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Benign paroxysmal positional vertigo
Background
Overview
Definition
BPPV is a common disorder of the inner ear characterized by repeated episodes of positional vertigo and nystagmus.
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Pathophysiology
BPPV has an unknown origin but is thought to result from degeneration of the macula. Secondary causes include otoconial dislodgement due to otologic and nonotologic surgery, head trauma, or any means by which mechanical force reaches the inner ear, inner ear disorders (vestibular neuritis, Meniere's disease, and sudden sensorineural hearing loss.
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Disease course
The aberrant semicircular canal signaling (canalithiasis and cupulolithiasis) results in BPPV, which causes clinical manifestations of dizziness that lasts < 20 seconds accompanied by a lingering, nonspecific imbalance and characteristic nystagmus with Dix-Hallpike maneuver. Spontaneous resolution occurs in 25% of patients by 1 month and up to 50% at 3 months.
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Prognosis and risk of recurrence
BPPV is not associated with an increase in mortality.
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Guidelines
Key sources
The following summarized guidelines for the evaluation and management of benign paroxysmal positional vertigo are prepared by our editorial team based on guidelines from the Society for Academic Emergency Medicine (SAEM 2023), the American Physical Therapy Association (APTA 2022), the American Academy of Neurology (AAN 2017), and the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF 2017).
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