Skip to main content
SpringerLink
Log in

Benign Paroxysmal Positional Vertigo

  • Chapter
  • First Online:
Disorders of the Vestibular System

  • 377 Accesses

Abstract

Benign paroxysmal positional vertigo (BPPV) was first described in 1921 and is a purely mechanical disorder of the inner ear. The brief, positional spells of vertigo and nystagmus result from movement of displaced otoconia within one or more of the three semicircular canals of the inner ear. There are three distinct forms of the disorder—posterior, anterior, and horizontal canal forms, with the most common form resulting from free-floating particles in the posterior semicircular canal. Each canal can also show accumulation or entrapment of particles in or near the ampulla, resulting in a more prolonged direction changing positional nystagmus. Diagnosis and treatment rely upon maneuvers that move the otoconia within the affected canal to elicit the characteristic nystagmus, and other maneuvers that can rotate the particles out to resolve the disorder. More than 90% of cases can be resolved with maneuvers, and surgical canal plugging can be used in intractable cases.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. von Brevern M, Radtke A, Lezius F, Feldmann M, Ziese T, Lempert T, et al. Epidemiology of benign paroxysmal positional vertigo: a population based study. J Neurol Neurosurg Psychiatry. 2007;78(7):710–5.

    Article  Google Scholar 

  2. Barany R. Diagnose von krankheitserch-eingungen im mereiche de otolithenapparates. Acta Otolaryngol. 1921;2:434–7.

    Article  Google Scholar 

  3. Dix MR, Hallpike CS. The pathology symptomatology and diagnosis of certain common disorders of the vestibular system. Proc R Soc Med. 1952;45(6):341–54.

    CAS  PubMed  PubMed Central  Google Scholar 

  4. Hemenway WG, Lindsay JR. Postural vertigo due to unilateral sudden partial loss of vestibular function. Ann Otol Rhinol Laryngol. 1956;65(3):692–706.

    Article  CAS  PubMed  Google Scholar 

  5. Schuknecht HF. Cupulolithiasis. Arch Otolaryngol. 1969;90(6):765–78.

    Article  CAS  PubMed  Google Scholar 

  6. Hall SF, Ruby RR, McClure JA. The mechanics of benign paroxysmal vertigo. J Otolaryngol. 1979;8(2):151–8.

    CAS  PubMed  Google Scholar 

  7. Epley JM. The canalith repositioning procedure: for treatment of benign paroxysmal positional vertigo. Otolaryngology Head Neck Surg. 1992;107(3):399–404.

    Article  CAS  Google Scholar 

  8. McClure JA. Horizontal canal BPV. J Otolaryngol. 1985;14(1):30–5.

    CAS  PubMed  Google Scholar 

  9. Hillman DE, McLaren JW. Displacement configuration of semicircular canal cupulae. Neuroscience. 1979;4(12):1989–2000.

    Article  CAS  PubMed  Google Scholar 

  10. Ewald EJR. Physiologische Untersuchungen über das Endorgan des Nervus octavus. Wiesbaden Bergmann; 1892. 324 p.

    Google Scholar 

  11. Cremer PD, Halmagyi GM, Aw ST, Curthoys IS, McGarvie LA, Todd MJ, et al. Semicircular canal plane head impulses detect absent function of individual semicircular canals. Brain. 1998;121(Pt 4):699–716.

    Article  PubMed  Google Scholar 

  12. Kao WT, Parnes LS, Chole RA. Otoconia and otolithic membrane fragments within the posterior semicircular canal in benign paroxysmal positional vertigo. Laryngoscope. 2017;127(3):709–14.

    Article  PubMed  Google Scholar 

  13. Cakir BO, Ercan I, Cakir ZA, Civelek S, Sayin I, Turgut S. What is the true incidence of horizontal semicircular canal benign paroxysmal positional vertigo? Otolaryngol Head Neck Surg. 2006;134(3):451–4.

    Article  PubMed  Google Scholar 

  14. Shaikh AG, Palla A, Marti S, Olasagasti I, Optican LM, Zee DS, et al. Role of cerebellum in motion perception and vestibulo-ocular reflex-similarities and disparities. Cerebellum. 2013;12(1):97–107.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Foster C, Zaccaro K, Strong D. Canal conversion and re-entry: a risk of Dix-Hallpike during canalith repositioning procedures. Otol Neurotol. 2012;33:199–203.

