Benign Paroxysmal Positional Vertigo

Publication Date: March 1, 2017

Key Points

Key Points

  • A primary complaint of dizziness accounts for 5.6 million clinic visits in the United States per year.
  • Between 17% and 42% of patients with vertigo ultimately receive a diagnosis of benign paroxysmal positional vertigo (BPPV).
  • BPPV can recover spontaneously in approximately 20% of patients by one month of follow-up and up to 50% at three months.
  • Patients with BPPV are at increased risk for falls and impairment in the performance of daily activities and adverse effects on individual health-related quality of life and utility measures.
  • BPPV is most commonly clinically encountered as one of two variants:
    • Posterior canal BPPV is more common than horizontal canal BPPV, constituting approximately 85–95% of BPPV cases.
    • Lateral (horizontal) canal BPPV accounts for between 5% and 15% of BPPV cases.

Table 1. Definitions of Words Used in the Guideline

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Vertigo

An illusory sensation of motion of either the self or the surroundings in the absence of true motion.

Nystagmus

A rapid, involuntary, oscillatory movement of the eyeball.

Vestibular system/apparatus

The sensory system within the inner ear that together with the vestibular nerve and its connections in the brain provides the fundamental input to the brain regarding balance and spatial orientation.

Positional vertigo

Vertigo produced by changes in the head position relative to gravity

Benign paroxysmal positional vertigo (BPPV)

A disorder of the inner ear characterized by repeated episodes of positional vertigo.

Posterior canal BPPV

A form of BPPV in which dislodged inner ear particles in the posterior semicircular canal abnormally influence the balance system producing the vertigo, most commonly diagnosed with the Dix-Hallpike test.

Lateral canal BPPV

A form of BPPV in which dislodged inner ear particles in the lateral semicircular canal abnormally influence the balance system producing the vertigo, most commonly diagnosed by the supine roll test.

Canalithiasis

A theory for the pathogenesis of BPPV that proposes that there are free-floating particles (otoconia) that have moved from the utricle and collect near the cupula of the affected canal, causing forces in the canal leading to abnormal stimulation of the vestibular apparatus.

Cupulolithiasis

A theory for the pathogenesis of BPPV that proposes that otoconial debris attached to the cupula of the affected semicircular canal cause abnormal stimulation of the vestibular apparatus.

Canalith repositioning procedures (CRP)

A group of procedures in which the patient moves through specific body positions designed to relocate dislodged particles within the inner ear for the purpose of relieving symptoms of BPPV. The specific CRP chosen relates to the type of BPPV diagnosed. These have also been termed canalith repositioning maneuvers or canalith repositioning techniques.


Table 2. Summary of Key Action Statements (KAS)

...ummary of Key Action Statements (KAS)...

...osterior canal BPPVClinicians should...


...agnosis of lateral (horizontal) canal BPPVIf...


...agnosisClinicians should differentia...


...ing factorsClinicians should assess patients...


...adiographic testingClinicians should N...


...ngClinicians should NOT order vestibular testing i...


...oning procedures as initial therapyClinicia...


...ocedural restrictionsClinicians should NOT r...


...rvation as initial therapyClinicians ma...


...ar rehabilitation therapyThe clinician may offer...


...yClinicians should NOT routinely tr...


...sessmentClinicians should reassess patient...


...uation of treatment failureClinicians...


...cians should educate patients regardi...


Management

Manageme...

...ble 3. Basic Differential Diagnosis of BPPV...


...4. Common Causes of Acute Dizziness: Di...


.... Diagnostic Criteria for Posterior Ca...


...d Methods to Determine the Affected...


Treatment

...eatmen...

...iagrammatic representation of performance o...


...grammatic views of the supine roll testAda...


...ure 3. Depiction of the canalith repositioning...


...le 7. Stepwise Sequence for the Performance of...


...igure 4. Semont Liberatory maneuver for treat...


...wise Description of the Performance of the Semon...


...igure 5. The Lempert 360° roll maneuv...


...Stepwise Description of the Performance of...


...maneuver for treatment of right-side...


Figure 7. Gufoni maneuver for treatment of right-s...


...Maneuver for Treatment of Right-sid...


...1. Gufoni Maneuver for Treatment of Right-...


Figure 8. Alg...


Patient Information

Patient Informat...

...d Questions What is BPPV? Benig...