Abstract
Purpose of review
Although benign paroxysmal positional vertigo (BPPV) can be diagnosed and treated at bedside with positional testing and maneuvers, clinicians need to be aware of complications of maneuvers and factors that influence the treatment and education of BPPV. Appropriate integration of supplemental factors when managing BPPV will empower the clinician and may optimize treatment.
Recent findings
When treating BPPV, clinicians need to be aware of pathologies that mimic BPPV, precautions when treating BPPV, complications of treatment maneuvers, and assistive devices used for treating BPPV. Understanding aspects in addition to the diagnosis and treatment of BPPV allows the clinician to provide comprehensive care and fully treat BPPV.
Summary
The purpose of this manuscript is to simplify education that is related to BPPV, outside of diagnosis and treatment maneuvers, and increase awareness to supplemental information related to BPPV for all healthcare providers.
Similar content being viewed by others
References and Recommended Reading
Papers of particular interest, published recently, have been highlighted as: • Of importance
Kim JS, Zee DS. Clinical practice. Benign paroxysmal positional vertigo. N Engl J Med. 2014. https://doi.org/10.1056/nejmcp1309481.
Neuhauser HK. The epidemiology of dizziness and vertigo. In: Handbook of clinical neurology. 2016;67. https://doi.org/10.1016/b978-0-444-63437-5.00005-4.
Benecke H, Agus S, Kuessner D, Goodall G, Strupp M. The burden and impact of vertigo: findings from the REVERT Patient Registry. Front Neurol. 2013;4:136. https://doi.org/10.3389/fneur.2013.00136PMID:24106487;PMCID:PMC3788351.
Schubert MC, Carter N, Lo SL. Case report: bow hunter syndrome—one reason to add non-gravity dependent positional nystagmus testing to your clinical neuro-otologic exam. Front Neurol. 2021; 12. https://doi.org/10.3389/fneur.2021.814998.
Fife TD. Positional dizziness. Continuum (Minneap Minn). 2012;18(5 Neuro-otology):1060–1085. https://doi.org/10.1212/01.con.0000418376.80099.24.
Lemos J, Strupp M. Central positional nystagmus: an update. J Neurol. 2022;269(4):1851–60. https://doi.org/10.1007/s00415-021-10852-8.
• Peña Navarro P, Pacheco López S, Almeida Ayerve CN, et al. Early diagnosis of central disorders mimicking horizontal canal cupulolithiasis. Brain Sci. 2023;13(4). https://doi.org/10.3390/brainsci13040562. BPPV can mimic central pathologies and early identification of central disorders that mimic BPPV is critical to appropriately manage patients.
Gold DR, Morris L, Kheradmand A, Schubert MC. Repositioning maneuvers for benign paroxysmal positional vertigo. Curr Treat Options Neurol. 2014;16(8). https://doi.org/10.1007/s11940-014-0307-4.
Nogi A, Schubert MC. Complex nystagmus in traumatic benign paroxysmal positional vertigo: a case study on the critical value of knowing semicircular canal excitation and inhibition patterns. Journal of otology. 2021;16(3):199–204. https://doi.org/10.1016/j.joto.2021.01.004.
Uneri A. Falling sensation in patients who undergo the Epley maneuver: a retrospective study. Ear Nose Throat J. 2005;84(2):82–5. https://doi.org/10.1177/014556130508400211.
Bhattacharyya N, Baugh RF, Orvidas L, et al. Clinical practice guideline: benign paroxysmal positional vertigo. Otolaryngology-head and neck surgery. 2008;139(5):47–81. https://doi.org/10.1016/j.otohns.2008.08.022.
Bhattacharyya N, Gubbels SP, Schwartz SR, Edlow JA, El-Kashlan H, Fife T, Holmberg JM, Mahoney K, Hollingsworth DB, Roberts R, Seidman MD, Steiner RW, Do BT, Voelker CC, Waguespack RW, Corrigan MD. Clinical practice guideline: benign paroxysmal positional vertigo (update). Otolaryngol Head Neck Surg. 2017;156(3):S1–47. https://doi.org/10.1177/0194599816689667.
• Kalderon L, Chaimoff M, Katz-Leurer M. The distinction between state and trait anxiety levels in patients with BPPV in comparison with healthy controls. Front Psychol. 2022;13. https://doi.org/10.3389/fpsyg.2022.1055467. Anxiety does not predispose individuals to BPPV; however, when experiencing BPPV, individuals have higher temporary anxiety states.
