From the Guidelines
Vertigo is worse in the supine position with the affected ear down for Benign Paroxysmal Positional Vertigo (BPPV) affecting the posterior semicircular canal.
Key Points
- The Dix-Hallpike maneuver is used to diagnose posterior semicircular canal BPPV, which involves bringing the patient from an upright to supine position with the head turned 45° to one side and neck extended 20° with the affected ear down 1.
- This maneuver can provoke torsional, upbeating nystagmus and vertigo in patients with posterior canal BPPV 1.
- The supine position with the affected ear down is the position that typically worsens vertigo in patients with posterior semicircular canal BPPV, as it is the position that stimulates the posterior semicircular canal and causes the abnormal sensation of motion 1.
- Some key characteristics of the nystagmus produced by the Dix-Hallpike maneuver in posterior canal BPPV include a latency period between the completion of the maneuver and the onset of subjective rotational vertigo and the objective nystagmus, as well as fatigability of the nystagmus response when the maneuver is repeated 1.
Diagnosis and Treatment
- The diagnosis of posterior semicircular canal BPPV is based on a combination of patient history and physical examination findings, including the presence of vertigo provoked by changes in head position relative to gravity and characteristic nystagmus provoked by the Dix-Hallpike maneuver 1.
- Treatment of posterior canal BPPV typically involves a canalith repositioning procedure, which is designed to relocate dislodged particles within the inner ear and relieve symptoms of BPPV 1.
From the Research
Position-Induced Vertigo in BPPV
- Vertigo in Benign Paroxysmal Positional Vertigo (BPPV) is triggered by changes in head position, with the severity and characteristics of vertigo varying depending on the semicircular canal affected 2.
- For BPPV affecting the posterior semicircular canal, vertigo is typically worse when the head is positioned so that the plane of the affected canal is spatially vertical and aligned with gravity 2, 3, 4.
- The Dix-Hallpike maneuver is commonly used to diagnose posterior-canal BPPV, with a paroxysm of vertigo and nystagmus developing after a brief latency when the head is positioned in a way that triggers the condition 2, 4.
Specific Positions that Exacerbate Vertigo
- Studies suggest that sleeping position may be related to the affected side in posterior semicircular canal BPPV, with patients who sleep on their right side more likely to have right posterior BPPV, and those who sleep on their left side more likely to have left posterior BPPV 5.
- However, the exact position that worsens vertigo in posterior-canal BPPV is not explicitly stated in the provided studies, but it is implied that positions that cause the otoliths to move within the posterior semicircular canal can trigger or exacerbate vertigo 2, 3, 4.
Treatment and Management
- Treatment for BPPV typically involves canalith repositioning maneuvers, which aim to clear the canaliths from the semicircular canal into the vestibule, providing immediate resolution of symptoms 2, 3.
- The effectiveness of these maneuvers can vary depending on the individual case and the specific canal affected, with some cases requiring multiple treatment sessions 6.