Vertigo & BPPV Management

Vertigo is the false sensation that you or the world around you is spinning. The most common cause is benign paroxysmal positional vertigo (BPPV) — small calcium crystals dislodged into the inner ear's balance canals — which responds remarkably well to specific repositioning maneuvers.

We assess vertigo using bedside vestibular tests including the Dix-Hallpike, supine roll and head-impulse tests, then choose the appropriate canalith repositioning maneuver — Epley, Semont or Gufoni — based on the canal involved.

• Benign paroxysmal positional vertigo (BPPV) — posterior, horizontal and anterior canal
• Cervicogenic dizziness arising from neck dysfunction
• Vestibular hypofunction after labyrinthitis or vestibular neuritis
• Persistent imbalance after a vertigo episode
• Motion sensitivity and visual-vestibular mismatch
• Falls and unsteadiness in older adults with a vestibular component

1. History TakingWe map the trigger, duration and direction of your spinning episodes — these point to the canal involved before any test is run.
2. Vestibular TestingDix-Hallpike, supine roll and head-impulse tests are performed in a structured sequence.
3. Repositioning ManeuverEpley, Semont or Gufoni — chosen for the affected canal. Most BPPV resolves in 1–3 maneuvers.
4. Habituation ExercisesFor motion-sensitive or hypofunction cases, we prescribe graded vestibular and balance exercises.
5. ReassessmentWe re-test the next visit. If the vertigo has recurred, we repeat or escalate. If it persists, we refer to ENT.

The repositioning maneuver itself takes 10–15 minutes and may briefly reproduce the spinning sensation — this is expected. You will typically be advised to keep your head upright for the rest of the day.

Most BPPV resolves in 1–3 sessions. Vestibular hypofunction and chronic dizziness require 6–12 sessions of graded exercise.

Severe cervical artery insufficiency, recent cervical spine surgery, severe cervical disc disease — we screen for these before any maneuver. Central causes of vertigo (stroke, tumor) require ENT or neurology referral, not repositioning.

• Bedside vestibular testing performed in clinic — no separate appointment elsewhere
• Trained in posterior, horizontal and anterior canal repositioning
• Honest about when you need ENT, not physiotherapy