Each canal has an area of sensory epithelia that respond to movenent of fluid within the canal secondary to head motion. The most commonly accepted theory of the etiology of BPPV suggests that some of the calcuim carbonate particles become dislodged and fall back, stimulating the sensory area of the posterior semicircular canal. On examination the Hallpike maneuver will elicit vertigo. When the affected ear is towards the floor, the loose particles in the inner ear then float down towards the posterior semicircular canal. The vertigo begins when the particles reach the canal, approximately 1-3 seconds after the maneuver, and will last up to 30 seconds.
Symptoms lessen with repetition of the maneuver.
Head and neck motion in the form of vestibular exercises can sometimes speed recovery. Persistent BPPV can significantly interfere with daily activity and daily functioning. The severity of symptoms will determine if surgery is indicated. In the past there were only two surgical options. The first, vestibular neurectomy, involves cutting the balance nerve.