Murdin L, Davies RA, Bronstein AM. Vertigo as a migraine trigger. Neurology. 2009;73:638–42. https://doi.org/10.1212/wnl.0b013e3181b38a04.
Chu C, Liu C, Lin L, Chen T, Wang S. Migraine is associated with an increased risk for benign paroxysmal positional vertigo: a nationwide population-based study. J Headache Pain. 2015;16(1):62. https://doi.org/10.1186/s10194-015-0547-z.
Nuti D, Agus G, Barbieri M, T et al. The management of horizontal canal paroxysmal positional vertigo. Acta Otolaryngol (Stockh) 1998;118:455–460. https://doi.org/10.1080/00016489850154559.
Epley JM. Human experience with canalith repositioning maneuvers. Ann NY Acad Sci. 2001;942:179–91. https://doi.org/10.1111/j.1749-6632.2001.tb03744.x.
Zanotti E, Yacovino DA. Benign paroxysmal positional vertigo: canal switching affecting all canals during a single session. Otol Neurootol 2021;42. https://doi.org/10.1097/MAO.0000000000002853
Foster CA, Zaccaro K, Strong D. Canal conversion and reentry: a risk of Dix-Hallpike during canalith repositioning procedures. Otol Neurotol. 2012;33(2):199–203. https://doi.org/10.1097/mao.0b013e31823e274a.
Yimtae K, Srirompotong S, Srirompotong S, Sae- SP. A randomized trial of the canalith repositioning procedure. Laryngoscope. 2003;113:828–32. https://doi.org/10.1097/00005537-200305000-00011.
• Scotto di Santillo L, Califano L. Canal switch: a possible complication of physical therapeutic maneuvers for posterior canal benign paroxysmal positional vertigo. Acta Otorhinolaryngol Ital. 2023;43(1):49–55. https://doi.org/10.14639/0392-100x-n2016. Canal switch can occur during repositioning maneuvers, and the risk of canal conversion should not influence clinical decision making.
Castellucci A, Malara P, Brandolini C, Del Vecchio V, Giordano D, Ghidini A, et al. Isolated horizontal canal hypofunction differentiating a canalith jam from an acute peripheral vestibular loss. Am J Oto- laryngol. 2019;40:319–22. https://doi.org/10.1016/j.amjoto.2018.12.005.
Comacchio F, Poletto E, Mion M. Spontaneous canalith jam and apogeotropic horizontal canal benign paroxysmal positional vertigo: considerations on a particular case mimicking an acute vestibular deficit. Otol Neurotol. 2018; 39(9): 843 848. https://doi.org/10.1097/mao.0000000000001949.
Ko KM, Song MH, Kim JH, Shim DB. Persistent spontaneous nystagmus following a canalith repositioning procedure in horizontal semicircular canal benign paroxysmal positional vertigo. JAMA Oto- laryngol Head Neck Surg. 2014;140:250–2. https://doi.org/10.1001/jamaoto.2013.6207.
Chang YS, Choi J, Chung WH. Persistent direction-fixed nystagmus following canalith repositioning maneuver for horizontal canal BPPV: a case of canalith jam. Clin Exp Otorhinolaryngol. 2014;7:138–41. https://doi.org/10.3342/ceo.2014.7.2.138.
• Martellucci S, Castellucci A, Malara P, et al. Spontaneous jamming of horizontal semicircular canal combined with canalolithiasis of contralateral posterior semicircular canal. J Audiol Otol. 2022;26(1):55. https://doi.org/10.7874/jao.2020.00507. Acute vestibular neuritis can be mimicked by spontaneous canal jam, which is an uncommon form of BPPV. This results in direction fixed nystagmus during head movements.
Kim JS, Oh SY, Lee SH, et al. Randomized clinical trial for geotropic horizontal canal benign paroxysmal positional vertigo. Neurology. 2012;79(7):700–7. https://doi.org/10.1212/WNL.0b013e3182648b8b.
von Brevern M, Clarke AH, Lempert T. Continuous vertigo and spontaneous nystagmus due to canalolithiasis of the horizontal canal. Neurology. 2001;56(5):684–6. https://doi.org/10.1212/wnl.56.5.684.
Luis L, Costa J, Vaz Garcia F, Valls-Sole J, Brandt T, Schneider E. Spontaneous plugging of the horizontal semicircular canal with reversible canal dysfunction and recovery of vestibular evoked myo-genic potentials. Otol Neurotol. 2013;34(4):743–7. https://doi.org/10.1097/MAO.0b013e318287f343.
