Why Looking at the Sky Can Make You Dizzy: Understanding BPPV

A recent article published on msn.com, “Do you feel dizzy when you look at the sky? This is not insignificant,” helped bring additional attention to benign paroxysmal positional vertigo (BPPV). BPPV, which is the most common cause of vertigo, will impact 50 percent of those over the age of 70 at some point. BPPV is characterized by transient and episodic attacks of vertigo that occur with positioning. When the posterior canal is involved, patients experience symptoms when lying supine, rolling, rising from supine, bending at the waist, and with head pitch. Episodes are short in duration, lasting less than 60 seconds.

The underlying pathophysiology of BPPV involves otolithic debris migrating into one of the ear’s semicircular canals (typically posterior). This migration causes the semicircular canals, which are typically angular acceleration sensors, responsive to gravity in an abnormal way. The migration of otoliths into a canal can happen for a number of reasons. Otoliths are primarily composed of calcium carbonate, housed in a sticky protein matrix, and originate from the macula of the utricle and saccule. Endolymph is considered calcium deficient. A certain degree of otolithic sluffing into endolymph is thought to be normal. In a typically functioning ear, these particles will be dissolved in endolymph. However, as calcium absorption slows with age, or the sticky matrix around these particles breaks down, excessive otoliths can be found floating in the endolymph-filled vestibule.

We also see excessive concentrations of otolithic debris in the vestibule following head trauma (a large check of debris can dislodge from the macula), after an inner-ear infection that negatively impacts function, and with other medical conditions (migraine, vestibular neuritis, hypertension, diabetes, etc). The excess otolithic debris floating in the vestibule will eventually settle into the ear’s lowest point, which happens to be the posterior semicircular canal. This debris will move within the canal with patient positioning, which will create a push or pull force on the canal’s sensory structure (crista ampullaris) that in-turn creates a false sense of motion. Fortunately, BPPV responds well to canalith repositioning, which audiologists are uniquely positioned to provide.

Reference

Anaëlle G. (2026, February 4). Do you feel dizzy when you look at the sky? This is not insignificant. MSN.