BPPV & Positional Vertigo Treatment in Cumming & Alpharetta, GA

Common symptoms

• 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.

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.

How we test

Your first visit is a full 60-minute, 1-on-1 evaluation, and treatment often starts the same day. Depending on your symptoms, 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

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.

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.

Ready to Reclaim Your Balance & Confidence?

Looking for relief? Schedule a 60-minute 1-on-1 evaluation at our Alpharetta Clinic (Inside GBSPT) or our Cumming Clinic, or call (470) 380-7007.

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

When to get urgent care

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

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.