    Article  PubMed  Google Scholar 

  16. Riga M, Korres S, Korres G, Danielides V. Apogeotropic variant of lateral semicircular canal benign paroxysmal positional vertigo: is there a correlation between clinical findings, underlying pathophysiologic mechanisms and the effectiveness of repositioning maneuvers? Otol Neurotol. 2013;34(6):1155–64.

    Article  PubMed  Google Scholar 

  17. 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):e843–8.

    Article  PubMed  Google Scholar 

  18. Schubert MC, Helminski J, Zee DS, Cristiano E, Giannone A, Tortoriello G, et al. Horizontal semicircular canal jam: two new cases and possible mechanisms. Laryngosc Invest Otolaryngol. 2020;5(1):163–7.

    Article  Google Scholar 

  19. Bronstein AM, Kaski D, Cutfield N, Buckwell D, Banga R, Ray J, et al. Head-jolting nystagmus: occlusion of the horizontal semicircular canal induced by vigorous head shaking. JAMA Otolaryngol Head Neck Surg. 2015;141(8):757–60.

    Article  PubMed  Google Scholar 

  20. Moriarty B, Rutka J, Hawke M. The incidence and distribution of cupular deposits in the labyrinth. Laryngoscope. 1992;102(1):56–9.

    Article  CAS  PubMed  Google Scholar 

  21. Epley JM. Human experience with canalith repositioning maneuvers. Ann N Y Acad Sci. 2001;942:179–91.

    Article  CAS  PubMed  Google Scholar 

  22. Young AS, Lechner C, Bradshaw AP, MacDougall HG, Black DA, Halmagyi GM, et al. Capturing acute vertigo: a vestibular event monitor. Neurology. 2019;92(24):e2743–53.

    Article  PubMed  Google Scholar 

  23. Della Santina CC, Potyagaylo V, Migliaccio AA, Minor LB, Carey JP. Orientation of human semicircular canals measured by three-dimensional multiplanar CT reconstruction. J Assoc Res Otolaryngol. 2005;6(3):191–206.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Ichijo H. Cupulolithiasis of the posterior semicircular canal. Am J Otolaryngol. 2013;34(5):458–63.

    Article  PubMed  Google Scholar 

  25. Asprella LG. Diagnostic and treatment strategy of lateral semicircular canal canalolithiasis. Acta Otorhinolaryngol Ital. 2005;25(5):277–83.

    Google Scholar 

  26. Choung YH, Shin YR, Kahng H, Park K, Choi SJ. ‘Bow and lean test’ to determine the affected ear of horizontal canal benign paroxysmal positional vertigo. Laryngoscope. 2006;116(10):1776–81.

    Article  PubMed  Google Scholar 

  27. Hiruma K, Numata T. Positional nystagmus showing neutral points. ORL. 2004;66(1):46–50.

    Article  PubMed  Google Scholar 

  28. Bisdorff AR, Debatisse D. Localizing signs in positional vertigo due to lateral canal cupulolithiasis. Neurology. 2001;57(6):1085–8.

    Article  CAS  PubMed  Google Scholar 

  29. 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 Otolaryngol Head Neck Surg. 2014;140(3):250–2.

    Article  PubMed  Google Scholar 

  30. Califano L, Vassallo A, Melillo MG, Mazzone S, Salafia F. Direction-fixed paroxysmal nystagmus lateral canal benign paroxysmal positioning vertigo (BPPV): another form of lateral canalolithiasis. Acta Otorhinolaryngol Ital. 2013;33(4):254–60.

    CAS  PubMed  PubMed Central  Google Scholar 

  31. Vannucchi P, Pecci R. About nystagmus transformation in a case of apogeotropic lateral semicircular canal benign paroxysmal positional vertigo. Int J Otolaryngol. 2011;2011:687921.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Yacovino DA, Hain TC, Gualtieri F. New therapeutic maneuver for anterior canal benign paroxysmal positional vertigo. J Neurol. 2009;256(11):1851–5.

    Article  PubMed  Google Scholar 

  33. Fetter M, Haslwanter T, Bork M, Dichgans J. New insights into positional alcohol nystagmus using three-dimensional eye-movement analysis. Ann Neurol. 1999;45(2):216–23.

    Article  CAS  PubMed  Google Scholar 

  34. Kim CH, Choi JM, Jung HV, Park HJ, Shin JE. Sudden sensorineural hearing loss with simultaneous positional vertigo showing persistent geotropic direction-changing positional nystagmus. Otol Neurotol. 2014;35(9):1626–32.