Schubert MC, Helminski J, Zee DS, et al. Horizontal semicircular canal jam: two new cases and possible mechanisms. Laryngoscope Investigative Otolaryngology. 2020;5(1):163. https://doi.org/10.1002/lio2.352.
von Brevern M, Radtke A, Lezius F, Feldmann M, Ziese T, Lempert T, Neuhauser H. Epidemiology of benign paroxysmal positional vertigo: a population based study. J Neurol Neurosurg Psychiatry. 2007;78(7):710–5. https://doi.org/10.1136/jnnp.2006.100420.
Li JC, Li CJ, Epley J, Weinberg L. Cost-effective management of benign positional vertigo using canalith repositioning. Otolaryngol Head Neck Surg. 2000;122(3):334–9. https://doi.org/10.1016/S01945998(00)70043-X.
Halmagyi GM, McGarvie LA, Strupp M. Nystagmus goggles: how to use them, what you find and what it means. Pract Neurol. 2020;20(6):446–50. https://doi.org/10.1136/practneurol-2020-002513.10.1136/practneurol-2020-002513.
• Kim H, Kim J, Choi K, et al. Effect of self-treatment of recurrent benign paroxysmal positional vertigo: a randomized clinical trial. Archives of neurology (Chicago). 2023;80(3):244–250. https://doi.org/10.1001/jamaneurol.2022.4944. A web-based system for the diagnosis and treatment of recurrent BPPV may be a successful way to manage BPP. This study demonstrates how telemedicine can be integrated into the care and management of individuals with BPPV.
Barreto RG, Yacovino DA, Teixeira LJ, Freitas MM. Teleconsultation and teletreatment protocol to diagnose and manage patients with benign paroxysmal positional vertigo (BPPV) during the COVID-19 pandemic. Int Arch Otorhinolaryngol. 2021;25. https://doi.org/10.1055/s-0040-1722252.
Balatsouras DG, Kaberos A, Assimakopoulos D, Katotomichelakis M, Economou NC, Korres SG. Etiology of vertigo in children. Int J Pediatr Otorhinolaryngol. 2007;71:487–94. https://doi.org/10.1016/j.ijporl.2006.11.024.
Lee JD, Kim CH, Hong SM, et al. Prevalence of vestibular and balance disorders in children and adolescents according to age: a multi-center study. Int J Pediatr Otorhinolaryngol. 2017;94:36–9. https://doi.org/10.1016/j.ijporl.2017.01.012.
O’Reilly RC, Greywoode J, Morlet T, et al. Comprehensive vestibular and balance testing in the dizzy pediatric population. Otolaryngol Head Neck Surg. 2011;144:142–8. https://doi.org/10.1177/0194599810393679.
Yetiser S. Review of the pathology underlying benign paroxysmal positional vertigo. J Int Med Res. 2020;48. https://doi.org/10.1177/0300060519892370.
Buki B, Ecker M, Junger H, Lundberg YW. Vitamin D deficiency and benign paroxysmal positioning vertigo. Med Hypotheses. 2013;80:201–4. https://doi.org/10.1016/j.mehy.2012.11.029.
Jeong SH, Lee SU, Kim JS. Prevention of recurrent benign paroxysmal positional vertigo with vitamin D supplementation: a meta-analysis. J Neurol. 2020;95:1117–25. https://doi.org/10.1007/s00415-020-09952-8.
Brodsky JR, Shoshany TN, Lipson S, Zhou G. Peripheral vestibular disorders in children and adolescents with concussion. Otolaryngol Head Neck Surg. 2018;159:365–70. https://doi.org/10.1177/0194599818770618.
Wang A, Zhou G, Kawai K, O’Brien M, Shearer AE, Brodsky JR. Benign paroxysmal positional vertigo in children and adolescents with concussion. Sports Health. 2021;13:380–6. https://doi.org/10.1177/1941738120970515.
Wang A, Zhou G, Lipson S, Kawai K, Corcoran M, Brodsky JR. Multifactorial characteristics of pediatric dizziness and imbalance. Laryngoscope. 2020;131:1308–14. https://doi.org/10.1002/lary.29024.
