Materiały źródłowe

• #1 Benign paroxysmal positional vertigo: Effective diagnosis and treatment | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/89/11/653

  Benign paroxysmal positional vertigo (BPPV), caused by wayward crystals (rocks) in the semicircular canals of the inner ear, is the most common cause of brief symptoms of vertigo secondary to head and body movements. Diagnosing and treating it are simple to do in the medical office. This article reviews the differential diagnosis for patients presenting with dizziness and vertigo, the pathophysiology of BPPV, how to diagnose it using maneuvers to elicit symptoms and nystagmus, how to interpret the nystagmus pattern to determine where the rocks are, and how to treat it using different maneuvers to reposition (roll) the rocks back where they belong. […] Dizziness or vertigo when lying down or changing positions is a strong predictor of BPPV. The condition is easily diagnosed with the Dix-Hallpike and supine roll maneuvers.

• #2 Benign paroxysmal positional vertigo (BPPV) – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/vertigo/symptoms-causes/syc-20370055

  Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of vertigo the sudden sensation that you’re spinning or that the inside of your head is spinning. […] BPPV causes brief episodes of mild to intense dizziness. […] You can receive effective treatment for BPPV during a doctor’s office visit. […] The signs and symptoms of benign paroxysmal positional vertigo (BPPV) may include: Dizziness, A sense that you or your surroundings are spinning or moving (vertigo), A loss of balance or unsteadiness, Nausea, Vomiting. […] The signs and symptoms of BPPV can come and go and commonly last less than one minute. […] Generally, see your doctor if you experience any recurrent, sudden, severe, or prolonged and unexplained dizziness or vertigo. […] Although it’s uncommon for dizziness to signal a serious illness, see your doctor immediately if you experience dizziness or vertigo along with any of the following: A new, different or severe headache, A fever, Double vision or loss of vision, Hearing loss, Trouble speaking, Leg or arm weakness, Loss of consciousness, Falling or difficulty walking, Numbness or tingling.

• #3 Benign Paroxysmal Positional Vertigo – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470308/

  Benign paroxysmal positional vertigo (BPPV) is the most common cause of peripheral vertigo, accounting for over half of all cases. […] It is crucial to distinguish BPPV from other causes of vertigo as the differential diagnosis includes a spectrum of disease processes ranging from benign to life-threatening. […] The Dix-Hallpike test is pathognomonic, which is why laboratory tests are not indicated to establish the diagnosis of benign paroxysmal positional vertigo. […] Benign paroxysmal positional vertigo is largely a clinical diagnosis, and often, the battery of laboratory and imaging tests ordered only helps rule out other possibilities. […] The initial step in managing benign paroxysmal positional vertigo is patient education and proper counseling. […] The Epley maneuver can be performed after using the Dix-Hallpike maneuver to localize the problematic side.

• #4 Benign Paroxysmal Positional Vertigo – Ear, Nose, and Throat Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/ear-nose-and-throat-disorders/inner-ear-disorders/benign-paroxysmal-positional-vertigo

  In benign paroxysmal positional vertigo, short (60 seconds) episodes of vertigo occur with certain head positions. […] Diagnosis is clinical. […] The diagnosis of BPPV is based on characteristic symptoms, nystagmus elicited by the Dix-Hallpike maneuver (also called the Barany maneuver), and the absence of other abnormalities noted during neurologic examination. Such patients require no further testing. […] If patients have nystagmus suggesting a CNS lesion, gadolinium-enhanced MRI of the brain and internal auditory canal is performed. […] Diagnosis is clinical, but some patients require MRI to rule out other conditions.

• #5 Benign paroxysmal positional vertigo – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-us/73

  Benign paroxysmal positional vertigo (BPPV) is a common, often self-limiting condition, but can be chronic and relapsing. […] Diagnosis is based on a suggestive history and physical examination with a positive Dix-Hallpike manoeuvre or a positive supine lateral head turn. Other tests are not usually required. […] Key diagnostic factors include the presence of risk factors, specific provoking positions, brief duration of vertigo, episodic vertigo, severe episodes of vertigo, sudden onset of vertigo, nausea, imbalance, and lightheadedness, absence of associated neurological or otological symptoms, normal neurological examination, positive Dix-Hallpike manoeuvre or positive supine lateral head turn, and normal otological examination. […] 1st investigations to order include the Dix-Hallpike manoeuvre and supine lateral head turns.

• #6 Benign Paroxysmal Positional Vertigo (BPPV) | Stanford Health Care

  https://stanfordhealthcare.org/medical-conditions/ear-nose-and-throat/benign-paroxysmal-positional-vertigo.html

  Benign paroxysmal positional vertigo (BPPV) is an inner ear disorder that causes a spinning sensation (vertigo). […] Our vestibular balance disorder specialists have extensive expertise in diagnosing and treating BPPV. Youll receive a careful evaluation to pinpoint the cause of your symptoms and a tailored treatment plan to help you find relief. […] BPPV can mimic other conditions, so a skilled evaluation is essential. Your clinician will ask about your medical history and symptoms, including when they occur and how long they last. […] Diagnostic maneuvers are specific movements your clinician performs on you to find out if they trigger symptoms. The Dix-Hallpike maneuver is a standard test for BPPV. […] During the test, your clinician watches your eyes for involuntary eye movements. […] Based on your eye movements during the maneuvers, your clinician can also determine which of the three semicircular canals is affected. […] Vestibular diagnostic tests evaluate your vestibular system to check the function of your inner ears and eyes.

• #7 Benign Paroxysmal Positional Vertigo (BPPV) Symptoms & Treatment

  https://www.emedicinehealth.com/benign_positional_vertigo/article_em.htm

  Benign Paroxysmal Positional Vertigo (BPPV) Diagnosis […] Diagnosis of BPPV begins with the health care practitioner taking a detailed history and performing a physical examination. History may include questions in regard to when vertigo began, how long it lasted, and whether certain positions make it better or worse. Information about past medical history, medications, and recent surgeries may be helpful. Other potential complaints need to be assessed including the presence of fever or chills, weakness, recent falls, history of head trauma, loss of power or sensation on one side of the body, loss of vision or hearing, ringing in the ears, headache, neck stiffness, or slurred speech. […] During the eye exam, the health care practitioner may try to demonstrate nystagmus (involuntary eye movements that occur as the brain tries to compensate for the abnormal signals it is receiving from the inner ear). Sometimes the health care practitioner will need to have the patient change positions to get nystagmus to occur; the position change often reproduces the vertigo complaint. This reproduction of symptoms is called the Dix-Hallpike test.

• #8 Diagnosis and management of benign paroxysmal positional vertigo (BPPV)

  https://pmc.ncbi.nlm.nih.gov/articles/PMC202288/

  THERE IS COMPELLING EVIDENCE THAT FREE-FLOATING endolymph particles in the posterior semicircular canal underlie most cases of benign paroxysmal positional vertigo (BPPV). […] It is a condition that is usually easily diagnosed and, even more importantly, most cases are readily treatable with a simple office-based procedure. […] In this paper, we review the normal vestibular physiology, discuss the pathophysiology and causes of BPPV, and then go on to discuss diagnoses, office-based management and, finally, surgical management. […] The use of the DixHallpike manoeuvre to diagnose posterior canal BPPV was first described in 1952. […] Overall, the history and eye-findings during positional testing are the gold standards for diagnosing BPPV. […] A certain subset of patients may not demonstrate the typical nystagmus during the DixHallpike manoeuvre, but they may still experience the classic vertigo during positioning.

• #9 Benign Paroxysmal Positional Vertigo – Ear, Nose, and Throat Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/ear-nose-and-throat-disorders/inner-ear-disorders/benign-paroxysmal-positional-vertigo

  Benign paroxysmal positional vertigo (BPPV) is a common disorder causing short episodes of vertigo (a false sensation of moving or spinning) in response to changes in head position that stimulate the posterior semicircular canal of the inner ear. […] Doctors base the diagnosis on symptoms and the situations in which they occur and results of a physical examination. […] Diagnosis of BPPV is based on a description of the symptoms and the circumstances in which they occur. […] Usually, the test used is the Dix-Hallpike maneuver. […] If the maneuver is repeated several times, the intensity of the vertigo and nystagmus decreases (called habituation or fatigability) in people who have BPPV. […] Sometimes imaging tests (such as gadolinium-enhanced magnetic resonance imaging) are done when doctors are not sure whether the vertigo is being caused by another, possibly dangerous, disorder.

• #10 Benign paroxysmal positional vertigo – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-us/73

  Benign paroxysmal positional vertigo (BPPV) is a common, often self-limiting condition, but can be chronic and relapsing. […] Diagnosis is based on a suggestive history and physical examination with a positive Dix-Hallpike manoeuvre or a positive supine lateral head turn. Other tests are not usually required. […] Key diagnostic factors include the presence of risk factors, specific provoking positions, brief duration of vertigo, episodic vertigo, severe episodes of vertigo, sudden onset of vertigo, nausea, imbalance, and lightheadedness, absence of associated neurological or otological symptoms, normal neurological examination, positive Dix-Hallpike manoeuvre or positive supine lateral head turn, and normal otological examination. […] 1st investigations to order include the Dix-Hallpike manoeuvre and supine lateral head turns.

• #11 Dix-Hallpike Maneuver: Test, Purpose & Results

  https://my.clevelandclinic.org/health/treatments/24859-dix-hallpike-maneuver

  The Dix-Hallpike maneuver is a test that healthcare providers use to diagnose benign paroxysmal positional vertigo (BPPV). […] Since 1952, healthcare providers have used the Dix-Hallpike Maneuver to diagnose BPPV. Its still the gold standard in use today. […] Providers use the Dix-Hallpike maneuver to diagnose BPPV, a common type of vertigo. […] If you have nystagmus, then it probably means you have BPPV. […] A positive result means that your vertigo symptoms result from BPPV. […] A proper diagnosis is important because the Epley maneuver only works for BPPV not for other types of vertigo. […] Healthcare providers have been using the Dix-Hallpike maneuver to diagnose BPPV for over 70 years. Its a quick, noninvasive and still one of the most accurate diagnostic tests available. The Dix-Hallpike maneuver cant treat BPPV, but it can tell your provider whether you have BPPV so they can recommend appropriate treatment.

