When the room spins: Understanding BPPV and why sudden dizziness isn’t always dangerous

Dubai: Feeling dizzy. The room spinning. That frightening sense that something is terribly wrong. For many people, it feels like the world is about to end.

But relax — don’t panic. What you may be experiencing is a very common and highly treatable inner‑ear condition called BPPV.

“BPPV sounds complicated, but it’s actually one of the most straightforward causes of vertigo we see,” says Dr Sundarrajan Santhanam, ENT Specialist based in Dubai. “Once patients understand what’s happening, their anxiety immediately drops.”

BPPV stands for Benign Paroxysmal Positional Vertigo.

“Each word tells us something important,” explains Dr Santhanam. “Benign means it’s not life‑threatening. Paroxysmal means it comes suddenly and briefly. Positional means it’s triggered by head movement. And vertigo is that false sensation of spinning.”

Inside the inner ear are tiny calcium carbonate particles called otoconia, commonly referred to as “ear crystals”. “They normally help us sense gravity and movement,” he says. “But sometimes they become dislodged and slip into the wrong part of the balance system.”

When that happens, normal head movements send false signals to the brain. “That’s why doctors say ‘the crystals have moved’. It simply means they’re in the wrong place,” Dr Santhanam explains.

BPPV has a very distinctive pattern.

“Patients often say that when they roll over in bed, the whole room suddenly spins,” says Dr Santhanam. “Others notice it when bending down, looking up, or turning quickly.”

What makes BPPV different from general dizziness is that the episodes are:

“Because the spinning can be so dramatic, people often feel anxious and unsteady for the rest of the day,” he adds. “That lingering imbalance worries patients, but it’s very typical after a BPPV episode.”

This is not the same as lightheadedness, faintness, weakness, or a constant rocking sensation. “The hallmark of BPPV is true spinning linked to head movement,” he says.

Everyday movements that trigger it

Many people only realize the pattern after thinking about when symptoms occur.

Common triggers include:

“These are normal, everyday movements, which is why BPPV can feel so unpredictable,” Dr Santhanam says.

While BPPV itself is benign, not all dizziness is. “Any dizziness accompanied by weakness, slurred speech, facial droop, severe headache, double vision, numbness, or loss of consciousness needs urgent evaluation,” Dr Santhanam stresses. “Those are red flags and should never be ignored.”

Diagnosis is usually quick and clinical.

“We use bedside positional tests, most commonly the Dix‑Hallpike manoeuvre,” he explains. “We move the patient into specific positions and watch for two things — whether they feel spinning, and whether characteristic eye movements called nystagmus appear.”

The eyes are crucial because they reveal which ear and which balance canal is affected. “That information guides the exact treatment,” he says.

“The standard treatment is repositioning manoeuvres,” Dr Santhanam says. “These are precise head and body movements designed to guide the crystals back to where they belong.”

When done correctly, the results can be dramatic. “Many patients feel immediate or near ‑ immediate relief, sometimes after just one session.”

Medication plays only a limited role. “Tablets may help nausea temporarily, but they don’t fix the cause,” he warns. “Unfortunately, long‑term dizziness medication is often prescribed when it’s not needed.”

Surgery is almost never required. “This is one condition where it’s not just bedside manners — it’s bedside manoeuvres that matter,” he says.

Yes, it can — but not always.

“Some people may have another episode months or years later, while others never experience it again,” Dr Santhanam explains. Recurrence may be linked to incomplete manoeuvres, canal conversion, or individual risk factors such as age, migraine, head injury, vitamin D deficiency, or previous episodes.

“To reduce fall risk during flare‑ups, patients should move slowly, use support when getting up, and avoid sudden head movements until treated,” he advises.

In Dubai’s multicultural environment, the doctor’s approach stays simple. “The core message is universal — BPPV is common, not dangerous, and highly treatable,” Dr Santhanam says.

Clear explanations, visual aids, and demonstrations go a long way. “Once patients understand why the spinning happens and how we fix it, fear disappears.”

“It’s probably one of the most common reasons patients visit ENT clinics here,” Dr Santhanam says from his clinical experience. “Roughly 10 to 15 per cent of daily outpatient visits involve dizziness, and the majority of those cases turn out to be BPPV.”

If the world suddenly spins, it doesn’t mean the worst. “In most cases,” Dr Santhanam reassures, “it’s a simple inner‑ear problem — with a simple solution.”