Choi HG, Kim G, Kim BJ, Hong SK, Kim H, Lee H. How rare is benign paroxysmal positional vertigo in children? A review of 20 cases and their epidemiology. International journal of pediatric otorhinolaryngology. 2020;132. https://doi.org/10.1016/j.ijporl.2020.110008.
• Wang A, Zhou G, Brodsky JR. Characteristics of benign paroxysmal positional vertigo in young children. Laryngoscope. 2023;133(3):694. https://doi.org/10.1002/lary.30172.10.1002/lary.30172 . In children with dizziness, BPPV should be screened using positional testing.
Lapenna R, Faralli M, Cipriani L, Marcelli V, Ricci G. Efficacy of Epley’s canalith repositioning procedure according to the number of repetitions in the same session: comparison of three protocols. Acta Oto- Laryngologica. 2021;141(6):599–602. https://doi.org/10.1080/00016489.2021.1912387.
Gordon CR, Gadoth N. Repeated vs single physical maneuver in benign paroxysmal positional vertigo. Acta Neurol Scand. 2004;110:166–9. https://doi.org/10.1111/j.1600-0404.2004.00296.x.
Korn GP, Dorigueto RS, Ganança MM, Caovilla HH. Epley’s maneuver in the same session in BPPV. Brazilian Journal of otorhinolaryngology. 2007;73(4). https://doi.org/10.1016/s18088694(15)30106–3.
Isaradisaikul S, Chowsilpa S, Hanprasertpong C, Rithirangsriroj T. Single cycle versus multiple cycles of canalith repositioning procedure for treatment of posterior canal benign paroxysmal positional vertigo: a randomized controlled trial. Otol Neurotol. 2021;42(1):121–8. https://doi.org/10.1097/mao.0000000000002894.
Yang H, Zhao X, Xu Y, Wang L, He Q, Lundberg YW. Matrix recruitment and calcium sequestration for spatial specific otoconia development. PLoS One. 2011;6. https://doi.org/10.1371/journal.pone.0020498.
Lee JD, Park MK, Lee BD, Lee TK, Sung KB, Park JY. Abnormality of cervical vestibular-evoked myogenic potentials and ocular vestibular-evoked myogenic potentials in patients with recurrent benign paroxysmal positional vertigo. Acta Otolaryngol. 2013;133:150–3. https://doi.org/10.3109/00016489.2012.723823.
Chen G, Dai X, Ren X, Lin N, Zhang M, Du Z, et al. Ocular vs. cervical vestibular evoked myogenic potentials in benign paroxysmal positional vertigo: a systematic review and meta-analysis. Front Neurol 2020;11. https://doi.org/10.3389/fneur.2020.596454
Parham K, Leonard G, Feinn RS, Lafreniere D, Kenny AM. Prospective clinical investigation of the relationship between idiopathic benign paroxysmal positional vertigo and bone turnover: a pilot study. Laryngoscope. 2013;123(11):2834–9. https://doi.org/10.1002/lary.24162.
Lee A, Hassannia F, Bergin MJ, Al Zaabi K, Misale P, Rutka JA. The relationship between disorders of bone metabolism and benign paroxysmal positional vertigo: a systematic review. Ear Hear. 2021;42(6):1462–71. https://doi.org/10.1097/aud.0000000000001063.
Lundberg YW, Zhao X, Yamoah EN. Assembly of the otoconia complex to the macular sensory epithelium of the vestibule. Brain Res. 2006;1091:47–57. https://doi.org/10.1016/j.brainres.2006.02.083.
• Shin H, Park Y, Lee HJ, Jeon E. Correlation between serum vitamin D level and benign paroxysmal positional vertigo recurrence. Auris, nasus, larynx. 2023. https://doi.org/10.1016/j.anl.2022.12.017. Individuals with BPPV need to have their vitamin D levels monitored and evaluated, as it may be related to the risk of BPPV recurrence.
Talaat HS, Abuhadied G, Talaat AS, Abdelaal MS. Low bone mineral density and vitamin D deficiency in patients with benign positional paroxysmal vertigo. Eur Arch Otorhinolaryngol. 2015;272:2249–53. https://doi.org/10.1007/s00405-014-3175-3.
Rhim, GI. Serum vitamin D and recurrent benign paroxysmal positional vertigo. Laryngoscope Investig Otolaryngol. 2016;150–153. https://doi.org/10.1002/lio2.35.
Yang C, Kim Y, Lee H. Bone mineral density and serum 25-hydroxyvitamin D in patients with idiopathic benign paroxysmal positional vertigo. J Vestib Res. 2017;27:287–94. https://doi.org/10.3233/ves-170625.
