From the Guidelines
Benign Paroxysmal Positional Vertigo (BPPV) is a common inner ear disorder that causes brief episodes of dizziness when you change head positions, and it can be effectively treated with repositioning maneuvers such as the Epley maneuver, which has a high success rate of around 80% with only 1-3 treatments 1, 2.
What is BPPV?
BPPV is the most common inner ear problem and cause of vertigo, or false sense of spinning, characterized by sudden, short spells of vertigo triggered by specific head movements, with symptoms including nausea, vomiting, and a severe sense of disorientation in space 1.
Causes of BPPV
The condition is caused by the displacement of tiny calcium crystals, or "otoconia," from their normal location in the inner ear, which can be triggered by trauma, migraine, other inner ear problems, diabetes, osteoporosis, and lying in bed for long periods 1, 3.
Diagnosis of BPPV
Diagnosis is typically made through simple bedside testing, such as the Dix-Hallpike test or supine roll test, which involves moving the patient's head into a position that triggers the vertigo, and observing for specific eye movements 1, 3.
Treatment of BPPV
Treatment primarily involves repositioning maneuvers, such as the Epley maneuver, which can be performed by a healthcare provider or taught for home use, with the goal of guiding the displaced crystals back to their normal location in the inner ear 2, 4.
Post-Treatment Care
After the procedure, patients should avoid rapid head movements, sleeping on the affected side, and bending over for 48 hours, and may experience some brief distress from vertigo, nausea, and feelings of disorientation, but most patients experience significant improvement after 1-3 treatments 1, 2.
Importance of Follow-Up
Follow-up is crucial to assess the resolution of symptoms and to evaluate for any underlying conditions that may have contributed to the development of BPPV, and patients should be counseled on the risk of recurrence and the importance of seeking medical attention if symptoms persist or worsen 4, 5.
Quality of Life
Treatment of BPPV can significantly improve quality of life, and patients should be educated on the condition, its treatment, and the potential for recurrence, to empower them to manage their condition effectively 6.
From the Research
Diagnosis of Benign Paroxysmal Positional Vertigo (BPPV)
- BPPV is a common condition that causes acute vertigo or dizziness in patients presenting to an emergency department (ED) 7
- The Dix-Hallpike test is used to diagnose BPPV, and it is recommended to perform this test at the bedside 7, 8, 9
- The Dix-Hallpike test is used to confirm the diagnosis of BPPV, and it is also used to assess the effectiveness of treatment 8, 9, 10
Treatment of BPPV
- The Epley maneuver is a recommended treatment for posterior canal BPPV, and it has been shown to be effective in resolving vertigo symptoms 7, 8, 9
- The Semont maneuver is also used to treat BPPV, but its efficacy is comparable to the Epley maneuver 11, 9, 10
- The Brandt-Daroff exercise is another treatment option for BPPV, but it has been shown to be less effective than the Epley and Semont maneuvers 9, 10
- The choice of treatment maneuver depends on the clinician's preference, the patient's movement restrictions, and the failure of previous maneuvers 11
Effectiveness of Treatment
- The Epley maneuver has been shown to be effective in resolving vertigo symptoms in patients with posterior canal BPPV, with a success rate of 56% compared to 21% for sham treatment 9
- The Semont maneuver has also been shown to be effective, but its efficacy is comparable to the Epley maneuver 9
- The Brandt-Daroff exercise has been shown to be less effective than the Epley and Semont maneuvers, with a success rate of 50% 10
- The treatment of BPPV has been shown to improve quality of life in patients, with significant improvements in vestibular activities and participation 10