Benign paroxysmal positional vertigo
Summary
Definition
History and exam
Key diagnostic factors
- 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
Other diagnostic factors
- age >50 years
- female sex
- positional vertigo in absence of nystagmus
Risk factors
- 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)
Diagnostic investigations
1st investigations to order
- Dix-Hallpike maneuver
- supine lateral head turns
Investigations to consider
- audiogram
- brain MRI
Treatment algorithm
initial presentation
multiple repositioning maneuvers and vestibular rehabilitation exercises ineffective
Contributors
Authors
Lorne S. Parnes, MD, FRCSC
Professor
Departments of Otolaryngology-Head and Neck Surgery and Clinical Neurological Sciences
University of Western Ontario
London
Canada
Disclosures
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
Disclosures
SN declares that he has no competing interests.
Peer reviewers
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
Declarações
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
Declarações
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
Declarações
MH is the author of one reference cited in this topic.
Créditos aos pareceristas
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Referências
Principais artigos
Hilton MP, Pinder DK. The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo. Cochrane Database Syst Rev. 2014 Dec 8;(12):CD003162.Texto completo Resumo
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. Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
Diagnósticos diferenciais
- Meniere disease
- Vestibular neuronitis
- Labyrinthitis
Mais Diagnósticos diferenciaisGuidelines
- ACR appropriateness criteria: dizziness and ataxia
- Clinical practice guideline: benign paroxysmal positional vertigo (update)
Mais GuidelinesPatient information
Benign paroxysmal positional vertigo
More Patient information
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