Vertigo

Benign Paroxysmal Positional Vertigo

(Affirmation of Value, November 2016)

The guideline, Benign Paroxysmal Positional Vertigo (BPPV), was updated by the  American Academy of Otolaryngology—Head and Neck Surgery and categorized as Affirmation of Value by American Academy of Family Physicians.

Key Recommendations

• Posterior semicircular canal BPPV should be diagnosed when vertigo associated with nystagmus is provoked by the Dix-Hallpike maneuver.

• If the patient has a history compatible with BPPV and the Dix-Hallpike test is negative, a supine roll test should be performed to assess for lateral semicircular canal BPPV.

• BPPV should be differentiated from other causes of imbalance, dizziness, and vertigo.

• Patients with BPPV should be questioned for factors that modify management including impaired mobility or balance, CNS disorders, lack of home support and increased risk for falling.
  

• Radiographic imaging and/or vestibular testing should not be used in patients diagnosed with BPPV, unless the diagnosis is uncertain or there are additional symptoms or signs unrelated to BPPV that warrant testing.

• Patients with posterior canal BPPV should be treated with a canalith repositioning procedure (CRP). Post-procedural postural restrictions should not be recommended after repositioning procedure is performed. 

• BPPV should not be routinely treated with vestibular suppressant medications such as antihistamines or benzodiazepines.

• Patients with persistent symptoms should be evaluated for unresolved BPPV or underlying peripheral vestibular or CNS disorders.

• Patients should be educated regarding the impact of BPPV on their safety, the potential for recurrence, and the importance of follow-up.

See the full recommendation for further details, including specifics about the Dix-Hallpike maneuver and a treatment algorithm.