Benign Paroxysmal Positional Vertigo

Publication Date: March 1, 2017
Last Updated: December 16, 2022

Table 2. Summary of Key Action Statements (KAS)

Diagnosis of posterior canal BPPV

Clinicians should diagnose posterior semicircular canal BPPV when vertigo associated with torsional, up-beating nystagmus is provoked by the Dix-Hallpike maneuver, performed by bringing the patient from an upright to supine position with the head turned 45º to one side and neck extended 20º with the affected ear down. The maneuver should be repeated with the opposite ear down if the initial maneuver is negative. ( Strong Recommendation (S) , B )
571

Diagnosis of lateral (horizontal) canal BPPV

If the patient has a history compatible with BPPV and the Dix-Hallpike test exhibits horizontal or no nystagmus, the clinician should perform, or refer to a clinician who can perform, a supine roll test to assess for lateral semicircular canal BPPV. ( Recommendation (R) , B )
571

Differential diagnosis

Clinicians should differentiate, or refer to a clinician who can differentiate, BPPV from other causes of imbalance, dizziness, and vertigo. ( Recommendation (R) , C )
571

Modifying factors

Clinicians should assess patients with BPPV for factors that modify management, including impaired mobility or balance, central nervous system disorders, a lack of home support, and/or increased risk for falling. ( Recommendation (R) , C )
571

Radiographic testing

Clinicians should NOT obtain radiographic imaging in a patient who meets diagnostic criteria for BPPV in the absence of additional signs and/or symptoms inconsistent with BPPV that warrant imaging. ( Recommendation (R) , C )
571

Vestibular testing

Clinicians should NOT order vestibular testing in a patient who meets diagnostic criteria for BPPV in the absence of additional vestibular signs and/or symptoms inconsistent with BPPV that warrant testing. ( Recommendation (R) , C )
571

Repositioning procedures as initial therapy

Clinicians should treat, or refer to a clinician who can treat, patients with posterior canal BPPV with a canalith repositioning procedure. ( Strong Recommendation (S) , A )
571

Postprocedural restrictions

Clinicians should NOT recommend postprocedural postural restrictions after canalith repositioning procedure for posterior canal BPPV. ( Strong Recommendation (S) , A )
571

Observation as initial therapy

Clinicians may offer observation with follow-up as initial management for patients with BPPV. ( Option (O) , B )
571

Vestibular rehabilitation therapy

The clinician may offer vestibular rehabilitation, either self-administered or with a clinician, in the treatment of BPPV. ( Option (O) , B )
571

Medical therapy

Clinicians should NOT routinely treat BPPV with vestibular suppressant medications such as antihistamines and/or benzodiazepines. ( Recommendation (R) , C )
571

Outcome Assessment

Clinicians should reassess patients within one month after an initial period of observation or treatment to document resolution or persistence of symptoms. ( Recommendation (R) , C )
571

Evaluation of treatment failure

Clinicians should evaluate, or refer to a clinician who can evaluate, patients with persistent symptoms for unresolved BPPV and/or underlying peripheral vestibular or central nervous system disorders. ( Recommendation (R) , A )
571

Education

Clinicians should educate patients regarding the impact of BPPV on their safety, the potential for disease recurrence and the importance of follow-up. ( Recommendation (R) , C )
571

Recommendation Grading

Overview

Title

Benign Paroxysmal Positional Vertigo

Authoring Organization

American Academy of Otolaryngology - Head and Neck Surgery Foundation

Endorsing Organizations

American Academy of Emergency Medicine

American Academy of Physical Medicine and Rehabilitation

American Physical Therapy Association

American Otological Society

American Academy of Physician Assistants

Publication Month/Year

March 1, 2017

Last Updated Month/Year

November 18, 2024

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

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.

Target Patient Population

Aged ≥18 years with a suspected or potential diagnosis of benign paroxysmal positional vertigo (BPPV)

Target Provider Population

All clinicians who are likely to diagnose and manage patients with benign paroxysmal positional vertigo (BPPV)

Inclusion Criteria

Male, Female, Adult, Older adult

Health Care Settings

Ambulatory, Long term care

Intended Users

Audiologist, nurse, nurse practitioner, physician, physician assistant

Scope

Diagnosis, Management

Diseases/Conditions (MeSH)

D065635 - Benign Paroxysmal Positional Vertigo

Keywords

benign paroxysmal positional vertigo (BPPV), BPPV, vertigo

Source Citation

Bhattacharyya N, Gubbels SP, Schwartz SR, et al. Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update). Otolaryngology–Head and Neck Surgery. 2017;156(3_suppl):S1-S47. doi:10.1177/0194599816689667
  
 

Supplemental Methodology Resources

Data Supplement

Methodology

Number of Source Documents
294
Literature Search Start Date
January 1, 2008
Literature Search End Date
September 1, 2015