• #12 Benign Paroxysmal Positional Vertigo (BPPV) | Doctor

  https://patient.info/doctor/benign-paroxysmal-positional-vertigo-pro

  Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo which is experienced as the illusion of movement. […] Diagnosing BPPV (investigations) The Hallpike (or Dix-Hallpike) manoeuvre can be used to check for BPPV in adults with vertigo on head movement. […] A positive result is one that provokes vertigo and torsional (rotatory) upbeating nystagmus (the upper pole of the eye beats towards the dependent ear with the vertical component towards the forehead when looking straight ahead). […] If BPPV is confirmed, treatment to relieve it using a canalith repositioning manoeuvre can be given. […] The Semont manoeuvre can be used for people who have mobility or musculo-skeletal issues which make the Hallpike manoeuvre difficult or impossible. […] If symptoms have not settled by a week and the diagnosis of BPPV is highly likely, consider repeating Epley’s manoeuvre.

• #13 Diagnosis and management of benign paroxysmal positional vertigo (BPPV)

  https://pmc.ncbi.nlm.nih.gov/articles/PMC202288/

  THERE IS COMPELLING EVIDENCE THAT FREE-FLOATING endolymph particles in the posterior semicircular canal underlie most cases of benign paroxysmal positional vertigo (BPPV). […] It is a condition that is usually easily diagnosed and, even more importantly, most cases are readily treatable with a simple office-based procedure. […] In this paper, we review the normal vestibular physiology, discuss the pathophysiology and causes of BPPV, and then go on to discuss diagnoses, office-based management and, finally, surgical management. […] The use of the DixHallpike manoeuvre to diagnose posterior canal BPPV was first described in 1952. […] Overall, the history and eye-findings during positional testing are the gold standards for diagnosing BPPV. […] A certain subset of patients may not demonstrate the typical nystagmus during the DixHallpike manoeuvre, but they may still experience the classic vertigo during positioning.

• #14 Benign Paroxysmal Positional Vertigo: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/884261-overview

  Benign paroxysmal positional vertigo (BPPV) is defined as an abnormal sensation of motion that is elicited by certain critical provocative positions. The Dix-Hallpike maneuver is the standard clinical test for BPPV. The finding of classic rotatory nystagmus with latency and limited duration is considered pathognomonic. A negative test result is meaningless except to indicate that active canalithiasis is not present at that moment. […] Treatment options for BPPV include watchful waiting, vestibulosuppressant medication, vestibular rehabilitation, canalith repositioning, and surgery. Since the benefit-to-risk ratio is so high with canalith repositioning, it appears to be the obvious first choice among treatment modalities. […] The Dix-Hallpike maneuver is performed by rapidly moving the patient from a sitting position to the supine position with the head turned 45 to the right. After waiting approximately 20-30 seconds, the patient is returned to the sitting position. If no nystagmus is observed, the procedure is then repeated on the left side.

• #15 Benign Paroxysmal Positional Vertigo – Zero To Finals

  https://zerotofinals.com/surgery/ent/bppv/

  Benign paroxysmal positional vertigo (BPPV) is a common cause of recurrent episodes of vertigo triggered by head movement. It is a peripheral cause of vertigo, meaning the problem is located in the inner ear rather than the brain. It is more common in older adults. […] The Dix-Hallpike manoeuvre can be used to diagnose BPPV (Dix for Dx – diagnosis). It involves moving the patient’s head in a way that moves endolymph through the semicircular canals and triggers vertigo in patients with BPPV. […] In patients with BPPV, the Dix-Hallpike manoeuvre will trigger rotational nystagmus and symptoms of vertigo. The eye will have rotational beats of nystagmus towards the affected ear (clockwise with left ear and anti-clockwise for right ear BPPV).

• #16 Benign Paroxysmal Positional Vertigo: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/884261-overview

  Benign paroxysmal positional vertigo (BPPV) is defined as an abnormal sensation of motion that is elicited by certain critical provocative positions. The Dix-Hallpike maneuver is the standard clinical test for BPPV. The finding of classic rotatory nystagmus with latency and limited duration is considered pathognomonic. A negative test result is meaningless except to indicate that active canalithiasis is not present at that moment. […] Treatment options for BPPV include watchful waiting, vestibulosuppressant medication, vestibular rehabilitation, canalith repositioning, and surgery. Since the benefit-to-risk ratio is so high with canalith repositioning, it appears to be the obvious first choice among treatment modalities. […] The Dix-Hallpike maneuver is performed by rapidly moving the patient from a sitting position to the supine position with the head turned 45 to the right. After waiting approximately 20-30 seconds, the patient is returned to the sitting position. If no nystagmus is observed, the procedure is then repeated on the left side.

• #17 Dix-Hallpike Maneuver: Test, Purpose & Results

  https://my.clevelandclinic.org/health/treatments/24859-dix-hallpike-maneuver

  The Dix-Hallpike maneuver is a test that healthcare providers use to diagnose benign paroxysmal positional vertigo (BPPV). […] Since 1952, healthcare providers have used the Dix-Hallpike Maneuver to diagnose BPPV. Its still the gold standard in use today. […] Providers use the Dix-Hallpike maneuver to diagnose BPPV, a common type of vertigo. […] If you have nystagmus, then it probably means you have BPPV. […] A positive result means that your vertigo symptoms result from BPPV. […] A proper diagnosis is important because the Epley maneuver only works for BPPV not for other types of vertigo. […] Healthcare providers have been using the Dix-Hallpike maneuver to diagnose BPPV for over 70 years. Its a quick, noninvasive and still one of the most accurate diagnostic tests available. The Dix-Hallpike maneuver cant treat BPPV, but it can tell your provider whether you have BPPV so they can recommend appropriate treatment.

• #18 Benign paroxysmal positional vertigo: Effective diagnosis and treatment | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/89/11/653

  BPPV is relatively simple to diagnose and treat. By moving the patient into different positions, observing their eye movements, and asking if they feel like their head is spinning, clinicians can determine which semicircular canal is being stimulated. […] The variants of BPPV affecting the vertical semicircular canals (ie, the posterior and anterior) are diagnosed by performing the Dix-Hallpike maneuver. […] Recent clinical practice guidelines outline that proper diagnosis of BPPV is made when both patient-reported symptoms and the appropriate nystagmus pattern are observed during position changes. […] If these maneuvers elicit symptoms and nystagmus, consider treatment for BPPV or refer the patient to a vestibular physical therapist or vestibular audiologist to perform the treatment maneuver.

• #19 Benign Paroxysmal Positional Vertigo (BPPV) | Doctor

  https://patient.info/doctor/benign-paroxysmal-positional-vertigo-pro

  Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo which is experienced as the illusion of movement. […] Diagnosing BPPV (investigations) The Hallpike (or Dix-Hallpike) manoeuvre can be used to check for BPPV in adults with vertigo on head movement. […] A positive result is one that provokes vertigo and torsional (rotatory) upbeating nystagmus (the upper pole of the eye beats towards the dependent ear with the vertical component towards the forehead when looking straight ahead). […] If BPPV is confirmed, treatment to relieve it using a canalith repositioning manoeuvre can be given. […] The Semont manoeuvre can be used for people who have mobility or musculo-skeletal issues which make the Hallpike manoeuvre difficult or impossible. […] If symptoms have not settled by a week and the diagnosis of BPPV is highly likely, consider repeating Epley’s manoeuvre.

• #20

  https://journals.lww.com/mtsm/fulltext/2023/07040/diagnostic_criteria_of_benign_paroxysmal.1.aspx

  Benign paroxysmal positional vertigo (BPPV) is the most common cause of peripheral vertigo. […] The observation of positional and/or positioning nystagmus is needed for the diagnosis of BPPV. […] The diagnosis of BPPV is supported if the changes in head position with respect to gravity-induced symptoms and elicit the patterns characteristic of BPPV. […] The complete diagnosis of BPPV includes the specification of the affected semicircular canal(s) and the pathophysiology such as canalolithiasis or cupulolithiasis. […] The exact diagnosis of BPPV needs diagnostic positional maneuvers that lead to the observation of canal-specific positional nystagmus. […] The clinical features such as latency, direction, time course, and duration of the positional nystagmus are important parts of getting the diagnosis.

• #21 :: JCN :: Journal of Clinical Neurology

  https://www.thejcn.com/DOIx.php?id=10.3988/jcn.2010.6.2.51

  Benign paroxysmal positional vertigo (BPPV) is characterized by brief recurrent episodes of vertigo triggered by changes in head position. BPPV is the most common etiology of recurrent vertigo and is caused by abnormal stimulation of the cupula by free-floating otoliths (canalolithiasis) or otoliths that have adhered to the cupula (cupulolithiasis) within any of the three semicircular canals. Typical symptoms and signs of BPPV are evoked when the head is positioned so that the plane of the affected semicircular canal is spatially vertical and thus aligned with gravity. […] Each type of BPPV is diagnosed by observing the patterns of nystagmus induced during positioning maneuvers that have been designed to move only the involved canal in the direction of maximal gravity. However, accurate observations of the nystagmus require the fixation to be removed during the maneuvers.

• #22 Benign Paroxysmal Positional Vertigo – Ear, Nose, and Throat Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/ear-nose-and-throat-disorders/inner-ear-disorders/benign-paroxysmal-positional-vertigo

  Benign paroxysmal positional vertigo (BPPV) is a common disorder causing short episodes of vertigo (a false sensation of moving or spinning) in response to changes in head position that stimulate the posterior semicircular canal of the inner ear. […] Doctors base the diagnosis on symptoms and the situations in which they occur and results of a physical examination. […] Diagnosis of BPPV is based on a description of the symptoms and the circumstances in which they occur. […] Usually, the test used is the Dix-Hallpike maneuver. […] If the maneuver is repeated several times, the intensity of the vertigo and nystagmus decreases (called habituation or fatigability) in people who have BPPV. […] Sometimes imaging tests (such as gadolinium-enhanced magnetic resonance imaging) are done when doctors are not sure whether the vertigo is being caused by another, possibly dangerous, disorder.

• #23 Roll Test for Benign Paroxysmal Positional Vertigo (BPPV) | APTA

  https://www.apta.org/patient-care/evidence-based-practice-resources/test-measures/roll-test-for-benign-paroxysmal-positional-vertigo-bppv

  Used to confirm diagnosis of benign paroxysmal positional vertigo (BPPV) and identify the involved semicircular canal (SCC), most commonly the horizontal SCC. […] BPPV is classified according to: The SCC involved (posterior, anterior, horizontal) […] The involved SCC is determined based on the observation that nystagmus occurs when the patient is in the provoking position. […] In patients with horizontal SCC BPPV, the Hallpike-Dix Test and side-lying test might not provoke vertigo and nystagmus because the horizontal SCC is not placed in the plane of the pull of gravity. […] The direction of the nystagmus elicited (geotropic versus apogeotropic)-as well as duration of nystagmus-are used to identify the canalithiasis versus cupulolithiasis form of horizontal SCC BPPV. […] It is recommended, therefore, that clinicians note both the direction of the nystagmus and the duration of the nystagmus as criteria for distinguishing between horizontal SCC canalithiasis and cupulolithiasis. […] Using the roll test, in canalithiasis, the affected side is believed to be the side that is most symptomatic.

• #24 Benign paroxysmal positional vertigo – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/benign-paroxysmal-positional-vertigo/

  Benign paroxysmal positional vertigo (BPPV) is a clinical diagnosis that is supported by a combination of characteristic features as well as the presence of nystagmus and vertigo elicited by provoking maneuvers (e.g., Dix-Hallpike test). […] BPPV is a clinical diagnosis based on characteristic findings and elicitation of nystagmus and vertigo on provoking maneuvers for BPPV. […] All of the following criteria should be met to confirm the clinical diagnosis of posterior canal BPPV. […] The Dix-Hallpike maneuver should be performed in all patients with suspected BPPV to identify posterior canal BPPV. […] If the Dix-Hallpike maneuver is negative, the supine head roll test should be performed to assess for lateral canal BPPV. […] Positive Dix-Hallpike test: positional vertigo and nystagmus triggered during the maneuver.

• #25 :: JCN :: Journal of Clinical Neurology

  https://www.thejcn.com/DOIx.php?id=10.3988/jcn.2010.6.2.51

  In PC-BPPV, the positioning nystagmus is typically induced by Dix-Hallpike maneuvers in the direction of the involved canal. […] The Dix-Hallpike maneuver has been considered the gold standard for diagnosing PC-BPPV. […] HC-BPPV is diagnosed by the supine roll test (the Pagnini-McClure maneuver), in which the head is turned by about 90 to each side while supine. […] Determination of the involved side (lateralization) is very important for the proper treatment of HC-BPPV using CRMs. […] In BPPV, spontaneous reversal of the initial positioning nystagmus rarely occurs without further position changes.

• #26 Benign paroxysmal positional vertigo | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/benign-paroxysmal-positional-vertigo?lang=us

  Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of vertigo. It occurs secondary to change in posture and typically is associated with nystagmus. The etiology is thought to be due to changes of position of the otoliths in the inner ear, most commonly into the posterior semicircular canal. […] Classically, benign paroxysmal positional vertigo presents with recurrent, paroxysmal, short-lasting vertigo brought upon by sudden changes in head position, for example, rolling over in bed or hyperextending the neck. The vertigo occurs abruptly (sometimes seconds) and subsides quickly, usually less than one minute. Importantly, there is no hearing loss or tinnitus, and there are no associated symptoms of central nervous system disease. […] This vertigo is associated with nystagmus, that can be elicited to confirm the diagnosis via various clinical maneuvers depending on the canal that is affected: posterior canal BPPV: the Dix-Hallpike maneuver reveals upbeating-torsional nystagmus; horizontal canal BPPV: the log-roll maneuver reveals purely horizontal nystagmus; anterior canal BPPV: the Dix-Hallpike maneuver reveals downbeating-torsional nystagmus. […] Imaging is often not necessary because the diagnosis is clear cut from the history and clinical examination and should generally only be performed to exclude other causes for vertigo.

• #27 Roll Test for Benign Paroxysmal Positional Vertigo (BPPV) | APTA

  https://www.apta.org/patient-care/evidence-based-practice-resources/test-measures/roll-test-for-benign-paroxysmal-positional-vertigo-bppv

  Used to confirm diagnosis of benign paroxysmal positional vertigo (BPPV) and identify the involved semicircular canal (SCC), most commonly the horizontal SCC. […] BPPV is classified according to: The SCC involved (posterior, anterior, horizontal) […] The involved SCC is determined based on the observation that nystagmus occurs when the patient is in the provoking position. […] In patients with horizontal SCC BPPV, the Hallpike-Dix Test and side-lying test might not provoke vertigo and nystagmus because the horizontal SCC is not placed in the plane of the pull of gravity. […] The direction of the nystagmus elicited (geotropic versus apogeotropic)-as well as duration of nystagmus-are used to identify the canalithiasis versus cupulolithiasis form of horizontal SCC BPPV. […] It is recommended, therefore, that clinicians note both the direction of the nystagmus and the duration of the nystagmus as criteria for distinguishing between horizontal SCC canalithiasis and cupulolithiasis. […] Using the roll test, in canalithiasis, the affected side is believed to be the side that is most symptomatic.

• #28

  https://journals.lww.com/mtsm/fulltext/2023/07040/diagnostic_criteria_of_benign_paroxysmal.1.aspx

  The diagnostic criteria of posterior canal-BPPV (pc-BPPV) include: (a) The recurrent attacks of positional vertigo or positional dizziness are provoked by lying down or turning over in the supine position. […] The diagnostic criteria of hc-BPPV include: (a) Attacks of rotatory vertigo or dizziness are occurred by changes in the head position relative to gravity. […] The diagnostic criteria of the anterior canal-BPPV include: (a) Recurrent episodes of positional vertigo or positional dizziness induced by lying down or turning over in the supine position. […] The diagnostic criteria of the pc-BPPV-cupulolithiasis include: (a) Recurrent episodes of positional vertigo or positional dizziness provoked by lying down or turning over in the supine position. […] The diagnostic criteria of hc-BPPV-cupulolithiasis include: (a) Attacks of rotatory vertigo or dizziness are induced by specific head positions. […] The diagnostic criteria of multiple semicircular canals-BPPV include (a) Recurrent episodes of positional vertigo or positional dizziness provoked by lying down or turning over in the supine position. […] A diagnosis of BPPV is often made through clinical history along with diagnostic maneuvers.

• #29 Benign Paroxysmal Positional Vertigo (BPPV) – Vestibular Disorders Association

  https://vestibular.org/article/diagnosis-treatment/types-of-vestibular-disorders/benign-paroxysmal-positional-vertigo-bppv/

  Benign Paroxysmal Positional Vertigo (or BPPV) is the most common cause of vertigo, which is a false sensation of spinning. […] Normal medical imaging (e.g., an MRI) is not effective in diagnosing BPPV, because it does not show the crystals that have moved into the semicircular canals. However, when someone with BPPV has their head moved into a position that makes the dislodged crystals move within a canal, the error signals cause the eyes to move in a very specific pattern, called nystagmus. […] The most common form of BPPV causes rotational, or torsional, nystagmus which is why most people with BPPV related vertigo report a spinning sensation. […] Tests like the Dix-Hallpike or Roll Tests involve moving the head into specific orientations, which allow gravity to move the dislodged crystals and trigger the vertigo while the practitioner watches for the tell-tale eye movements, or nystagmus.

• #30

  https://journals.lww.com/mtsm/fulltext/2023/07040/diagnostic_criteria_of_benign_paroxysmal.1.aspx

  The diagnostic criteria of posterior canal-BPPV (pc-BPPV) include: (a) The recurrent attacks of positional vertigo or positional dizziness are provoked by lying down or turning over in the supine position. […] The diagnostic criteria of hc-BPPV include: (a) Attacks of rotatory vertigo or dizziness are occurred by changes in the head position relative to gravity. […] The diagnostic criteria of the anterior canal-BPPV include: (a) Recurrent episodes of positional vertigo or positional dizziness induced by lying down or turning over in the supine position. […] The diagnostic criteria of the pc-BPPV-cupulolithiasis include: (a) Recurrent episodes of positional vertigo or positional dizziness provoked by lying down or turning over in the supine position. […] The diagnostic criteria of hc-BPPV-cupulolithiasis include: (a) Attacks of rotatory vertigo or dizziness are induced by specific head positions. […] The diagnostic criteria of multiple semicircular canals-BPPV include (a) Recurrent episodes of positional vertigo or positional dizziness provoked by lying down or turning over in the supine position. […] A diagnosis of BPPV is often made through clinical history along with diagnostic maneuvers.