Han W, Fan Z, Zhou M, Guo X, Yan W, Lu X, Li L, Gu C, Chen C, Wu Y. Low 25-hydroxyvitamin D levels in postmenopausal female patients with benign paroxysmal positional vertigo. Acta Otolaryngol. 2018;138:443–6. https://doi.org/10.1080/00016489.2017.1416168.
Thomas RJ, Goutham MK, Bhat VS, Kamath SßD, Aroor R, Bhandary SK. Association of serum calcium and vitamin D with benign paroxysmal positional vertigo. Int Arch Otorhinolaryngol. 2022; 26. https://doi.org/10.1055/s-0041-1724093.
Cikrikci Isik G, Cevik Y, Emektar E, et al. Analysis of vitamin D and calcium levels in benign paroxysmal positional vertigo. Eurasian Journal of Emergency Medicine. 2017;16(03):128–32. https://doi.org/10.5005/jp-journals-10003-1359.
Maslovara S, Butkovic Soldo S, Sestak A, Milinkovic K, Rogic- Namacinski J, Soldo A. 25 (OH) D3 levels, incidence and recurrence of different clinical forms of benign paroxysmal positional vertigo. Braz J Otorhinolaryngol. 2018;84:453–9. https://doi.org/10.1016/j.bjorl.2017.05.007.
Karataş A, Acar Yüceant G, Yüce T, Hacı C, Cebi IT, Salviz M. Association of benign paroxysmal positional vertigo with osteoporosis and vitamin D deficiency: a case controlled study. J Int Adv Otol. 2017;13:259–65. https://doi.org/10.5152/iao.2016.2640.
Goldschagg N, Teupser D, Feil K, Strupp M. No evidence for a specific vitamin D deficit in benign paroxysmal positional vertigo. Eur J Neurol. 2021;28(9):3182–6. https://doi.org/10.1111/ene.14980.
Talaat HS, Kabel AM, Khaliel LH, Abuhadied G, El-Naga HA, Talaat AS. Reduction of recurrence rate of benign paroxysmal positional vertigo by treatment of severe vitamin D deficiency. Auris Nasus Larynx. 2016;43:237–41. https://doi.org/10.1016/j.anl.2015.08.009.
Sheikhzadeh M, Lotfi Y, Mousavi A, Heidari B, Bakhshi E. The effect of serum vitamin D normalization in preventing recurrences of benign paroxysmal positional vertigo: a case-control study. Caspian J Intern Med. 2016;7:173–7.
Sheikhzadeh M, Lotfi Y, Mousavi A, Heidari B, Monadi M, Bakhshi E. Influence of supplemental vitamin D on intensity of benign paroxysmal positional vertigo: a longitudinal clinical study. Caspian J Intern Med. 2016;7:93–8.
Lynn S, Rose O, Brey R, Suman V. Randomized trial of the canalith repositioning procedure. Otolaryngol Head Neck Surg. 1995;113:712–20. https://doi.org/10.1016/s0194-59989570010-2.
Devaiah AK, Andreoli S. Postmaneuver restrictions in benign paroxysmal positional vertigo: an individual patient data meta- analysis. Otolaryngol Head Neck Surg. 2010;142:155–9. https://doi.org/10.1016/j.otohns.2009.09.013.
Balikci HH, Ozbay I. Effects of postural restriction after modified Epley maneuver on recurrence of benign paroxysmal positional vertigo. Auris Nasus Larynx. 2014;41:428–31. https://doi.org/10.1016/j.anl.2014.05.007.
Toupet M, Ferrary E, Bozorg Grayeli A. Effect of repositioning maneuver type and post maneuver restrictions on vertigo and dizziness in benign positional paroxysmal vertigo. Scientific World Journal. 2012;2012. https://doi.org/10.1016/j.anl.2014.05.007.
De Stefano A, Dispenza F, Citraro L, et al. Are postural restrictions necessary for management of posterior canal benign paroxysmal positional vertigo? Annals of Otology, Rhinology & Laryngology. 2011;120(7):460–4. https://doi.org/10.1177/000348941112000707.
Bashir K., Pathan S., Farook S., Khalid M.M., Zayed S. Disconnect between available literature and clinical practice: exploring gaps in the management of t-BPPV in the emergency department. J Emerg Med. 2017; 6.
