What is Benign Paroxysmal Positional Vertigo (BPPV)?

From the Guidelines

Benign Paroxysmal Positional Vertigo (BPPV) should be treated with the Epley maneuver, a series of head position changes that help relocate displaced calcium crystals in the inner ear, as it has been shown to be effective in resolving symptoms with a high success rate of around 80% with only 1-3 treatments 1. The Epley maneuver is a simple and effective treatment for BPPV, and it can be performed by a healthcare provider or at home with proper guidance. Some key points to consider when treating BPPV include:

• The Epley maneuver is most commonly used to treat posterior semicircular canal BPPV, which accounts for approximately 85% to 95% of BPPV cases 1.
• The procedure takes about 15 minutes and may need to be repeated several times for complete resolution 1.
• Medications like meclizine (25mg every 4-6 hours as needed) or diazepam can provide temporary symptom relief but don't treat the underlying cause 1.
• Most BPPV cases resolve within weeks without treatment, though recurrence is common (about 30% within one year) 1.
• BPPV occurs when calcium carbonate crystals (otoconia) become dislodged from their normal location and move into the semicircular canals, causing inappropriate signals about head movement to be sent to the brain, resulting in vertigo 1.
• Avoiding sudden head movements, sleeping with your head slightly elevated, and rising slowly from bed can help manage symptoms during recovery 1. It's also important to note that the diagnosis of BPPV is typically made through a combination of patient history and physical examination, including the Dix-Hallpike test or supine roll test 1. Overall, the Epley maneuver is a safe and effective treatment for BPPV, and it should be considered as the first line of treatment for patients with this condition.

From the Research

BPPV Overview

• Benign paroxysmal positional vertigo (BPPV) is a common condition characterized by short-lived episodes of vertigo in association with rapid changes in head position 2, 3.
• It is a common cause of vertigo presenting to primary care and specialist otolaryngology clinics 3.
• BPPV is an important cause of acute vertigo or dizziness in patients presenting to an emergency department (ED) 2.

Diagnosis and Treatment

• The most efficient management of BPPV is to perform a bedside test (Dix-Hallpike test) and then to treat the patients with a bedside positional (the Epley) maneuver 2.
• The Epley manoeuvre is a safe and effective treatment for posterior canal BPPV, based on the results of 11 randomised controlled trials with relatively short follow-up 3.
• The modified Epley maneuver is more effective for self-treatment of PC-BPPV than modified Semont maneuver and Brandt-Daroff maneuver 4.
• A single Epley maneuver can be effective in treating PC-BPPV, but some patients may require multiple maneuvers 5, 6.

Treatment Outcomes

• Complete resolution of vertigo occurred significantly more often in the Epley treatment group when compared to a sham manoeuvre or control 3.
• The Epley manoeuvre is associated with a high recurrence rate of BPPV after treatment (36%) 3.
• The success rates of repositioning maneuvers in treating patients diagnosed with PC-BPPV are high, but more than a single maneuver is required in some resistant patients 5.
• There is no statistically significant difference between performing a single Epley maneuver versus multiple Epley maneuvers for treatment of PC-BPPV in the emergency department 6.