Benign paroxysmal positional vertigo

Background

• Otolith are dislodged from utricle and migrate into one of the semicircular canals

Diagnosis

• Dix-Hallpike Maneuver (50-80% Sn)
  • Contraindications:
    • Carotid bruits
    • Cerebrovascular disease
    • Concern for vertebrobasilar insufficiency
    • Spinal injury
    • Cervical spondylosis
  • Procedure
    • Step 1 of the Epley maneuver (see below)
    • Positive test = onset of nystagumus after few seconds of latency lasting <30s
    • If pt has positive test with head turned to right then right ear is affected

Treatment

• Epley maneuver
  • Dix-Hallpike maneuver plus additional maneuvers to replace the migrated otolith

Source

• UpToDate