• Gambacorta V, Orazio A, Pugliese V, Di Giovanni A, Ricci G, Faralli M. Persistent postural perceptual dizziness in episodic vestibular disorders. Audiology research. 2022;12(6):589–95. https://doi.org/10.3390/audiolres12060058. BPPV can lead to persistent postural perceptual dizziness, which is a chronic functional vestibular disorder. Individuals with multiple vestibular comorbidities have increased risk of PPPD.
Caruso G, Nuti D. Epidemiological data from 2.270 PPV patients. Audiol Med. 2005;3:7–11. https://doi.org/10.1080/16513860510028310.
Horii A, Kitahara T, Osaki Y, et al. Intractable benign paroxysmal positioning vertigo: long-term follow-up and inner ear abnormality detected by three-dimensional magnetic resonance imaging. Otol Neurotol. 2010;31(2). https://doi.org/10.1097/mao.0b013e3181cabd77.
Cohen HS, Kimball KT, Stewart MG. Benign paroxysmal positional vertigo and comorbid conditions. ORL. 2004;66:11–5. https://doi.org/10.1159/000077227.
Gross EM, Viirre ES, Nelson JR, Harris JP. Intractable benign paroxysmal positional vertigo in patients with Meniere’s disease. Laryngoscope. 2000;110:655–9. https://doi.org/10.1097/00005537-200004000-00022.
Ishiyama Jacobsom K, Baloh R. Migraine and benign positional vertigo. Ann Otol Rhinol Larynology. 2000;190:377–80. https://doi.org/10.1177/000348940010900407.
Katsarkas A. Benign paroxysmal positional vertigo(BPPV): idiopathic versus post-traumatic. Acta Otolaryngol. 1999;119:745–9. https://doi.org/10.1080/00016489950180360.
Gordon CR, Levite R, Joffe V, Gadoth N. Is post- traumatic benign paroxysmal positional vertigo different from the idiopathic form? Arch Neurol. 2004;61:1590–3. https://doi.org/10.1001/archneur.61.10.1590.
Vibert D, Kompis M, Häusler R. Benign paroxysmal positional vertigo in older women may be related to osteoporosis and osteopenia. Ann Otol Rhinol Laryngol 2003;112. https://doi.org/10.1177/000348940311201010.
Del Rio M, Arriaga MA. Benign positional vertigo: prognostic factors. Otolaryngol Head Neck Surg. 2004;130. https://doi.org/10.1016/j.otohns.2003.12.015.
Power L, Murray K, Bullus K, Drummond KJ, Trost N, Szmulewicz DJ. Central conditions mimicking benign paroxysmal positional vertigo: a case series. J Neurol Phys Ther. 2019;43:186–91. https://doi.org/10.1097/npt.0000000000000276.
You P, Instrum R, Parnes L. Benign paroxysmal positional vertigo. Laryngoscope Investig Otolaryngol. 2019;4(1):116–23. https://doi.org/10.1002/lio2.230.
Ahmed RM, Pohl DV, MacDougall HG, Makeham T, Halmagyi GM. Posterior semicircular canal occlusion for intractable benign positional vertigo: outcome in 55 ears in 53 patients operated upon over 20 years. J Laryngol Otol. 2012;126(7):677–82. https://doi.org/10.1017/s0022215112000758.
Kisilevsky V, Bailie NA, Dutt SN, Rutka JA. Lessons learned from the surgical management of benign paroxysmal positional vertigo: the University Health Network experience with posterior semicircular canal occlusion surgery (1988–2006). J Otolaryngol Head Neck Surg. 2009;38(2):212–21.
Maas BDPJ, van der Zaag-Loonen HJ, van Benthem PPG, Bruintjes TD. Effectiveness of canal occlusion for intractable posterior canal benign paroxysmal positional vertigo: a systematic review. Otolaryngol Head Neck Surg. 2020;162(1):40–9. https://doi.org/10.1177/0194599819881437.
Motamed M, Osinubi O, Cook JA. Effect of mastoid oscillation on the outcome of the canalith repositioning procedure. The Laryngoscope. 2004;114(7):1296–1298. https://api.istex.fr/ark:/67375/WNG-263GZXXL-2/fulltext.pdf.
Li JC. Mastoid oscillation: a critical factor for success in the canalith repositioning procedure. Otolaryngol Head Neck Surg. 1995;112:670–5. https://doi.org/10.1016/s0194-59989570174-5.
