Benign Paroxysmal Positional Vertigo
Publication Date: March 1, 2017
Last Updated: December 16, 2022
Table 2. Summary of Key Action Statements (KAS)
Diagnosis of posterior canal BPPV
Clinicians should diagnose posterior semicircular canal BPPV when vertigo associated with torsional, up-beating nystagmus is provoked by the Dix-Hallpike maneuver, performed by bringing the patient from an upright to supine position with the head turned 45º to one side and neck extended 20º with the affected ear down. The maneuver should be repeated with the opposite ear down if the initial maneuver is negative. ( Strong Recommendation (S) , B )
571
Diagnosis of lateral (horizontal) canal BPPV
If the patient has a history compatible with BPPV and the Dix-Hallpike test exhibits horizontal or no nystagmus, the clinician should perform, or refer to a clinician who can perform, a supine roll test to assess for lateral semicircular canal BPPV. ( Recommendation (R) , B )
571
Differential diagnosis
Clinicians should differentiate, or refer to a clinician who can differentiate, BPPV from other causes of imbalance, dizziness, and vertigo. ( Recommendation (R) , C )
571
Modifying factors
Clinicians should assess patients with BPPV for factors that modify management, including impaired mobility or balance, central nervous system disorders, a lack of home support, and/or increased risk for falling. ( Recommendation (R) , C )
571
Radiographic testing
Clinicians should NOT obtain radiographic imaging in a patient who meets diagnostic criteria for BPPV in the absence of additional signs and/or symptoms inconsistent with BPPV that warrant imaging. ( Recommendation (R) , C )
571
Vestibular testing
Clinicians should NOT order vestibular testing in a patient who meets diagnostic criteria for BPPV in the absence of additional vestibular signs and/or symptoms inconsistent with BPPV that warrant testing. ( Recommendation (R) , C )
571
Repositioning procedures as initial therapy
Clinicians should treat, or refer to a clinician who can treat, patients with posterior canal BPPV with a canalith repositioning procedure. ( Strong Recommendation (S) , A )
571
Postprocedural restrictions
Clinicians should NOT recommend postprocedural postural restrictions after canalith repositioning procedure for posterior canal BPPV. ( Strong Recommendation (S) , A )
571
Observation as initial therapy
Clinicians may offer observation with follow-up as initial management for patients with BPPV. ( Option (O) , B )
571
Vestibular rehabilitation therapy
The clinician may offer vestibular rehabilitation, either self-administered or with a clinician, in the treatment of BPPV. ( Option (O) , B )
571
Medical therapy
Clinicians should NOT routinely treat BPPV with vestibular suppressant medications such as antihistamines and/or benzodiazepines. ( Recommendation (R) , C )
571
Outcome Assessment
Clinicians should reassess patients within one month after an initial period of observation or treatment to document resolution or persistence of symptoms. ( Recommendation (R) , C )
571
Evaluation of treatment failure
Clinicians should evaluate, or refer to a clinician who can evaluate, patients with persistent symptoms for unresolved BPPV and/or underlying peripheral vestibular or central nervous system disorders. ( Recommendation (R) , A )
571
Education
Clinicians should educate patients regarding the impact of BPPV on their safety, the potential for disease recurrence and the importance of follow-up. ( Recommendation (R) , C )
571
Title
Benign Paroxysmal Positional Vertigo
Authoring Organization
American Academy of Otolaryngology - Head and Neck Surgery Foundation
Endorsing Organizations
American Academy of Emergency Medicine
American Academy of Physical Medicine and Rehabilitation
American Physical Therapy Association
American Otological Society
American Academy of Physician Assistants
Publication Month/Year
March 1, 2017
Last Updated Month/Year
July 26, 2023
External Publication Status
Published
Country of Publication
US
Document Objectives
The primary purposes of this guideline are to improve the quality of care and outcomes for BPPV by improving the accurate and efficient diagnosis of BPPV, reducing the inappropriate use of vestibular suppressant medications, decreasing the inappropriate use of ancillary testing such as radiographic imaging, and increasing the use of appropriate therapeutic repositioning maneuvers.
Target Patient Population
Aged ≥18 years with a suspected or potential diagnosis of BPPV
Target Provider Population
All clinicians who are likely to diagnose and manage patients with BPPV
Inclusion Criteria
Female, Male, Adult, Older adult
Health Care Settings
Ambulatory, Long term care
Intended Users
Audiologist, nurse, nurse practitioner, physician, physician assistant
Scope
Diagnosis, Management
Diseases/Conditions (MeSH)
D065635 - Benign Paroxysmal Positional Vertigo
Keywords
benign paroxysmal positional vertigo (BPPV), BPPV, vertigo
Source Citation
Bhattacharyya N, Gubbels SP, Schwartz SR, et al. Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update). Otolaryngology–Head and Neck Surgery. 2017;156(3_suppl):S1-S47. doi:10.1177/0194599816689667
Methodology
Number of Source Documents
294
Literature Search Start Date
January 1, 2008
Literature Search End Date
September 1, 2015