From the Guidelines
Benign Paroxysmal Positional Vertigo (BPPV) is a common inner ear disorder characterized by brief episodes of vertigo triggered by specific changes in head position, and it is defined as a disorder of the inner ear characterized by repeated episodes of positional vertigo 1.
Key Characteristics of BPPV
- BPPV is the most common inner ear problem and cause of vertigo, or false sense of spinning 1.
- It is a specific diagnosis, and each word describes the condition: Benign—it is not life-threatening, even though the symptoms can be very intense and upsetting; Paroxysmal (par-ek-siz-muhl)—it comes in sudden, short spells; Positional—certain head positions or movements can trigger a spell; Vertigo—feeling like you are spinning or the world around you is spinning 1.
- BPPV occurs when calcium carbonate crystals become dislodged from the utricle and move into the semicircular canals, causing inappropriate fluid movement that sends false signals about head position to the brain, resulting in vertigo 1.
Diagnosis and Treatment of BPPV
- The diagnosis of BPPV is typically made using the Dix-Hallpike maneuver, which involves moving the patient's head into a position that triggers the vertigo and observing for specific eye movements 1.
- The primary treatment for BPPV is the Epley maneuver, a series of head movements that helps reposition displaced calcium crystals (otoconia) in the inner ear 1.
- Medications like meclizine or diazepam may help manage symptoms temporarily but don't treat the underlying cause 1.
Outcomes and Prognosis
- Most cases of BPPV resolve with proper repositioning maneuvers, though recurrence is common (about 30% within one year) 1.
- Patients with BPPV are at increased risk for falls, particularly if they have coexisting vestibular system dysfunction or other underlying medical conditions 1.
- Education and patient counseling are essential components of BPPV management, as they can help patients understand their condition, reduce their risk of falls, and improve their overall quality of life 1.
From the Research
Definition and Characteristics of BPPV
- Benign Paroxysmal Positional Vertigo (BPPV) is a common cause of vertigo that can be easily diagnosed and treated in primary care 2.
- BPPV is characterized by short-lived episodes of vertigo in association with rapid changes in head position 3, 4.
- It is a common cause of vertigo presenting to primary care and specialist otolaryngology clinics 3, 4.
Causes and Pathogenesis of BPPV
- The cause of BPPV is usually idiopathic 5.
- There are two popular hypotheses described regarding the pathogenesis of BPPV: the "cupulolithiasis" hypothesis and the "canalithiasis" hypothesis 5.
Diagnosis and Treatment of BPPV
- The diagnosis of BPPV is confirmed by observing a classical response during the Dix-Hallpike maneuver 5.
- Treatments for BPPV have ranged from no intervention to surgical treatment 5.
- The Epley maneuver, also known as the canalith repositioning procedure, is a safe and effective treatment for BPPV 6, 3, 5, 4.
- The Epley maneuver has a high success rate, with studies showing significant improvement in symptoms and conversion of a positive Dix-Hallpike test to a negative test 2, 3, 4.