BPPV Treatment in Cary, NC
Benign paroxysmal positional vertigo is the most common cause of vertigo — and one of the most treatable. Most people feel substantially better within one to three visits.
What BPPV feels like
BPPV announces itself through movement. You roll over in bed and the room lurches. You tip your head back to reach a high shelf, or bend down to tie a shoe, and everything spins.
The spinning is intense but brief — usually seconds, rarely more than a minute. What often lingers afterward is a washed-out, unsteady feeling that can last for hours, which is part of why the condition wears people down even though each episode is short.
- Sudden spinning triggered by a change in head position, not by standing still
- Episodes lasting seconds to under a minute, often followed by lingering unsteadiness
- Commonly worst first thing in the morning, or when rolling over during the night
- Nausea, and a growing wariness of the movements that set it off
- Usually no change in hearing — which helps separate BPPV from other inner ear conditions
Why it happens
Your inner ear contains tiny calcium carbonate crystals called otoconia. They belong in a chamber called the utricle, where they help your brain sense gravity and straight-line motion.
In BPPV, some of those crystals break loose and drift into one of the semicircular canals — the loops that sense rotation. Now, every time you move your head, the crystals shift and push fluid that should not be moving. The canal sends your brain an urgent message that you are spinning. Your eyes and body react to a rotation that never happened, and you feel the room turn.
It can follow a head injury, an inner ear infection, or a long stretch of lying flat after illness or surgery. Often there is no identifiable cause at all. It becomes more common with age, and it is not a sign of anything sinister happening in your brain.
How we find it
BPPV is diagnosed by provoking it deliberately and watching what your eyes do. When crystals move through a canal, they produce a distinctive involuntary eye movement called nystagmus — and its direction, timing, and duration identify which ear and which specific canal is involved.
We use positional tests, principally the Dix-Hallpike and the supine roll, and we watch your eyes through infrared video goggles. The goggles matter more than they might sound: they let us see your eyes in complete darkness. Without visual fixation to suppress it, the response is far clearer, and subtle patterns that would otherwise be missed become obvious.
This step is the whole game. There are several canals and two ears, and each combination calls for a different treatment. Identifying the right one is what makes the treatment work.
How we treat it
Once we know which canal holds the crystals, we treat it with a canalith repositioning maneuver — the Epley for the posterior canal, a roll maneuver for the horizontal canal, and other variations as the findings dictate.
A maneuver is a guided sequence of head and body positions that uses gravity to walk the crystals back around the canal and out into the utricle, where they no longer generate false signals. It is a procedure performed in the clinic, not a set of exercises to repeat at home for weeks.
You will likely feel dizzy partway through. That is expected — it usually means the crystals are moving, and it tells us we are working in the right canal. It passes quickly, and we go at a pace you can tolerate.
What to expect afterward
Many people notice a marked difference after a single treatment. Most are done in one to three visits. We re-test at the following visit rather than assuming it worked, because confirming the canal is clear matters as much as the treatment itself.
BPPV can come back. Some people have one episode and never another; others get it periodically for years. That is not a treatment failure, and it is not something you have to simply live with — you will leave knowing what to watch for and how quickly it can be sorted out if it returns.
If dizziness persists once the crystals are cleared, that tells us something useful too: something else is contributing, and we look at that next rather than repeating a maneuver that has already done its job.
Common questions about BPPV
- Can I just do the Epley maneuver from a video at home?
- It sometimes works, and it sometimes makes things worse. The maneuver you need depends on which ear and which canal the crystals are in, and the videos online overwhelmingly show the posterior canal version for one side. Performed on the wrong canal, a maneuver can push crystals somewhere less convenient and turn a straightforward problem into a stubborn one. The testing is what makes the treatment reliable — that is the part that is hard to do to yourself.
- Will the treatment make me dizzy?
- Briefly, yes, and that is a good sign rather than a bad one — it usually means the crystals are moving through the canal as intended. It settles within a minute or so. Most people feel fine to drive home afterward, though you are welcome to bring a driver for your first visit if that is more comfortable.
- How quickly can I be seen?
- New patients are typically seen within a week. Because BPPV often resolves in one to three visits, getting in sooner tends to mean being finished sooner.
- Do I need a referral?
- North Carolina is a direct access state, so you can usually start physical therapy without one. Some insurers require a referral for reimbursement, and we are happy to check that for you when you call.
- How is this billed?
- We accept Medicare Part B and bill it directly. We are an out-of-network provider for Medicare Part C (Medicare Advantage). All other patients are cash-pay with pricing published up front, and we can provide a superbill for potential out-of-network reimbursement.
Get the spinning sorted out
BPPV is one of the few causes of vertigo with a direct, mechanical fix. If that is what you have, there is little reason to wait it out.
Referring a patient? Download the referral form or fax (844) 458-1371.