• #31 Benign paroxysmal positional vertigo | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/benign-paroxysmal-positional-vertigo?lang=us

  Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of vertigo. It occurs secondary to change in posture and typically is associated with nystagmus. The etiology is thought to be due to changes of position of the otoliths in the inner ear, most commonly into the posterior semicircular canal. […] Classically, benign paroxysmal positional vertigo presents with recurrent, paroxysmal, short-lasting vertigo brought upon by sudden changes in head position, for example, rolling over in bed or hyperextending the neck. The vertigo occurs abruptly (sometimes seconds) and subsides quickly, usually less than one minute. Importantly, there is no hearing loss or tinnitus, and there are no associated symptoms of central nervous system disease. […] This vertigo is associated with nystagmus, that can be elicited to confirm the diagnosis via various clinical maneuvers depending on the canal that is affected: posterior canal BPPV: the Dix-Hallpike maneuver reveals upbeating-torsional nystagmus; horizontal canal BPPV: the log-roll maneuver reveals purely horizontal nystagmus; anterior canal BPPV: the Dix-Hallpike maneuver reveals downbeating-torsional nystagmus. […] Imaging is often not necessary because the diagnosis is clear cut from the history and clinical examination and should generally only be performed to exclude other causes for vertigo.

• #32 Benign Paroxysmal Positional Vertigo (BPPV) – Vestibular Disorders Association

  https://vestibular.org/article/diagnosis-treatment/types-of-vestibular-disorders/benign-paroxysmal-positional-vertigo-bppv/

  There are two types of BPPV: one where the loose crystals can move freely in the fluid of the canal (canalithiasis), and, more rarely, one where the crystals are thought to be hung up on the bundle of nerves that sense the fluid movement (cupulolithiasis). […] The nystagmus will have different characteristics that allow a trained practitioner to identify which ear the displaced crystals are in, and which canal(s) they have moved into. […] It is important to make this distinction, as the treatment is different for each variant. […] Once your healthcare provider knows which canal(s) the crystals are in, and whether it is canalithiasis or cupulolithiasis, then they can take you through the appropriate treatment maneuver. […] Many studies have been done into the effectiveness of treatment maneuvers for BPPV, with results showing rates of resolution well into the 90% range by 1-3 treatments.

• #33 Benign paroxysmal positional vertigo – UpToDate

  https://www.uptodate.com/contents/benign-paroxysmal-positional-vertigo

  Benign paroxysmal positional vertigo (BPPV) is a common form of vertigo, accounting for nearly one-half of patients with peripheral vestibular dysfunction. It is most commonly attributed to calcium debris within the posterior semicircular canal, known as canalithiasis. While symptoms can be troublesome, the disorder usually responds to treatment with particle-repositioning maneuvers, an office-based procedure and one that patients can be taught to perform at home. […] BPPV is commonly attributed to canalithiasis (ie, calcium debris within the semicircular canal). This debris likely represents loose otoconia (calcium carbonate crystals) originating from the utricular sac. […] The semicircular canals normally detect angular head accelerations. Heavy debris in the canal causes inappropriate movement of the endolymph with linear accelerations, such as gravity, and causes the erroneous sensation of spinning when the head shifts with respect to gravity.

• #34 Benign Paroxysmal Positional Vertigo (BPPV)

  https://www.earscience.org.au/lions-hearing-clinic/vertigo-balance-and-dizziness/benign-paroxysmal-positional-vertigo-bppv/

  The likelihood of onset is known to increase with age. […] Head trauma can cause BPPV, and evidence suggests that hormonal factors can affect BPPV, with a significant association between benign positional vertigo and osteopenia/osteoporosis. […] BPPV most commonly affects the posterior semicircular canal, but the horizontal and anterior canals can also be affected. […] The affected canal will determine the sorts of movements that will trigger the dizziness and the direction of spinning sensations that the BPPV sufferer will experience. […] There are two types of BPPV. […] The most common type is canalithiasis, in which the ear crystals are free-floating within the fluid in the semicircular canal. […] The second, much rarer type is cupulolithiasis. […] Positional vertigo is diagnosed with the use of positioning manoeuvres which aim to evoke the BPPV symptoms and record eye movements while it is occurring. […] By combining information about the activity that elicits the response and eye movement direction, the specialist can establish which canal the ear crystals are in.

• #35 Benign Paroxysmal Positional Vertigo Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/884261-workup

  Because the Dix-Hallpike maneuver is pathognomonic, laboratory tests are not needed to make the diagnosis of benign paroxysmal positional vertigo (BPPV). However, since a high association with inner ear disease exists, laboratory workup may be needed to delineate these other pathologies. […] Imaging studies are not needed in the workup of a patient in whom BPPV is suspected. […] The Dix-Hallpike maneuver is the standard clinical test for BPPV.

• #36 Benign Paroxysmal Positional Vertigo – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470308/

  Benign paroxysmal positional vertigo (BPPV) is the most common cause of peripheral vertigo, accounting for over half of all cases. […] It is crucial to distinguish BPPV from other causes of vertigo as the differential diagnosis includes a spectrum of disease processes ranging from benign to life-threatening. […] The Dix-Hallpike test is pathognomonic, which is why laboratory tests are not indicated to establish the diagnosis of benign paroxysmal positional vertigo. […] Benign paroxysmal positional vertigo is largely a clinical diagnosis, and often, the battery of laboratory and imaging tests ordered only helps rule out other possibilities. […] The initial step in managing benign paroxysmal positional vertigo is patient education and proper counseling. […] The Epley maneuver can be performed after using the Dix-Hallpike maneuver to localize the problematic side.

• #37 Benign paroxysmal positional vertigo (BPPV) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/vertigo/diagnosis-treatment/drc-20370060

  Your doctor may do a series of tests to determine the cause of your dizziness. During a physical exam, your doctor will likely look for: […] If your doctor can’t find the cause of your signs and symptoms, he or she may order additional testing, such as: […] Electronystagmography (ENG) or videonystagmography (VNG). The purpose of these tests is to detect abnormal eye movement. ENG (which uses electrodes) or VNG (which uses small cameras) can help determine if dizziness is due to inner ear disease by measuring involuntary eye movements while your head is placed in different positions or your balance organs are stimulated with water or air. […] Magnetic resonance imaging (MRI). This test uses a magnetic field and radio waves to create cross-sectional images of your head and body. Your doctor can use these images to identify and diagnose a range of conditions. MRI may be performed to rule out other possible causes of vertigo.

• #38 Benign paroxysmal positional vertigo (BPPV) // Middlesex Health

  https://middlesexhealth.org/learning-center/diseases-and-conditions/benign-paroxysmal-positional-vertigo-bppv

  Electronystagmography (ENG) or videonystagmography (VNG). The purpose of these tests is to detect abnormal eye movement. […] Magnetic resonance imaging (MRI). This test uses a magnetic field and radio waves to create cross-sectional images of your head and body. Your doctor can use these images to identify and diagnose a range of conditions. MRI may be performed to rule out other possible causes of vertigo.

• #39 Benign Paroxysmal Positional Vertigo | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions/b/benign-paroxysmal-positional-vertigo.html

  Benign paroxysmal positional vertigo (BPPV) is a disease of the vestibular (balance) system of your inner ear. […] BPPV may be diagnosed and treated by your primary healthcare provider, an ear, nose, and throat (ENT) doctor (otolaryngologist), a neurologist, or often an emergency room healthcare provider. The provider will ask about your health history. You may also have a physical exam. This may include hearing and balance tests. It will also include an exam of the nervous and cardiovascular systems. Problems with these systems can also cause vertigo. […] If your healthcare provider is still not sure about the diagnosis, you may need other tests such as: ENG (electronystagmography). This test uses electrodes to test your eye movements in response to stimuli that may cause your vertigo. […] VNG (videonystagmography). This test is similar to an ENG but it uses cameras instead. Your eyes are a part of your sense of balance. So ENG and VNG tests may help find the cause of your vertigo. […] Imaging tests. Tests such as an MRI can help rule out nervous system problems as a cause.

• #40 Benign Paroxysmal Positional Vertigo – Ear, Nose, and Throat Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/ear-nose-and-throat-disorders/inner-ear-disorders/benign-paroxysmal-positional-vertigo

  In benign paroxysmal positional vertigo, short (60 seconds) episodes of vertigo occur with certain head positions. […] Diagnosis is clinical. […] The diagnosis of BPPV is based on characteristic symptoms, nystagmus elicited by the Dix-Hallpike maneuver (also called the Barany maneuver), and the absence of other abnormalities noted during neurologic examination. Such patients require no further testing. […] If patients have nystagmus suggesting a CNS lesion, gadolinium-enhanced MRI of the brain and internal auditory canal is performed. […] Diagnosis is clinical, but some patients require MRI to rule out other conditions.

• #41 Benign paroxysmal positional vertigo (BPPV): Causes and treatment

  https://www.medicalnewstoday.com/articles/326157

  Benign paroxysmal positional vertigo, or BPPV, is a common cause of vertigo. […] A doctor can confirm BPPV after reviewing a person’s symptoms and medical history. They may perform a physical examination and inspect the ear for signs that could indicate a different underlying condition. […] Tests that a doctor can use to help them diagnose BPPV include: Dix-Hallpike test. During this test, a person lies on their back while a doctor rotates their head. These movements should induce vertigo if the person has BPPV. A doctor will also look for rapid eye movements that indicate nystagmus. […] Electronystagmography (ENG). A doctor will use this test to record a person’s eye movements under different conditions, such as when looking at a light or moving the head. […] Electroencephalogram (EEG). A doctor can use an EEG to measure brain activity and rule out any possible underlying neurological conditions. […] MRI scan. If a doctor cannot confirm a diagnosis, they may use an MRI to examine the head and inner ears.

