Resumen
Definición
Anamnesis y examen
Principales factores de diagnóstico
- positive past medical history
- recent history of head trauma or inner ear surgery
- specific provoking positions
- normal otologic exam
- brief duration of vertigo
- episodic vertigo
- severe episodes of vertigo
- sudden onset of vertigo
- nausea, imbalance, and lightheadedness
- absence of associated neurologic or otologic symptoms
- normal neurologic exam
- positive Dix-Hallpike maneuver or positive supine lateral head turn
Otros factores de diagnóstico
- age >50 years
- female sex
- positional vertigo in absence of nystagmus
Factores de riesgo
- increasing age
- female sex
- head trauma
- vestibular neuronitis
- labyrinthitis
- migraines
- inner ear surgery
- Meniere disease
- otitis media
- hypertension
- hyperlipidemia
- diabetes mellitus
- vertebrobasilar insufficiency
- giant cell arteritis
- osteoporosis
- intubation
- habitual lateral head-positioning during bed rest (ipsilateral BPPV)
Pruebas diagnósticas
Primeras pruebas diagnósticas para solicitar
- Dix-Hallpike maneuver
- supine lateral head turns
Pruebas diagnósticas que deben considerarse
- audiogram
- brain MRI
Algoritmo de tratamiento
initial presentation
multiple repositioning maneuvers and vestibular rehabilitation exercises ineffective
Colaboradores
Autores
Lorne S. Parnes, MD, FRCSC
Professor
Departments of Otolaryngology-Head and Neck Surgery and Clinical Neurological Sciences
University of Western Ontario
London
Canada
Divulgaciones
LSP is an author of a number of references cited in this topic.
Shahin Nabi, MD, FRCSC
Departments of Otolaryngology-Head and Neck Surgery and Clinical Neurological Sciences
University of Western Ontario
London
Canada
Divulgaciones
SN declares that he has no competing interests.
Revisores por pares
Joel Goebel, MD, FACS
Professor and Vice Chairman
Residency Program Director
Dizziness and Balance Center Director
Otolaryngology-Head and Neck Surgery
Washington University School of Medicine
St. Louis
MO
Disclosures
JG is an author of a number of references cited in this topic.
Stephen P. Cass, MD
Associate Professor
Department of Otolaryngology
University of Colorado
Aurora
CO
Disclosures
SPC is an author of a number of references cited in this topic.
Steven D. Rauch, MD
Associate Professor of Otology and Laryngology
Harvard Medical School
Boston
MA
Disclosures
SDR declares that he has no competing interests.
Malcolm Hilton, BA, BMBCh, FRCS (Eng), FRCS (ORL-HNS)
Consultant Otolaryngologist & Honorary Lecturer
Royal Devon & Exeter NHS Foundation Trust
Exeter
UK
Disclosures
MH is the author of one reference cited in this topic.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Hilton MP, Pinder DK. The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo. Cochrane Database Syst Rev. 2014 Dec 8;(12):CD003162.Full text Abstract
Leveque M, Labrousse M, Seidermann L, et al. Surgical therapy in intractable benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg. 2007 May;136(5):693-8. Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Meniere disease
- Vestibular neuronitis
- Labyrinthitis
More DifferentialsGuidelines
- ACR appropriateness criteria: dizziness and ataxia
- Clinical practice guideline: benign paroxysmal positional vertigo (update)
More GuidelinesPatient information
Benign paroxysmal positional vertigo
More Patient information
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