    Article  PubMed  Google Scholar 

  35. Imai T, Matsuda K, Takeda N, Uno A, Kitahara T, Horii A, et al. Light cupula: the pathophysiological basis of persistent geotropic positional nystagmus. BMJ Open. 2015;5(1):e006607.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Fife TD, Iverson DJ, Lempert T, Furman JM, Baloh RW, Tusa RJ, et al. Practice parameter: therapies for benign paroxysmal positional vertigo (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2008;70(22):2067–74.

    Article  CAS  PubMed  Google Scholar 

  37. Foster CA, Foster CA, Ponnapan A, Zaccaro K, Strong D. A comparison of two home exercises for benign positional vertigo: half somersault versus Epley maneuver. Audiol Neurotol Extra. 2012;2(1):16–23.

    Article  Google Scholar 

  38. Oron Y, Cohen-Atsmoni S, Len A, Roth Y. Treatment of horizontal canal BPPV: pathophysiology, available maneuvers, and recommended treatment. Laryngoscope. 2015;125(8):1959–64.

    Article  PubMed  Google Scholar 

  39. Lempert T, Tiel-Wilck K. A positional maneuver for treatment of horizontal-canal benign positional vertigo. Laryngoscope. 1996;106(4):476–8.

    Article  CAS  PubMed  Google Scholar 

  40. Asprella Libonati G, Gagliardi G, Cifarelli D, Larotonda G. “Step by step” treatment of lateral semicircular canal canalolithiasis under videonystagmoscopic examination. Acta Otorhinolaryngol Ital. 2003;23(1):10–5.

    CAS  PubMed  Google Scholar 

  41. Kim J-S, Oh S-Y, Lee S-H, Kang J-H, Kim DU, Jeong S-H, et al. Randomized clinical trial for apogeotropic horizontal canal benign paroxysmal positional vertigo. Neurology. 2012;78(3):159–66.

    Article  PubMed  Google Scholar 

  42. Kim YK, Shin JE, Chung JW. The effect of canalith repositioning for anterior semicircular canal canalithiasis. ORL J Otorhinolaryngol Relat Spec. 2005;67(1):56–60.

    Article  PubMed  Google Scholar 

  43. Foster CA. Overcoming positional vertigo. Boulder, CO: Bull Publishing; 2019. p. 200.

    Google Scholar 

  44. Agrawal SK, Parnes LS. Human experience with canal plugging. Ann N Y Acad Sci. 2001;942:300–5.

    Article  CAS  PubMed  Google Scholar 

  45. Brantberg K, Bergenius J. Treatment of anterior benign paroxysmal positional vertigo by canal plugging: a case report. Acta Otolaryngol. 2002;122(1):28–30.

    Article  PubMed  Google Scholar 

  46. Uetsuka S, Kitahara T, Horii A, Imai T, Uno A, Okazaki S, et al. Transient low-tone air-bone gaps during convalescence immediately after canal plugging surgery for BPPV. Auris Nasus Larynx. 2012;39(4):356–60.

    Article  PubMed  Google Scholar 

  47. Hunt WT, Zimmermann EF, Hilton MP. Modifications of the Epley (canalith repositioning) manoeuvre for posterior canal benign paroxysmal positional vertigo (BPPV). Cochrane Database Syst Rev. 2012;2012(4):CD008675.

    PubMed  PubMed Central  Google Scholar 

  48. Faralli M, Longari F, Ricci G, Marinetti D, Frenguelli A. Mastoid oscillation in the treatment of the apogeotropic variant of benign paroxysmal positional vertigo of the lateral semicircular canal. Mediterr J Otol. 2008;4:152–6.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Aurora, CO, USA

    Carol A. Foster

Authors
  1. Carol A. Foster
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Carol A. Foster .

Editor information

Editors and Affiliations

  1. Department of Otolaryngology, University of Rochester, Rochester, NY, USA

    Benjamin T. Crane

  2. Department of Otolaryngology, Columbia University, New York, NY, USA

    Lawrence Lustig

  3. Department of Otolaryngology, Lilavati Hospital, Mumbai, Maharashtra, India

    Christopher de Souza

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Foster, C.A. (2023). Benign Paroxysmal Positional Vertigo. In: Crane, B.T., Lustig, L., de Souza, C. (eds) Disorders of the Vestibular System. Springer, Cham. https://doi.org/10.1007/978-3-031-40524-2_7

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-40524-2_7

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-40523-5

  • Online ISBN: 978-3-031-40524-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation