the stones that may have become stuck on the walls of the semicircular canal.

Your Neuro-Visual and Vestibular Team  

Dr. Newman-TokerDr. Newman-Toker, Director, Division of Neuro-Visual & Vestibular Disorders

Our multidisciplinary team is dedicated to advancing neuro-visual and vestibular conditions’ treatment and research, and improving patients' lives.



Daniel Gold, D.O. 
Amir Kheradmand, M.D.
David Newman-Toker, M.D., Ph.D.
David Zee, M.D.

Patient Resources

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Maryland Patients

To request an appointment or refer a patient, please contact the Vestibular Disorder Staff at 410-955-9313.
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Adult Neurology: 410-955-9441
Pediatric Neurology: 410-955-4259
Adult Neurosurgery: 410-955-6406
Pediatric Neurosurgery: 410-955-7337


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