BPPV & Positional Vertigo Treatment in Cumming & Alpharetta, GA

What is BPPV?

BPPV (benign paroxysmal positional vertigo) is the most common cause of vertigo. Tiny calcium crystals (otoconia) drift into one of the inner ear's semicircular canals, so certain head movements trigger brief, intense spinning.

It is usually treated in the clinic with repositioning maneuvers.

What causes BPPV?

Often there is no clear cause. Common triggers include a head injury, aging, other inner-ear problems such as vestibular neuritis, and lying in one position for a long time, for example at the dentist or hairdresser. BPPV is more common in older adults.

BPPV sometimes follows another inner-ear problem, such as vestibular neuritis, or a head injury. In older adults it is often missed and mistaken for general unsteadiness, which is why we screen for it in every balance and fall-risk evaluation.

The Biomechanics of BPPV

Benign Paroxysmal Positional Vertigo (BPPV) represents the most prevalent neurotologic disorder encountered in clinical settings. The pathophysiology of BPPV is fundamentally mechanical, characterized by the displacement of microscopic calcium carbonate crystals (otoconia) from the utricular macula into one or more of the fluid-filled semicircular canals of the inner ear.

When you undergo spatial reorientations relative to gravity—such as rolling over in bed, bending forward, or looking up—these free-floating particles shift under gravity, creating abnormal fluid dynamics that deflect the cupula and generate an asymmetric neural firing rate that causes intense room-spinning vertigo.

Why Infrared Video Goggle Mapping is Essential

Approximately 85% to 95% of BPPV cases involve the posterior semicircular canal, while 5% to 15% involve the horizontal canal and bifurcate mechanically into canalithiasis (free-floating crystals) or cupulolithiasis (crystals adhered to the cupula). We utilize Infrared Video Frenzel Goggles in total darkness to observe involuntary nystagmus and pinpoint the exact affected canal on your first visit.

Common symptoms of BPPV

• Spinning that lasts less than a minute when you roll over, lie down or look up
• Nausea, sometimes vomiting, during an episode
• Feeling off-balance or light-headed between spells
• Episodes that come and go over days or weeks

Not sure this matches? Take the 60-second dizziness self-check.

How we diagnose BPPV in Cumming and Alpharetta

At North Atlanta Vertigo & Physical Therapy, serving Alpharetta, Cumming, Johns Creek and Suwanee, your first visit is a full 60-minute, one-on-one evaluation with our physical therapy team, led by Dr. Manan Patel, PT, DPT, a Certified Vestibular Specialist. To confirm BPPV and rule out conditions that look similar, we record your eye movements with infrared video goggles and measure your balance on our BioSway computerized balance system. Testing can include:

• Dix-Hallpike and supine roll tests to provoke symptoms and find the affected canal
• Infrared video goggles to record the direction and timing of nystagmus (involuntary eye movements)
• Screening to separate BPPV from other causes of vertigo
• Balance testing to check fall risk

When to get urgent care

Specialized physical therapy treatment for BPPV

At North Atlanta Vertigo & Physical Therapy, serving Cumming and Alpharetta, GA, Dr. Manan Patel and our physical therapists treat BPPV with canalith repositioning maneuvers matched to the affected canal: the Epley or Semont maneuver for the posterior canal, the BBQ roll or Gufoni maneuver for the horizontal canal, and a deep head-hanging maneuver for the anterior canal. Every visit is 60 minutes, one-on-one, and we re-test as you improve.

Our Evidence-Based Canalith Repositioning Protocols

• Posterior Canal Protocols (Epley, Semont-Plus & Half Somersault): The Epley maneuver utilizes gravity to guide debris out of the posterior canal, while the Semont-Plus maneuver uses high-velocity acceleration to dislodge particles and accelerate recovery.
• Horizontal Canal Protocols (Barbecue Roll, Gufoni, Appiani & Casani): For geotropic and apogeotropic horizontal canal variants, we deploy sequential 360-degree Lempert rotations or Gufoni/Casani shear-force maneuvers to clear both free-floating and cupula-adhered crystals.
• Cervical-Safe & Anterior Canal Protocols (Gans & Yacovino): For patients with cervical spine restrictions who cannot hyperextend their neck, we utilize the Gans maneuver, as well as the Yacovino maneuver for rare anterior canal involvement.

Your treatment plan

1. Identify the canal

   We pinpoint which ear and which canal is involved, and whether the crystals are loose in the canal (canalithiasis) or stuck to the cupula (cupulolithiasis).

2. Reposition the crystals

   Canalith repositioning maneuvers, such as the Epley maneuver for the posterior canal or roll maneuvers for the horizontal canal, guide the crystals back where they belong.

3. Restore balance and confidence

   If unsteadiness lingers after the spinning stops, short-term balance exercises help, along with guidance on reducing the chance of recurrence.

Recovery and what to expect

The American Academy of Otolaryngology–Head and Neck Surgery guideline recommends repositioning maneuvers as first-line treatment for posterior-canal BPPV, and many patients improve within one to three treatments. BPPV can come back, so we show you what to watch for. Individual results vary.

Tips for daily life

• Get up in stages: sit on the edge of the bed for a moment before standing
• Avoid driving or climbing ladders until positional spinning settles
• Keep a light on at night and clear the path to the bathroom
• Note which movements trigger spinning, since that helps us find the affected canal

Frequently asked questions about BPPV

Related guides

• The Epley maneuver: when it works, and why the side mattersHow canalith repositioning works, why home attempts fail, and what to expect afterward.4 min read · Patients
• Vertigo, dizziness or lightheadedness? How to tell the differenceWhat spinning, rocking, woozy and faint usually mean, and when dizziness is an emergency.4 min read · Patients

Browse all guides in our learning center

Questions patients ask

• Still dizzy? How does vestibular rehabilitation therapy (VRT) restore balance?
• What is the difference between peripheral and central vertigo, and how does physical therapy help?
• What exercises are used in vestibular therapy, and why don't YouTube routines work for everyone?
• How do I know if my dizziness is an inner ear problem or blood pressure?
• What should I do during a sudden dizzy spell, and when should I see a vestibular specialist?
• Why doesn't general physical therapy fix complex dizziness? What does a Certified Vestibular Specialist do differently?
• What is BPPV? Are loose inner ear crystals causing your spinning?
• Why do I still feel wobbly after my BPPV crystals were cleared?

Related conditions

• Vestibular rehabilitationHow testing and treatment work for every type of dizziness.
• Vestibular neuritisInflammation of the balance nerve causing sudden, prolonged vertigo.
• Concussion & post-concussion syndromeHeadaches, dizziness, fog and visual strain after a head injury.
• Balance & fall preventionAge-related balance decline and increased fall risk.

References

1. Bhattacharyya N, et al. Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update). Otolaryngology–Head and Neck Surgery. 2017.

Led by Dr. Manan Patel, PT, DPT, TPSCertified Vestibular Specialist with 15+ years of outpatient care. Meet Dr. Patel and the team

Where to get treated

Book at either clinic. Same phone number, same team, same 60-minute visits.

Also serving Johns Creek, Milton, Roswell, Suwanee and nearby communities.