Are BPPV Treatment Medication and Hearing Loss Connected?

Dizzy spells or feeling off-balance after sudden head movements are often a sign of a balance problem linked to tiny crystals in the inner ear, known as benign paroxysmal positional vertigo (BPPV). Because it appears without warning and overlaps with other vestibular disorders, patients often question what is happening in their ears. Even more so, they may wonder whether BPPV treatment medication is necessary, how effective it is, and if it might pose risks to their hearing.

In this blog post, let’s look at what the evidence and clinical practice guidelines actually say about the BPPV medication and hearing loss connection.

What Is Benign Paroxysmal Positional Vertigo (BPPV)?

BPPV is a common balance problem that happens when tiny crystals in the inner ear move into the wrong place. It usually occurs when these calcium carbonate crystals (otoconia) break free from the utricle and drift into the semicircular canals. These canals normally detect head movements and send nerve impulses to the brain to help control balance. When displaced, the crystals give false signals about head position, causing sudden episodes of vertigo.

To better understand this disorder, let’s break down the term itself:

• Benign: It is not life-threatening and not considered a serious or progressive disease. Although it can be uncomfortable, it is not medically dangerous.

• Paroxysmal: The spinning sensations, or vertigo, come on suddenly and are brief, typically lasting less than a minute.

• Positional: The episodes are triggered by specific changes in your head’s position relative to gravity, such as tilting your head back or lying down.

• Vertigo: A false sensation that you or your surroundings are spinning or moving.

BPPV is more common after neck surgery and head injuries, and while dizziness is the main feature, some patients also report tinnitus or hearing changes. This raises concerns about whether treatment could be linked to hearing loss.

A 2025 study found that people with tinnitus were more likely to develop BPPV, and people with BPPV were also more likely to develop tinnitus. The risk was nearly double compared to those without either condition, and it was especially higher in younger adults and in men. These results suggest a two-way connection between tinnitus and BPPV, pointing to shared underlying causes.

What Are the Common Symptoms and Health Conditions Linked to BPPV?

BPPV affects people in different ways, but most share a set of recognizable symptoms that help specialists identify the condition. These symptoms can range from brief dizzy spells to additional issues that may overlap with other balance or hearing disorders.

Dizziness and Head Position Triggers

The classic symptoms of BPPV include short bursts of vertigo, typically lasting less than a minute, that occur when the head is turned or moved into a specific starting position. Patients often say they feel dizzy when rolling over in bed or lying with their head flat.

During an episode, doctors may observe involuntary eye movements (nystagmus), which help them diagnose BPPV during a physical examination. These movements reflect how the vestibular system and balance system are reacting to the misplaced crystals.

Hearing Changes and Tinnitus Concerns

Unlike conditions such as Ménière’s disease or vestibular neuritis, BPPV does not typically cause hearing loss. However, patients sometimes notice other symptoms such as ringing in the ears or temporary blurred vision. These are more often linked to overlapping vestibular disorders or unrelated health conditions, rather than BPPV itself.

BPPV Treatment Medication and Its Role

Unlike many conditions, BPPV is not usually treated with medication. The primary approach is through specific physical therapy maneuvers, such as the Epley or Semont maneuver. These techniques work by carefully moving the head and body to guide the loose calcium crystals back to their proper position in the inner ear. They directly address the cause of vertigo rather than just easing the symptoms.

However, in some cases, doctors may recommend short-term medication to ease severe dizziness or nausea, though repositioning manoeuvres remain the mainstay of treatment.

Medications Prescribed for Benign Paroxysmal Positional Vertigo

There is no specific drug that cures BPPV. In some clinical practices, medication may be used alongside repositioning therapy to make symptoms more manageable. Options can include:

• Antihistamines to ease dizziness

• Antiemetics to reduce nausea

• Calcium channel blockers to help lower the inner ear’s sensitivity to the crystals

• Betahistamine may also be considered to improve blood flow in the inner ear and relieve vertigo

Still, these drugs are not a cure and may not work for every patient. They should only be used under medical guidance and usually as a support to physical therapy, not as a replacement.

Disclaimer: Bloor Hearing Clinic does not prescribe medication.

Non-Medication Approaches to Treating BPPV

BPPV often improves without the need for drugs. The most effective treatments focus on physical techniques that directly move the inner ear crystals back into place.

Canalith Repositioning Procedure Explained

The gold-standard treatment options for BPPV are repositioning maneuvers, collectively known as the canalith repositioning procedure. These use gravity and precise head movements to guide the loose crystals out of the semicircular canals and back into the utricle, where they no longer disturb balance.

Repositioning Maneuvers: The Epley Maneuver

The Epley maneuvre is the most widely recommended technique in clinical practice guidelines. In this procedure, a clinician or physical therapist moves the patient through a series of head turns and body position changes until the crystals roll into a less sensitive part of the ear. Patients are usually given post-treatment instructions to avoid certain positions for 24–48 hours.

Brandt Daroff Exercises for Long-Term Relief

For patients who cannot access clinical care or continue to feel dizzy, home treatments such as Brandt-Daroff exercises may help. These involve repeated transitions from sitting to side-lying on the opposite side, helping the brain adapt and reducing recurrence. Such vestibular rehabilitation can be part of broader physical therapy programmes for balance disorders.

What Do Clinical Trials Tell Us?

Research plays a key role in guiding treatment choices. Clinical studies comparing repositioning maneuvers with medication provide valuable insight into which approach works best for lasting relief.

Effectiveness of BPPV Treatment Medication vs Repositioning Maneuvers

Several clinical trials and systematic reviews have confirmed that canalith repositioning is significantly more effective in resolving BPPV symptoms than medication alone. Drugs may reduce other symptoms in the short term, but they do not address the root cause: the misplaced crystals in the semicircular canal.

Long-Term Impact on Inner Ear and Hearing Health

Evidence from clinical practice suggests that neither repositioning manoeuvres nor short-term use of medication leads to permanent hearing loss. In fact, restoring balance through maneuvers reduces the risk of falls, vision problems, and longer-term complications linked to vestibular imbalance.

Key Takeaways for Patients

Understanding your options makes it easier to choose the right path to recovery. Knowing when to use maneuvers, when medication might help, and how to monitor your hearing health can help you manage BPPV more confidently.

When to Consider Medication vs Physical Maneuvers

Patients may benefit from BPPV treatment medication if vertigo symptoms are severe or interfere with daily function. However, repositioning maneuvers, such as the Epley or Brandt-Daroff, remain the first-line treatment in most clinical practice guidelines.

Monitoring Hearing Health Alongside BPPV Treatment

If you experience tinnitus, muffled hearing, or vision problems alongside vertigo, it is essential to share your medical history with a healthcare professional. These could be signs of another vestibular disorder. A physical examination, hearing test, and balance assessment will help confirm the correct diagnosis and rule out other conditions.

Conclusion

BPPV highlights how closely balance and hearing are connected through the inner ear. While vertigo stems from crystal movement in the balance canals, patients may notice tinnitus or hearing changes for unrelated reasons. This makes a full ear and balance check-up worthwhile.

While Bloor Hearing Clinic does not provide medical treatment for BPPV, our audiologists offer hearing tests, tinnitus assessments, earwax removal, hearing aid services, and custom ear protection. We can also help identify when further medical care may be needed.