• #42 Benign paroxysmal positional vertigo (BPPV) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/vertigo/diagnosis-treatment/drc-20370060

  Your doctor may do a series of tests to determine the cause of your dizziness. During a physical exam, your doctor will likely look for: […] If your doctor can’t find the cause of your signs and symptoms, he or she may order additional testing, such as: […] Electronystagmography (ENG) or videonystagmography (VNG). The purpose of these tests is to detect abnormal eye movement. ENG (which uses electrodes) or VNG (which uses small cameras) can help determine if dizziness is due to inner ear disease by measuring involuntary eye movements while your head is placed in different positions or your balance organs are stimulated with water or air. […] Magnetic resonance imaging (MRI). This test uses a magnetic field and radio waves to create cross-sectional images of your head and body. Your doctor can use these images to identify and diagnose a range of conditions. MRI may be performed to rule out other possible causes of vertigo.

• #43 Benign Paroxysmal Positional Vertigo | Cedars-Sinai

  https://www.cedars-sinai.org/health-library/diseases-and-conditions/b/benign-paroxysmal-positional-vertigo.html

  Benign paroxysmal positional vertigo (BPPV) is a disease of the vestibular (balance) system of your inner ear. […] BPPV may be diagnosed and treated by your primary healthcare provider, an ear, nose, and throat (ENT) doctor (otolaryngologist), a neurologist, or often an emergency room healthcare provider. The provider will ask about your health history. You may also have a physical exam. This may include hearing and balance tests. It will also include an exam of the nervous and cardiovascular systems. Problems with these systems can also cause vertigo. […] If your healthcare provider is still not sure about the diagnosis, you may need other tests such as: ENG (electronystagmography). This test uses electrodes to test your eye movements in response to stimuli that may cause your vertigo. […] VNG (videonystagmography). This test is similar to an ENG but it uses cameras instead. Your eyes are a part of your sense of balance. So ENG and VNG tests may help find the cause of your vertigo. […] Imaging tests. Tests such as an MRI can help rule out nervous system problems as a cause.

• #44 Benign Paroxysmal Positional Vertigo

  http://library.oumedicine.com/Search/134,512

  ENG (electronystagmography). This test uses electrodes to test your eye movements in response to stimuli that may cause your vertigo. […] VNG (videonystagmography). This test is similar to an ENG, but it uses cameras instead. Your eyes are a part of your sense of balance. So ENG and VNG tests may help find the cause of your vertigo. […] Imaging tests. Tests such as an MRI can help rule out nervous system problems as a cause.

• #45 Benign Paroxysmal Positional Vertigo (BPPV)

  https://www.verywellhealth.com/what-is-bppv-1191874

  BPPV is diagnosed using a combination of medical tests including patient history and a physical examination. […] BPPV is usually accompanied by nystagmus, a subtle „jumping” of the eyes. Your healthcare provider may look for this with a diagnostic test called the Dix-Hallpike maneuver. This involves turning your head 45 degrees to the side and quickly laying down with your head just over the edge of the examining table. This motion typically brings on vertigo and signs of nystagmus. […] A test called electronystagmography (ENG), which uses electrodes to examine eye movements and nerves in the brain, can also identify nystagmus. […] BPPV is often misdiagnosed. In fact, disorders that cause dizziness are thought to be incorrectly diagnosed around 74% to 81% of the time. Common misdiagnoses include vestibular neuritis and stroke. […] To arrive at an accurate diagnosis, your healthcare provider may order an MRI to rule out other disorders including stroke or tumor.

• #46 Benign Paroxysmal Positional Vertigo Workup: Laboratory Studies, Imaging Studies, Other Tests

  https://emedicine.medscape.com/article/884261-workup

  Because the Dix-Hallpike maneuver is pathognomonic, laboratory tests are not needed to make the diagnosis of benign paroxysmal positional vertigo (BPPV). However, since a high association with inner ear disease exists, laboratory workup may be needed to delineate these other pathologies. […] Imaging studies are not needed in the workup of a patient in whom BPPV is suspected. […] The Dix-Hallpike maneuver is the standard clinical test for BPPV.

• #47 Benign paroxysmal positional vertigo (BPPV) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/vertigo/diagnosis-treatment/drc-20370060

  Your doctor may do a series of tests to determine the cause of your dizziness. During a physical exam, your doctor will likely look for: […] If your doctor can’t find the cause of your signs and symptoms, he or she may order additional testing, such as: […] Electronystagmography (ENG) or videonystagmography (VNG). The purpose of these tests is to detect abnormal eye movement. ENG (which uses electrodes) or VNG (which uses small cameras) can help determine if dizziness is due to inner ear disease by measuring involuntary eye movements while your head is placed in different positions or your balance organs are stimulated with water or air. […] Magnetic resonance imaging (MRI). This test uses a magnetic field and radio waves to create cross-sectional images of your head and body. Your doctor can use these images to identify and diagnose a range of conditions. MRI may be performed to rule out other possible causes of vertigo.

• #48 Benign Paroxysmal Positional Vertigo – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470308/

  Most patients with BPPV get better with repositioning maneuvers or resolve completely. However, surgical intervention is reserved for refractory cases. […] Benign paroxysmal positional vertigo may have the following differential diagnoses: Meniere disease, inner ear concussion, alcohol intoxication, labyrinthitis or vestibular neuronitis, vascular loop syndrome, positional nystagmus of central origin, lesion of the modulus from conditions such as stroke, Arnold-Chiari malformation, multiple sclerosis, cerebellar degeneration, ischemia, and intoxication, acoustic neuroma and meningioma, vertebral artery insufficiency, orthostatic hypotension. […] One-third of patients have remission at 3 weeks. The majority of patients remit at 6 months. […] Recurrence rates are variable in the literature, with 1 study observing an 18% recurrence rate over 10 years.

• #49 Benign Paroxysmal Positional Vertigo – Ear, Nose, and Throat Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/ear-nose-and-throat-disorders/inner-ear-disorders/benign-paroxysmal-positional-vertigo

  In benign paroxysmal positional vertigo, short (60 seconds) episodes of vertigo occur with certain head positions. […] Diagnosis is clinical. […] The diagnosis of BPPV is based on characteristic symptoms, nystagmus elicited by the Dix-Hallpike maneuver (also called the Barany maneuver), and the absence of other abnormalities noted during neurologic examination. Such patients require no further testing. […] If patients have nystagmus suggesting a CNS lesion, gadolinium-enhanced MRI of the brain and internal auditory canal is performed. […] Diagnosis is clinical, but some patients require MRI to rule out other conditions.

• #50 Benign Paroxysmal Positional Vertigo ENT Treatment in Utah – ENT Center of Utah

  https://entcenterutah.com/adult-care/dizziness-balance/benign-vertigo/

  If the cause of your signs and symptoms is difficult to determine, your doctor may order additional testing, such as: Videonystagmography (VNG). The purpose of this test is to detect abnormal eye movement. VNG (which uses small cameras) can help determine if dizziness is due to inner ear disease by measuring involuntary eye movements while your head is placed in different positions. Magnetic resonance imaging (MRI). This test uses a magnetic field and radio waves to create cross-sectional images of your head and body. Your doctor can use these images to identify and diagnose a range of conditions. MRI may be performed to rule out other possible causes of vertigo.

• #51 Benign paroxysmal positional vertigo – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/benign-paroxysmal-positional-vertigo/

  Positive test: Perform Epley repositioning maneuver. […] Negative test: BPPV not necessarily ruled out. […] Vestibular function tests: tests to identify nystagmus in response to vestibular stimulation and thereby assess the integrity and function of the vestibular apparatus of the inner ear. […] Audiometry: supportive findings are typically normal in BPPV. […] Neuroimaging: to rule out intracranial causes of vertigo.

• #52 Benign paroxysmal positional vertigo – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/benign-paroxysmal-positional-vertigo/

  Positive test: Perform Epley repositioning maneuver. […] Negative test: BPPV not necessarily ruled out. […] Vestibular function tests: tests to identify nystagmus in response to vestibular stimulation and thereby assess the integrity and function of the vestibular apparatus of the inner ear. […] Audiometry: supportive findings are typically normal in BPPV. […] Neuroimaging: to rule out intracranial causes of vertigo.

• #53 Benign Paroxysmal Positional Vertigo (BPPV) | Ear, Nose and Throat Care | Mercy Health

  https://www.mercy.com/health-care-services/ear-nose-throat-ent/conditions/benign-paroxysmal-positional-vertigo

  BPPV can be diagnosed with a Dix-Hallpike test during a physical exam. Your doctor, typically an otolaryngologist, will hold your head while instructing you to quickly lie down on a table. Your doctor will examine your eyes for abnormal movements and ask if you feel like you are spinning or swaying. […] Other tests that your doctor may order include: […] Neurological exam determines if you have any other conditions that may cause similar symptoms […] Caloric stimulation observes eye movements by warming and cooling the inner ear with water […] Imaging MRI, MRA or CT scan of the head and brain […] Hearing exam […] Electronystagmography records movement of the eyes […] Electroencephalogram measures activity in the brain.

• #54 Diagnosing Benign Paroxysmal Positional Vertigo by Historylogo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b

  https://www.jwatch.org/na51093/2020/03/12/diagnosing-benign-paroxysmal-positional-vertigo-history

  Responses to three questions had sensitivity of 87% and specificity of 90% for BPPV. […] Benign paroxysmal positional vertigo (BPPV) is characterized by brief episodes of vertigo that last less than 1 minute and are provoked by head movement. […] To examine the diagnostic accuracy of a simple set of questions, Korean researchers created a 6-item questionnaire and tested it on 578 consecutive patients referred to a university “dizziness clinic”; 32% ultimately received BPPV diagnoses, and the others received various other diagnoses according to history, neurotological examination, and video-oculography (all conducted by an expert in this field). […] Among patients who answered “yes” to all three questions, 80% received BPPV diagnoses (positive predictive value). Among patients who answered “no” to any of these questions, 94% did not have BPPV (negative predictive value); sensitivity was 87%, and specificity was 90%.

