Michigan Balance Vestibular Testing & Rehabilitation – Department of Otolaryngology

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Vestibular Rehabilitation

Posterior Canal BPPV: How do I know which side to treat?

Benign paroxysmal positional vertigo (BPPV) is the most common cause of

inner ear dizziness. BPPV is caused by loose crystals in your ear, called

otoconia. Sometimes these crystals can move from their normal location in

your ear and fall into one of the semicircular canals (shown in the picture

below) that affect your sense of balance. When this happens, changes in your

head position can cause the crystals to move around inside the semicircular

canals of your ear. This causes dizziness or a spinning feeling (vertigo).

What are the symptoms of BPPV?

BPPV involves short periods, or “spells,” of

dizziness that last less than 1 minute. Many

patients describe this feeling like the “room is

spinning.”

What causes the dizziness?

Changes in your head position can cause a dizziness spell. You might notice

this when rolling over in bed, getting in or out of bed, tipping your head up, or

bending your head down.

How do I know if I have BPPV?

You can do a simple positional test to figure out if you have BPPV. Instructions

for the BPPV test are on page 3 of this handout. This test will also tell you

which ear to treat using an exercise called the Epley Maneuver. It is not

common to have BPPV in both ears at the same time.

NASA, Public domain, via Wikimedia

Commons

Michigan Balance Vestibular Testing & Rehabilitation – Department of Otolaryngology Posterior Canal BPPV: How do I know which side to treat?

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What should I know before I do the test for BPPV?

If you do this positional test and learn that you have BPPV in one of your ears,

you can start treatment by doing the Epley Maneuver for that ear. Look at the

handouts and videos for the left and right Epley Maneuver to help you prepare.

• Go online to: careguides.med.umich.edu

• Click on “Search for a Care Guide” on the homepage or click the

magnifying glass icon in the top right corner.

• Then, in the search box, type “left Epley” or “right Epley.” This will take

you to links for the handouts, as well as videos that show you how to do

these exercises correctly.

What else do I need to know before I get started?

• If the tests don’t cause dizziness on either side, you may not have BPPV.

Talk with your healthcare provider if you continue to experience

symptoms of dizziness.

• It is okay to test both your left and right ears for BPPV. However, you

should never do the full Epley Maneuver for both right and left ears

within the same 24-hour period.

Testing for BPPV

• Begin by sitting on your bed.

• Place a pillow or folded blanket on the bed. The pillow or blanket should

be at the level of your shoulder blades when you lie down (the pictures

show where the pillow or blanket should be placed). This will allow your

head to tip back slightly when you lie down flat on your back.

• If you have someone with you, have them take a short, 10-second video

of your eyes while you do each test (they can use a smartphone to take

the video). They should hold the phone so it is close enough to clearly see

your eyes in the video. This video of your eye movements during the test

can help your provider figure out which one of your inner ear canals

Michigan Balance Vestibular Testing & Rehabilitation – Department of Otolaryngology Posterior Canal BPPV: How do I know which side to treat?

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needs treatment. As you do each positional test, say out loud what test

(left or right) you are doing.

To test the LEFT ear:

Turn your head halfway to the left and lie down

quickly. Keep your head turned halfway (45 degrees)

to the left. Your head should be slightly tipped back.

Wait for 30 to 60 seconds.

• If there is no dizziness after 60 seconds, sit back

up. Move on to the test for the right side.

• If you feel dizziness, stay in this position for

another 30 seconds. After 30 seconds, you should

do the Epley Maneuver for the left ear.

• Scan this QR code to see a video

demonstration of the left Epley:

To test the RIGHT ear:

Turn your head halfway to the right and lie down

quickly. Keep your head turned halfway (45 degrees) to

the right. Your head should be slightly tipped back.

Wait for 30 to 60 seconds.

• If there is no dizziness after 60 seconds, sit back up.

• If you feel dizziness, stay in this position for another

30 seconds. After 30 seconds, you should do the

Epley Maneuver for the right ear.

• Scan this QR code to see a video

demonstration of the right Epley:

Michigan Balance Vestibular Testing & Rehabilitation – Department of Otolaryngology Posterior Canal BPPV: How do I know which side to treat?

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Disclaimer: This document contains instructions for occupational and/or physical therapy exercises developed by University of Michigan Health. Your health care provider has determined that these exercises are beneficial to you based on your condition at this time.

Talk to your health care provider if you have any questions about this document, your condition or your treatment plan, including whether it is appropriate to continue doing these exercises should your condition change.

Patient Education by U-M Health is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International Public License. Last revised: 03/2024