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PC BPPV, or Posterior Canal Benign Paroxysmal Positional Vertigo, is the most common type of peripheral vertigo. It occurs when tiny calcium crystals, known as otoconia, become dislodged and migrate into the posterior semicircular canal of the inner ear. These crystals disrupt the normal flow of fluid in the canal, causing the brain to receive false signals about head position.
The hallmark symptom is a brief, intense sensation of spinning (vertigo) triggered by specific head movements. Common triggers include rolling over in bed, tilting the head back to look up, or bending forward. Episodes typically last less than a minute but can be accompanied by nausea, imbalance, and unsteadiness. Unlike some other causes of vertigo, PC BPPV rarely causes hearing loss or tinnitus.
PC BPPV is often idiopathic, meaning no specific cause is identified. However, known triggers include head trauma (such as whiplash from a car accident), aging (which can cause otoconia to degenerate), viral inner ear infections, and prolonged bed rest. Women over age 50 are more frequently affected than men.
Diagnosis is primarily clinical, based on the patient's history and a physical test called the Dix-Hallpike maneuver. During this test, the doctor rapidly moves the patient's head and body into a specific position while observing for characteristic eye movements (nystagmus). A positive test confirms the presence of PC BPPV and identifies the affected ear.
The first-line treatment for PC BPPV is a series of guided head and body movements called the Epley maneuver (also known as canalith repositioning). This maneuver uses gravity to move the loose crystals out of the posterior canal and back into the utricle, where they are reabsorbed. The procedure is highly effective, with a success rate of over 80% after one or two treatments. Patients are often advised to avoid sudden head movements for 24–48 hours afterward.
For most people, PC BPPV resolves completely with canalith repositioning. However, recurrence is common, affecting 15–50% of individuals within five years. If symptoms return, the repositioning maneuvers can be repeated safely. In rare, persistent cases, surgical options like posterior canal occlusion may be considered.
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