• #55 Diagnosing Benign Paroxysmal Positional Vertigo by Historylogo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b

  https://www.jwatch.org/na51093/2020/03/12/diagnosing-benign-paroxysmal-positional-vertigo-history

  Responses to three questions had sensitivity of 87% and specificity of 90% for BPPV. […] Benign paroxysmal positional vertigo (BPPV) is characterized by brief episodes of vertigo that last less than 1 minute and are provoked by head movement. […] To examine the diagnostic accuracy of a simple set of questions, Korean researchers created a 6-item questionnaire and tested it on 578 consecutive patients referred to a university “dizziness clinic”; 32% ultimately received BPPV diagnoses, and the others received various other diagnoses according to history, neurotological examination, and video-oculography (all conducted by an expert in this field). […] Among patients who answered “yes” to all three questions, 80% received BPPV diagnoses (positive predictive value). Among patients who answered “no” to any of these questions, 94% did not have BPPV (negative predictive value); sensitivity was 87%, and specificity was 90%.

• #56 Diagnosing Benign Paroxysmal Positional Vertigo by Historylogo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b

  https://www.jwatch.org/na51093/2020/03/12/diagnosing-benign-paroxysmal-positional-vertigo-history

  Responses to three questions had sensitivity of 87% and specificity of 90% for BPPV. […] Benign paroxysmal positional vertigo (BPPV) is characterized by brief episodes of vertigo that last less than 1 minute and are provoked by head movement. […] To examine the diagnostic accuracy of a simple set of questions, Korean researchers created a 6-item questionnaire and tested it on 578 consecutive patients referred to a university “dizziness clinic”; 32% ultimately received BPPV diagnoses, and the others received various other diagnoses according to history, neurotological examination, and video-oculography (all conducted by an expert in this field). […] Among patients who answered “yes” to all three questions, 80% received BPPV diagnoses (positive predictive value). Among patients who answered “no” to any of these questions, 94% did not have BPPV (negative predictive value); sensitivity was 87%, and specificity was 90%.

• #57 Diagnosing Benign Paroxysmal Positional Vertigo by Historylogo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b

  https://www.jwatch.org/na51093/2020/03/12/diagnosing-benign-paroxysmal-positional-vertigo-history

  The other three questions were designed to determine more specifically which ear was affected and which subtype of BPPV was present. […] These findings could be of use to primary care physicians, particularly when making a tentative diagnosis over the phone or during an office visit when a provocative maneuver (e.g., Dix-Hallpike) is equivocal or cannot be done.

• #58 Benign Paroxysmal Positional Vertigo – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470308/

  Most patients with BPPV get better with repositioning maneuvers or resolve completely. However, surgical intervention is reserved for refractory cases. […] Benign paroxysmal positional vertigo may have the following differential diagnoses: Meniere disease, inner ear concussion, alcohol intoxication, labyrinthitis or vestibular neuronitis, vascular loop syndrome, positional nystagmus of central origin, lesion of the modulus from conditions such as stroke, Arnold-Chiari malformation, multiple sclerosis, cerebellar degeneration, ischemia, and intoxication, acoustic neuroma and meningioma, vertebral artery insufficiency, orthostatic hypotension. […] One-third of patients have remission at 3 weeks. The majority of patients remit at 6 months. […] Recurrence rates are variable in the literature, with 1 study observing an 18% recurrence rate over 10 years.

• #59 Dizziness: Approach to Evaluation and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/0201/p154.html

  Episodic vertigo triggered by head motion may be due to benign paroxysmal positional vertigo. […] Benign paroxysmal positional vertigo can be treated with a canalith repositioning procedure (e.g., Epley maneuver). […] BPPV is diagnosed with the Dix-Hallpike maneuver. Transient upbeat-torsional nystagmus during the maneuver is diagnostic of BPPV if the timing and trigger are consistent with BPPV. […] BPPV occurs when loose otoconia, known as canaliths, become dislodged and enter the semicircular canals, usually the posterior canal. […] Treatment of BPPV consists of a canalith repositioning procedure such as the Epley maneuver, which repositions the canalith from the semicircular canal into the vestibule. […] Pharmacologic treatment has no role in the treatment of BPPV. Vestibular suppressant medications should be avoided because they interfere with central compensation and may increase the risk of falls.

• #60 Benign paroxysmal positional vertigo: Effective diagnosis and treatment | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/89/11/653

  Benign paroxysmal positional vertigo (BPPV), caused by wayward crystals (rocks) in the semicircular canals of the inner ear, is the most common cause of brief symptoms of vertigo secondary to head and body movements. Diagnosing and treating it are simple to do in the medical office. This article reviews the differential diagnosis for patients presenting with dizziness and vertigo, the pathophysiology of BPPV, how to diagnose it using maneuvers to elicit symptoms and nystagmus, how to interpret the nystagmus pattern to determine where the rocks are, and how to treat it using different maneuvers to reposition (roll) the rocks back where they belong. […] Dizziness or vertigo when lying down or changing positions is a strong predictor of BPPV. The condition is easily diagnosed with the Dix-Hallpike and supine roll maneuvers.

• #61 Benign Paroxysmal Positional Vertigo – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470308/

  Most patients with BPPV get better with repositioning maneuvers or resolve completely. However, surgical intervention is reserved for refractory cases. […] Benign paroxysmal positional vertigo may have the following differential diagnoses: Meniere disease, inner ear concussion, alcohol intoxication, labyrinthitis or vestibular neuronitis, vascular loop syndrome, positional nystagmus of central origin, lesion of the modulus from conditions such as stroke, Arnold-Chiari malformation, multiple sclerosis, cerebellar degeneration, ischemia, and intoxication, acoustic neuroma and meningioma, vertebral artery insufficiency, orthostatic hypotension. […] One-third of patients have remission at 3 weeks. The majority of patients remit at 6 months. […] Recurrence rates are variable in the literature, with 1 study observing an 18% recurrence rate over 10 years.

• #62 Benign Paroxysmal Positional Vertigo (BPPV) for ophthalmologists – EyeWiki

  https://eyewiki.org/Benign_Paroxysmal_Positional_Vertigo_(BPPV)_for_ophthalmologists

  Subjective BPPV is the sensation of vertigo during provocative maneuvers without nystagmus. […] Findings of down beating nystagmus on the Dix-Hallpike maneuver or direction-changing nystagmus occurring without changes in head position suggests a neurologic/central cause of vertigo and not peripheral, such as BPPV. […] BPPV can usually be treated using particle repositioning maneuvers. […] BPPV has an overall favorable prognosis for recovery because untreated episodes of BPPV usually resolve spontaneously. […] Ophthalmologists should be aware of BPPV. The roles of the ophthalmologist are to ensure that there are no ophthalmologic signs of central (rather than peripheral) vestibulopathy.

• #63 Benign Paroxysmal Positional Vertigo (BPPV) for ophthalmologists – EyeWiki

  https://eyewiki.org/Benign_Paroxysmal_Positional_Vertigo_(BPPV)_for_ophthalmologists

  Subjective BPPV is the sensation of vertigo during provocative maneuvers without nystagmus. […] Findings of down beating nystagmus on the Dix-Hallpike maneuver or direction-changing nystagmus occurring without changes in head position suggests a neurologic/central cause of vertigo and not peripheral, such as BPPV. […] BPPV can usually be treated using particle repositioning maneuvers. […] BPPV has an overall favorable prognosis for recovery because untreated episodes of BPPV usually resolve spontaneously. […] Ophthalmologists should be aware of BPPV. The roles of the ophthalmologist are to ensure that there are no ophthalmologic signs of central (rather than peripheral) vestibulopathy.

• #64 Benign Paroxysmal Positional Vertigo (BPPV) for ophthalmologists – EyeWiki

  https://eyewiki.org/Benign_Paroxysmal_Positional_Vertigo_(BPPV)_for_ophthalmologists

  Subjective BPPV is the sensation of vertigo during provocative maneuvers without nystagmus. […] Findings of down beating nystagmus on the Dix-Hallpike maneuver or direction-changing nystagmus occurring without changes in head position suggests a neurologic/central cause of vertigo and not peripheral, such as BPPV. […] BPPV can usually be treated using particle repositioning maneuvers. […] BPPV has an overall favorable prognosis for recovery because untreated episodes of BPPV usually resolve spontaneously. […] Ophthalmologists should be aware of BPPV. The roles of the ophthalmologist are to ensure that there are no ophthalmologic signs of central (rather than peripheral) vestibulopathy.

• #65 Diagnosis and management of benign paroxysmal positional vertigo (BPPV)

  https://pmc.ncbi.nlm.nih.gov/articles/PMC202288/

  THERE IS COMPELLING EVIDENCE THAT FREE-FLOATING endolymph particles in the posterior semicircular canal underlie most cases of benign paroxysmal positional vertigo (BPPV). […] It is a condition that is usually easily diagnosed and, even more importantly, most cases are readily treatable with a simple office-based procedure. […] In this paper, we review the normal vestibular physiology, discuss the pathophysiology and causes of BPPV, and then go on to discuss diagnoses, office-based management and, finally, surgical management. […] The use of the DixHallpike manoeuvre to diagnose posterior canal BPPV was first described in 1952. […] Overall, the history and eye-findings during positional testing are the gold standards for diagnosing BPPV. […] A certain subset of patients may not demonstrate the typical nystagmus during the DixHallpike manoeuvre, but they may still experience the classic vertigo during positioning.

