Last reviewed: March 2019
Last updated: April  2019

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
  • 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
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Lorne S. Parnes

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

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 VIEW ALL

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.

Associate Professor

Department of Otolaryngology

University of Colorado

Aurora

CO

Disclosures

SPC is an author of a number of references cited in this topic.

Associate Professor of Otology and Laryngology

Harvard Medical School

Boston

MA

Disclosures

SDR declares that he has no competing interests.

Consultant Otolaryngologist & Honorary Lecturer

Royal Devon & Exeter NHS Foundation Trust

Exeter

UK

Disclosures

MH is the author of one reference cited in this topic.

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