Benign Paroxysmal Postional Vertigo (BPPV) is the most common cause of
vertigo due to a peripheral vestibular disorder. It occurs spontaneously in many patients
but may be caused by head trauma, labyrinthitis, or ischemia in the distribution of the
anterior vestibular artery.
BPPV is characterized by vertigo that begins 1 to 40 seconds after the patient has been
placed in a provoking position. Most common situations: “getting out of bed, gardening,
washing hair, going to the dentist”.
The most common cause of BPPV, canalithiasis, suggests that degenerative debris, probably
fragments of otoconia from the utricle, is floating freely in the endolymph of the canal, most often the posterior semicircular canal.
Diagnosis of BPPV is made by performing the Dix-Hallpike Maneuver. This maneuver
allows you to:
- Confirm presence of BPPV
- Identify which side is affected
- Identify which canal is involved (most commonly the posterior semicircular canal, but in rare cases of BPPV (6-8%) the horizontal semicircular canal may be involved)
In the Dix-Hallpike maneuver, the patient is brought from a sitting
position to a supine position,
with the head turned 45 degrees
horizontally toward the labyrinth
to be tested and with the head
slightly extended. The nystagmus
observed in BPPV has the following
- Latency: 3-5 seconds
- Duration: may range from seconds to minutes
- Direction: nystagmus is torsional and geotropic
- Fatigability: repeated maneuvers produce less and less responses
- Reversal of nystagmus when the patient returns to an upright position
Treatment of BPPV is based on identification of which side and which canal is involved and is achieved with the Epley Maneuver, also known as canal repositioning maneuver.
Properly performed BPPV has a success rate of 70-95% with a single treatment. If you
have diagnosed BPPV or strongly suspect BPPV based on history and symptoms, refer
your patient to an otolaryngologist for definite diagnosis
Call us at 612-339-2836 or toll-free at 866-316-0769 to refer your patient for an appointment, or submit an online referral.
Medical Illustration Copyright © 2007 Nucleus Medical Art.
All rights reserved. www.nucleusinc.com