• #66 Diagnosis and management of benign paroxysmal positional vertigo (BPPV)

  https://pmc.ncbi.nlm.nih.gov/articles/PMC202288/

  THERE IS COMPELLING EVIDENCE THAT FREE-FLOATING endolymph particles in the posterior semicircular canal underlie most cases of benign paroxysmal positional vertigo (BPPV). […] It is a condition that is usually easily diagnosed and, even more importantly, most cases are readily treatable with a simple office-based procedure. […] In this paper, we review the normal vestibular physiology, discuss the pathophysiology and causes of BPPV, and then go on to discuss diagnoses, office-based management and, finally, surgical management. […] The use of the DixHallpike manoeuvre to diagnose posterior canal BPPV was first described in 1952. […] Overall, the history and eye-findings during positional testing are the gold standards for diagnosing BPPV. […] A certain subset of patients may not demonstrate the typical nystagmus during the DixHallpike manoeuvre, but they may still experience the classic vertigo during positioning.

• #67 Diagnosis and management of benign paroxysmal positional vertigo (BPPV)

  https://pmc.ncbi.nlm.nih.gov/articles/PMC202288/

  The management of BPPV has changed dramatically in the past 20 years as our understanding of the condition has progressed. […] Although 50%70% of BPPV is idiopathic (with no identifiable cause), a history should be taken regarding possible secondary causes of BPPV. […] BPPV is a benign disease and, therefore, surgery should only be reserved for the most intractable or multiply recurrent cases. […] Patients with BPPV present with a history of brief, episodic, position-provoked vertigo with characteristic findings on DixHallpike testing. […] Current evidence does not support the routine use of skull vibration with repositioning.

• #68

  https://journals.lww.com/mtsm/fulltext/2023/07040/diagnostic_criteria_of_benign_paroxysmal.1.aspx

  The diagnostic criteria of posterior canal-BPPV (pc-BPPV) include: (a) The recurrent attacks of positional vertigo or positional dizziness are provoked by lying down or turning over in the supine position. […] The diagnostic criteria of hc-BPPV include: (a) Attacks of rotatory vertigo or dizziness are occurred by changes in the head position relative to gravity. […] The diagnostic criteria of the anterior canal-BPPV include: (a) Recurrent episodes of positional vertigo or positional dizziness induced by lying down or turning over in the supine position. […] The diagnostic criteria of the pc-BPPV-cupulolithiasis include: (a) Recurrent episodes of positional vertigo or positional dizziness provoked by lying down or turning over in the supine position. […] The diagnostic criteria of hc-BPPV-cupulolithiasis include: (a) Attacks of rotatory vertigo or dizziness are induced by specific head positions. […] The diagnostic criteria of multiple semicircular canals-BPPV include (a) Recurrent episodes of positional vertigo or positional dizziness provoked by lying down or turning over in the supine position. […] A diagnosis of BPPV is often made through clinical history along with diagnostic maneuvers.

• #69 Benign Paroxysmal Positional Vertigo (BPPV)

  https://www.earscience.org.au/lions-hearing-clinic/vertigo-balance-and-dizziness/benign-paroxysmal-positional-vertigo-bppv/

  The likelihood of onset is known to increase with age. […] Head trauma can cause BPPV, and evidence suggests that hormonal factors can affect BPPV, with a significant association between benign positional vertigo and osteopenia/osteoporosis. […] BPPV most commonly affects the posterior semicircular canal, but the horizontal and anterior canals can also be affected. […] The affected canal will determine the sorts of movements that will trigger the dizziness and the direction of spinning sensations that the BPPV sufferer will experience. […] There are two types of BPPV. […] The most common type is canalithiasis, in which the ear crystals are free-floating within the fluid in the semicircular canal. […] The second, much rarer type is cupulolithiasis. […] Positional vertigo is diagnosed with the use of positioning manoeuvres which aim to evoke the BPPV symptoms and record eye movements while it is occurring. […] By combining information about the activity that elicits the response and eye movement direction, the specialist can establish which canal the ear crystals are in.

• #70 Benign Paroxysmal Positional Vertigo (BPPV): Treatment, Symptoms & Causes

  https://my.clevelandclinic.org/health/diseases/11858-benign-paroxysmal-positional-vertigo-bppv

  Benign paroxysmal positional vertigo (BPPV) is an inner ear disorder. A person with BPPV experiences a sudden spinning sensation whenever they move their head. BPPV isn’t a sign of a serious problem. If it doesn’t disappear on its own within six weeks, a simple in-office procedure can help ease your symptoms. […] Your healthcare provider can diagnose BPPV during an office visit. They’ll perform a physical examination and ask questions about your symptoms and medical history. […] The most effective benign paroxysmal positional vertigo treatments involve physical therapy exercises. The goal of these exercises is to move the calcium carbonate particles out of your semicircular canals and back into your utricle. […] A single particle repositioning procedure is effective in treating about 80% to 90% of cases of BPPV. Additional BPPV exercises may be needed if symptoms continue. […] Yes. In many cases, BPPV goes away on its own eventually. But it can come back. If it does, your healthcare provider can tell you how to manage your symptoms when they occur.

• #71 Diagnosis and management of benign paroxysmal positional vertigo (BPPV)

  https://pmc.ncbi.nlm.nih.gov/articles/PMC202288/

  The management of BPPV has changed dramatically in the past 20 years as our understanding of the condition has progressed. […] Although 50%70% of BPPV is idiopathic (with no identifiable cause), a history should be taken regarding possible secondary causes of BPPV. […] BPPV is a benign disease and, therefore, surgery should only be reserved for the most intractable or multiply recurrent cases. […] Patients with BPPV present with a history of brief, episodic, position-provoked vertigo with characteristic findings on DixHallpike testing. […] Current evidence does not support the routine use of skull vibration with repositioning.

• #72 Benign Paroxysmal Positional Vertigo (BPPV) | Doctor

  https://patient.info/doctor/benign-paroxysmal-positional-vertigo-pro

  Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo which is experienced as the illusion of movement. […] Diagnosing BPPV (investigations) The Hallpike (or Dix-Hallpike) manoeuvre can be used to check for BPPV in adults with vertigo on head movement. […] A positive result is one that provokes vertigo and torsional (rotatory) upbeating nystagmus (the upper pole of the eye beats towards the dependent ear with the vertical component towards the forehead when looking straight ahead). […] If BPPV is confirmed, treatment to relieve it using a canalith repositioning manoeuvre can be given. […] The Semont manoeuvre can be used for people who have mobility or musculo-skeletal issues which make the Hallpike manoeuvre difficult or impossible. […] If symptoms have not settled by a week and the diagnosis of BPPV is highly likely, consider repeating Epley’s manoeuvre.

• #73 Benign Paroxysmal Positional Vertigo – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470308/

  Benign paroxysmal positional vertigo (BPPV) is the most common cause of peripheral vertigo, accounting for over half of all cases. […] It is crucial to distinguish BPPV from other causes of vertigo as the differential diagnosis includes a spectrum of disease processes ranging from benign to life-threatening. […] The Dix-Hallpike test is pathognomonic, which is why laboratory tests are not indicated to establish the diagnosis of benign paroxysmal positional vertigo. […] Benign paroxysmal positional vertigo is largely a clinical diagnosis, and often, the battery of laboratory and imaging tests ordered only helps rule out other possibilities. […] The initial step in managing benign paroxysmal positional vertigo is patient education and proper counseling. […] The Epley maneuver can be performed after using the Dix-Hallpike maneuver to localize the problematic side.

• #74 Benign paroxysmal positional vertigo diagnosis and treatment –

  https://caringmedical.com/prolotherapy-news/benign-paroxysmal-positional-vertigo-diagnosis-treatment/

  The canalith repositioning procedure can move the ear rocks or debris to other parts of the ear where they cause no symptoms. The procedure involves several simple head movements. The canalith repositioning procedure for posterior canal type BPPV is called the Epley maneuver, and the CRP for lateral canal type BPPV is called the Gufoni maneuver. […] The researchers noted that in the non-BPPV diagnosed patients: ” . . . analysis showed that from the history taking the description of the dizziness symptom (vertigo versus light-headedness), provocation of the dizziness by movements, and a short duration of the dizziness attack were highly suggestive of BPPV.” […] The physical therapist was sending patients back to their doctors for further evaluation. Listen to what the research team said: “Despite . . .prior medical screening, one-third of patients without BPPV (diagnosis) were sent back to the referring doctor for further evaluation. This illustrates the complexity of dizziness and the need for interdisciplinary collaboration.”

• #75 Benign Paroxysmal Positional Vertigo (BPPV): Treatment, Symptoms & Causes

  https://my.clevelandclinic.org/health/diseases/11858-benign-paroxysmal-positional-vertigo-bppv

  Benign paroxysmal positional vertigo (BPPV) is an inner ear disorder. A person with BPPV experiences a sudden spinning sensation whenever they move their head. BPPV isn’t a sign of a serious problem. If it doesn’t disappear on its own within six weeks, a simple in-office procedure can help ease your symptoms. […] Your healthcare provider can diagnose BPPV during an office visit. They’ll perform a physical examination and ask questions about your symptoms and medical history. […] The most effective benign paroxysmal positional vertigo treatments involve physical therapy exercises. The goal of these exercises is to move the calcium carbonate particles out of your semicircular canals and back into your utricle. […] A single particle repositioning procedure is effective in treating about 80% to 90% of cases of BPPV. Additional BPPV exercises may be needed if symptoms continue. […] Yes. In many cases, BPPV goes away on its own eventually. But it can come back. If it does, your healthcare provider can tell you how to manage your symptoms when they occur.

• #76 Benign Paroxysmal Positional Vertigo (BPPV) – Balance & Dizziness Canada

  https://balanceanddizziness.org/disorders/vestibular-disorders/bppv/

  Canalith (meaning “canal rocks”) repositioning procedures (CRP) are an effective, long-lasting and non-invasive treatment for all types of BPPV. […] Most BPPV affects the posterior canal. Over 85% of cases can be successfully treated by the Epley manoeuvre. […] Further investigation will be needed to rule out a central cause (originating in the brain) in cases when repositioning procedures do not successfully resolve nystagmus (involuntary eye movements) brought about by a change in head position. […] Research suggests that CRP therapy resolves symptoms in 85% of patients with BPPV after a single manoeuvre. Only 2% of patients need more than three treatments.

