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 tests
1st tests to order
- Dix-Hallpike maneuver
- supine lateral head turns
Tests 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
利益声明
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
利益声明
SN declares that he has no competing interests.
同行评议者
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
利益声明
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
利益声明
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
利益声明
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
利益声明
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.
参考文献
关键文献
Hilton MP, Pinder DK. The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo. Cochrane Database Syst Rev. 2014 Dec 8;(12):CD003162.全文 摘要
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. 摘要
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
鉴别诊断
- Meniere disease
- Vestibular neuronitis
- Labyrinthitis
更多 鉴别诊断指南
- ACR appropriateness criteria: dizziness and ataxia
- Clinical practice guideline: benign paroxysmal positional vertigo (update)
更多 指南患者教育信息
Benign paroxysmal positional vertigo
更多 患者教育信息
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