Welcome to Dr. Li's BPPV /CRP page!

Benign Paroxsysmal Positional Vertigo, 

Benign Positional Vertigo, Positional Vertigo, BPPV or BPV are the many names for a condition that troubles many patients.

What is Benign paroxysmal positional vertigo? (BPPV) is a type of dizziness caused by abnormal reaction of the balance organ to certain head movements. They are brought on by placing the affected ear downward. In some cases any head movement will aggravate the symptoms.

What causes it? In simple conceptual terms, there are crystals that occur normally in the inner ear. When these crystals are displaced into the semicircular canals, they can stimulate the balance nerve inappropriately. When the head is placed in certain positions, a severe spinning sensation is produced. Although the spinning sensation usually lasts about 20 seconds, it is often severe and can produce unsteadiness and nausea which may last several hours.

How is it diagnosed? It is important to realize that the diagnosis of the cause of vertigo can be most difficult. After a thorough history and physical, many tests may need to be done to differentiate the various types of vertigo. These tests range from blood tests to tests of inner ear function. When BPPV occurs, there is an involuntary movement of the eyes called nystagmus which occurs. To make the diagnosis, the patient's head is placed into certain positions and the eye movements are recorded with an electronic monitor (ENG) and/or observed.

How is it treated?

1. Watch and Wait. (The condition may resolve on its own after weeks, months or years.) This is not recommended now since the patient must unnecessarily endure vertigo that could otherwise be easily treated.
2. Exercises and Physical therapy. Certain balance exercises may be helpful. Improvement occurs slowly over six month or more. The exercises themselves may create much vertigo and nausea.
3.  "The Canalith Repositioning Procedure (CRP)". This is a non-surgical office procedure in which the offending crystals are repositioned to an area in the inner ear where they won't stimulate the balance nerve.
4. The "360 Manuver" is done in the special chair that turns people upside-down.  It uses the same concept of standard CRP.
5. Surgery. This is usually considered if the person is severely incapacitated, and all other methods have been exhausted. Depending on the hearing function, the balance organ can be either saved or destroyed or the nerve in the involved ear can be cut.

Is the canalith repositioning procedure is a safe and effective procedure? Yes!!! It is nonsurgical, painless and has few if any side effects. In our experience more than 95% of patients experience a significant nearly-immediate improvement. Sometimes patients may experience mild transient vertigo for a few days afterwards.

How is it done? During the procedure, the canalith crystals suspended into the solution of the inner ear with an oscillating machine strapped behind the affected ear. The appropriate head positions are effected to cause the crystals to be repositioned to an area away from the balance nerve receptors. This is often done under ENG guidance to ensure the procedure is being done at the appropriate pace. The procedure usually takes about 10-20 minutes. 95% cure is usually obtained as an end result although some patients need to be treated more than once.

If it is so simple, why haven't I heard about this before? Great question. For some strange reason, CRP has been slow to catch on -- It seems too good to be true. In seminars given by Dr. John Epley and Dr. John Li, there have been many "doubters and Naysayers" that have been "converted". An interesting editorial letter was written to the publication Otolaryngology Head and Neck Surgery in response to one of my CRP manuscripts deriding CRP as "Hocus Pocus".

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Last modified: Saturday November 15, 2008.