Vertigo is a sensation of movement or spinning when no actual motion is occurring, and it is one of the most frequent reasons patients seek ENT consultation. Among the various causes of vertigo, Benign Paroxysmal Positional Vertigo (BPPV) is the most common. BPPV originates from the inner ear and is characterized by brief but intense episodes of dizziness triggered by changes in head position, such as turning in bed, looking upward, or bending forward.

The inner ear contains a complex balance system composed of semicircular canals filled with fluid and sensory hair cells that detect movement. In BPPV, tiny calcium carbonate crystals known as otoconia become dislodged from their normal location in the utricle and migrate into one of the semicircular canals. When the head changes position, these crystals shift, sending false signals to the brain and creating the sensation of spinning. Although the condition is termed “benign,” the symptoms can be extremely distressing and disruptive to daily life.

Patients with BPPV typically report sudden episodes of vertigo lasting seconds to a minute. These episodes are often accompanied by nausea, imbalance, and sometimes vomiting. Unlike other neurological causes of dizziness, BPPV does not cause hearing loss, tinnitus, weakness, or loss of consciousness. Between attacks, patients may feel relatively normal, though some experience persistent unsteadiness or fear of movement due to symptom anticipation.

Diagnosis is primarily clinical and based on a detailed history and physical examination. Specific positional tests, such as the Dix-Hallpike maneuver, are performed to reproduce symptoms and observe characteristic involuntary eye movements known as nystagmus. These findings help confirm the diagnosis and identify the affected semicircular canal. Advanced imaging is rarely required unless symptoms are atypical or associated with neurological signs.

Treatment of BPPV is highly effective and usually non-surgical. Canalith repositioning procedures, such as the Epley maneuver, are designed to guide the displaced crystals back to their original position in the inner ear. These maneuvers are performed by trained ENT specialists and often provide immediate or rapid symptom relief. In some cases, repeated sessions may be necessary. Medications play a limited role and are generally used only for short-term symptom control in severe cases.

Without treatment, BPPV may resolve spontaneously over weeks or months, but recurrence is common. Early ENT intervention significantly reduces symptom duration, fall risk, and quality-of-life impairment. Patient education, reassurance, and follow-up are essential components of long-term management.