• #77 Benign Paroxysmal Positional Vertigo – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470308/

  Most patients with BPPV get better with repositioning maneuvers or resolve completely. However, surgical intervention is reserved for refractory cases. […] Benign paroxysmal positional vertigo may have the following differential diagnoses: Meniere disease, inner ear concussion, alcohol intoxication, labyrinthitis or vestibular neuronitis, vascular loop syndrome, positional nystagmus of central origin, lesion of the modulus from conditions such as stroke, Arnold-Chiari malformation, multiple sclerosis, cerebellar degeneration, ischemia, and intoxication, acoustic neuroma and meningioma, vertebral artery insufficiency, orthostatic hypotension. […] One-third of patients have remission at 3 weeks. The majority of patients remit at 6 months. […] Recurrence rates are variable in the literature, with 1 study observing an 18% recurrence rate over 10 years.

• #78 Benign Paroxysmal Positional Vertigo (BPPV) for ophthalmologists – EyeWiki

  https://eyewiki.org/Benign_Paroxysmal_Positional_Vertigo_(BPPV)_for_ophthalmologists

  Subjective BPPV is the sensation of vertigo during provocative maneuvers without nystagmus. […] Findings of down beating nystagmus on the Dix-Hallpike maneuver or direction-changing nystagmus occurring without changes in head position suggests a neurologic/central cause of vertigo and not peripheral, such as BPPV. […] BPPV can usually be treated using particle repositioning maneuvers. […] BPPV has an overall favorable prognosis for recovery because untreated episodes of BPPV usually resolve spontaneously. […] Ophthalmologists should be aware of BPPV. The roles of the ophthalmologist are to ensure that there are no ophthalmologic signs of central (rather than peripheral) vestibulopathy.

• #79 Benign Paroxysmal Positional Vertigo – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470308/

  Most patients with BPPV get better with repositioning maneuvers or resolve completely. However, surgical intervention is reserved for refractory cases. […] Benign paroxysmal positional vertigo may have the following differential diagnoses: Meniere disease, inner ear concussion, alcohol intoxication, labyrinthitis or vestibular neuronitis, vascular loop syndrome, positional nystagmus of central origin, lesion of the modulus from conditions such as stroke, Arnold-Chiari malformation, multiple sclerosis, cerebellar degeneration, ischemia, and intoxication, acoustic neuroma and meningioma, vertebral artery insufficiency, orthostatic hypotension. […] One-third of patients have remission at 3 weeks. The majority of patients remit at 6 months. […] Recurrence rates are variable in the literature, with 1 study observing an 18% recurrence rate over 10 years.

• #80 Benign Paroxysmal Positional Vertigo (BPPV) – Vestibular Disorders Association

  https://vestibular.org/article/diagnosis-treatment/types-of-vestibular-disorders/benign-paroxysmal-positional-vertigo-bppv/

  Unfortunately, BPPV is a condition that can recur periodically with long-term recurrence rates as high as 50% within 5 years. […] However, with a healthcare professional who is appropriately trained in the assessment and treatment of BPPV, most patients are pleased that their problem can be easily corrected so their world can stop spinning.

• #81 Benign paroxysmal positional vertigo diagnosis and treatment –

  https://caringmedical.com/prolotherapy-news/benign-paroxysmal-positional-vertigo-diagnosis-treatment/

  A significant increase in the incidence of recurrent BPPV was found in patients with reduced cervical range of motion. […] The results from this retrospective analysis unveiled the previously unexplored relation between reduction in cervical spine mobility and BPPV recurrence and treatment failure. The data from this study do not indicate the mechanisms by which this comorbidity might directly cause recurrent BPPV. However, they may suggest cervical range of motion to be evaluated, in association with other known risk factors for increased susceptibility to BPPV recurrence. […] Benign paroxysmal positional vertigo research suggests that the disorder may be linked to the rapid decrease in estrogen, observed in menopausal women, which disrupts otoconial metabolism within the inner ear. […] A high incidence of benign paroxysmal positional vertigo is reported in postmenopausal women, and the association between estradiol (E2) deficiency and the occurrence of BPPV has been made which may be a potential risk biomarker for postmenopausal women.

• #82 Benign paroxysmal positional vertigo diagnosis and treatment –

  https://caringmedical.com/prolotherapy-news/benign-paroxysmal-positional-vertigo-diagnosis-treatment/

  A significant increase in the incidence of recurrent BPPV was found in patients with reduced cervical range of motion. […] The results from this retrospective analysis unveiled the previously unexplored relation between reduction in cervical spine mobility and BPPV recurrence and treatment failure. The data from this study do not indicate the mechanisms by which this comorbidity might directly cause recurrent BPPV. However, they may suggest cervical range of motion to be evaluated, in association with other known risk factors for increased susceptibility to BPPV recurrence. […] Benign paroxysmal positional vertigo research suggests that the disorder may be linked to the rapid decrease in estrogen, observed in menopausal women, which disrupts otoconial metabolism within the inner ear. […] A high incidence of benign paroxysmal positional vertigo is reported in postmenopausal women, and the association between estradiol (E2) deficiency and the occurrence of BPPV has been made which may be a potential risk biomarker for postmenopausal women.

• #83 Benign paroxysmal positional vertigo: Effective diagnosis and treatment | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/89/11/653

  Benign paroxysmal positional vertigo (BPPV), caused by wayward crystals (rocks) in the semicircular canals of the inner ear, is the most common cause of brief symptoms of vertigo secondary to head and body movements. Diagnosing and treating it are simple to do in the medical office. This article reviews the differential diagnosis for patients presenting with dizziness and vertigo, the pathophysiology of BPPV, how to diagnose it using maneuvers to elicit symptoms and nystagmus, how to interpret the nystagmus pattern to determine where the rocks are, and how to treat it using different maneuvers to reposition (roll) the rocks back where they belong. […] Dizziness or vertigo when lying down or changing positions is a strong predictor of BPPV. The condition is easily diagnosed with the Dix-Hallpike and supine roll maneuvers.

• #84 Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update) – American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS)

  https://www.entnet.org/quality-practice/quality-products/clinical-practice-guidelines/bppv/

  The primary purposes of this guideline are to improve the quality of care and outcomes for BPPV by improving the accurate and efficient diagnosis of BPPV, reducing the inappropriate use of vestibular suppressant medications, decreasing the inappropriate use of ancillary testing such as radiographic imaging, and increasing the use of appropriate therapeutic repositioning maneuvers. […] The guideline is intended for all clinicians who are likely to diagnose and manage patients with BPPV, and it applies to any setting in which BPPV would be identified, monitored, or managed. […] The target patient for the guideline is aged ≥18 years with a suspected or potential diagnosis of BPPV. […] The primary outcome considered in this guideline is the resolution of the symptoms associated with BPPV.

• #85 Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update) – American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS)

  https://www.entnet.org/quality-practice/quality-products/clinical-practice-guidelines/bppv/

  Secondary outcomes considered include an increased rate of accurate diagnoses of BPPV, a more efficient return to regular activities and work, decreased use of inappropriate medications and unnecessary diagnostic tests, reduction in adverse events associated with undiagnosed or untreated BPPV. […] Other outcomes considered include minimizing costs in the diagnosis and treatment of BPPV, minimizing potentially unnecessary return physician visits, and maximizing the health-related quality of life of individuals afflicted with BPPV.

• #86 Benign Paroxysmal Positional Vertigo (BPPV)

  https://www.okoa.org/benign-paroxysmal-positional-vertigo-bppv

  Fortunately, BPPV can be diagnosed by clinicians in an outpatient setting most of the time without complicated testing. Once a proper diagnosis has been made, simple, effective treatment options are available to relieve most of the symptoms quickly. […] A strong recommendation for clinicians to diagnose posterior semicircular canal BPPV with an office-based diagnostic test (the Dix-Hallpike maneuver) […] A recommendation for clinicians to test patients for a second type of BPPV affecting the lateral semicircular canal when initial testing is not conclusive (using the supine roll test) […] Clinicians should differentiate BPPV from other causes of imbalance, dizziness and vertigo […] Clinicians should not routinely treat BPPV with vestibular suppressant medications such as antihistamines or benzodiazepines

• #87 Benign Paroxysmal Positional Vertigo (BPPV)

  https://www.okoa.org/benign-paroxysmal-positional-vertigo-bppv

  This set of guidelines was created by a multidisciplinary panel of clinicians representing otolaryngology, audiology, emergency medicine, physical medicine and rehabilitation, geriatrics, physical therapy, family physicians, neurology and chiropractic. These recommendations will help prevent some of the dangerous morbidities from BPPV.

• #88 Improving Diagnosis and Treatment of Benign Paroxysmal Positional Vertigo

  https://digitalcommons.kansascity.edu/facultypub/88/

  Vertigo is defined as an illusion of motion caused by a mismatch of information between the visual, vestibular and somatosensory systems. The most common diagnosis associated with whirling vertigo is benign paroxysmal positional vertigo (BPPV), which affects approximately 3.4% of patients older than 60 years of age. […] This paper aims to educate primary care providers on how to diagnose BPPV by performing canalith repositioning maneuvers at the initial point of care. Timely treatment of BPPV in the primary care office is believed to reduce healthcare costs by way of limiting unnecessary diagnostic testing and lowering referrals for specialty care. Immediate treatment is also believed to improve the quality of healthcare delivery for the vertigo patient by reducing morbidity and resolving the condition without the need for referrals or imaging. […] A history of positional vertigo and evidence of nystagmus with Dix-Hallpike positioning confirms the diagnosis. A detailed description of the performance of this test is elucidated.

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