Sargent EW, Bankaitis AE, Hollenbeak CS, Currens JW. Mastoid oscillation in canalith repositioning for paroxysmal positional vertigo. Otol Neurotol. 2001;22:205–9. https://doi.org/10.1097/00129492200103000-00015.
Kong TH, Song MH, Kang JW, Shim DB. Double-blind randomized controlled trial on efficacy of cupulolith repositioning maneuver for treatment of apogeotropic horizontal canal benign paroxysmal positional vertigo. Acta Otolaryngol. 2020;140(6):473–8. https://doi.org/10.1080/00016489.2020.1736339.
Organ B, Liu H, Bromwich M. An iPhone-assisted particle repositioning maneuver for benign paroxysmal positional vertigo (BPPV): a prospective randomized study. J Am Board Fam Med. 2015;28(1):118120. https://doi.org/10.3122/jabfm.2015.01.120295.
Ismail EI, Morgan AE, Abdeltawwab MM. Home particle repositioning maneuver to prevent the recurrence of posterior canal BPPV. Auris Nasus Larynx. 2018;45:980–4. https://doi.org/10.1016/j.anl.2018.02.005.
Kwon,C.etal. Quantitative assessment of self-treated canalith repositioning procedures using inertial measurement unit sensors. J. Vestib. Res. 2021; 31: 423–431. https://doi.org/10.3233/ves-190747
• Pastor CAC, Kwon C, Joo JS, et al. Feasibility of an inertial measurement unit sensor-based guiding system for benign paroxysmal positional vertigo treatment: a pilot study. Sci Rep. 2023;13. https://doi.org/10.1038/s41598-023-29685-8. Real-time feedback using inertial monitoring units (IMUs) may provide real-time feedback on head rotation to promote independence with repositioning maneuvers.
Abdulovski S, Klokker M. Repositioning chairs in the diagnosis and treatment of benign paroxysmal positional vertigo-a systematic review. Journal of International Advanced Otology. 2021;17(4):353–60. https://doi.org/10.5152/iao.2021.9434.
Castellucci A, Malara P, Martellucci S, Delmonte S, Ghidini A. Fluctuating posterior canal function in benign paroxysmal positional vertigo depending on how and where otoconia are disposed. Otol Neurotol. 2020;42(2):193–8. https://doi.org/10.1097/mao.0000000000002913.
Saltürk Z, Yetişer S. Video head impulse testing in patients with benign paroxysmal positional vertigo. Acta Otolaryngol. 2020;140(12):977–81. https://doi.org/10.1080/00016489.2020.1805123.
Califano L, Iannella R, Mazzone S, Salafia F, Melillo MG. The video head impulse test in the acute stage of posterior canal benign paroxysmal positional vertigo. Acta Otorhinolaryngol Ital 2021;41(1):69. https://doi.org/10.14639/0392-100x-n1033.
Abdulrahim R, Bhandary BSK, Rajeshwary A, Goutham MK, Bhat V, Saldanha M. The role of video head impulse test (Vhit) in diagnosing benign paroxysmal positional vertigo (BPPV). Indian J Otolaryngol Head Neck Surg. 2022;74:506–10. https://doi.org/10.1007/s12070-020-02351-5.
Carrillo Muñoz R, Ballve Moreno JL, Villar Balboa I, et al. Disability perceived by primary care patients with posterior canal benign paroxysmal positional vertigo. BMC Fam Pract. 2019;20(1). https://doi.org/10.1186/s12875-019-1035-3.
Agrawal Y, Ward BK, Minor LB. Vestibular dysfunction: prevalence, impact and need for targeted treatment. J Vestib Res. 2013;23(3):113–7. https://doi.org/10.3233/ves-130498.
von Brevern M, Lezius F, Tiel-Wilck K, Radtke A, Lempert T. Benign paroxysmal positional vertigo: current status of medical management. Otolaryngol Head Neck Surg. 2004;130:381–2. https://doi.org/10.1016/j.otohns.2003.07.007.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
Allison Nogi, Andrew Fischer, Daniel Ludwig, and Jennifer Millar all declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Nogi, A.L., Fischer, A., Ludwig, D. et al. Clinical Practice Update Part II: Considerations for Treatment and Management of Benign Paroxysmal Positional Vertigo. Curr Treat Options Neurol 25, 355–368 (2023). https://doi.org/10.1007/s11940-023-00764-5
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11940-023-00764-5