Clinical Practice Guideline

Vertigo

Benign Paroxysmal Positional Vertigo

(Endorsed, 2010)

The following guideline on Benign Paroxysmal Positional Vertigo was developed by the American Academy of Otolaryngology—Head and Neck Surgery Foundation and endorsed by the AAFP.

Summary of Recommendations

The panel made strong recommendations that:

  1. Clinicians should diagnose posterior semicircular canal BPPV when vertigo associated with nystagmus is provoked by the Dix-Hallpike maneuver.

The panel made recommendations against:

  1. Radiographic imaging, vestibular testing, or both in patients diagnosed with BPPV, unless the diagnosis is uncertain or there are additional symptoms or signs unrelated to BPPV that warrant testing; and
  2. Routinely treating BPPV with vestibular suppressant medications such as antihistamines or benzodiazepines

The panel made recommendations that:

  1. If the patient has a history compatible with BPPV and the Dix-Hallpike test is negative, clinicians should perform a supine roll test to assess for lateral semicircular canal BPPV;
  2. Clinicians should differentiate BPPV from other causes of imbalance, dizziness, and vertigo;
  3. Clinicians should question patients with BPPV for factors that modify management including impaired mobility or balance, CNS disorders, lack of home support, and increased risk for falling;
  4. Clinicians should treat patients with posterior canal BPPV with a particle repositioning maneuver (PRM);
  5. Clinicians should reassess patients within 1 month after an initial period of observation or treatment to confirm symptom resolution;
  6. Clinicians should evaluate patients with BPPV who are
    initial treatment failures for persistent BPPV or underlying peripheral vestibular or CNS disorders; and
  7. Clinicians should counsel patients regarding the impact of BPPV on their safety, the potential for disease recurrence, and the importance of follow-up.

These guidelines are provided only as assistance for physicians making clinical decisions regarding the care of their patients. As such, they cannot substitute the individual judgment brought to each clinical situation by the patient’s family physician. As with all clinical reference resources, they reflect the best understanding of the science of medicine at the time of publication, but they should be used with the clear understanding that continued research may result in new knowledge and recommendations. These guidelines are only one element in the complex process of improving the health of America. To be effective, the guidelines must be implemented.