Benign Positional Vertigo

Definition/diagnostic criteria Benign positional vertigo, also known as benign paroxysmal positional vertigo (BPPV), is characterised by brief episodes of mild to intense vertigo, typically triggered by specific changes in the position of the head. The condition is linked to tiny calcium particles (otoconia) in the semi-circular canals, which on moving disrupt endolymph, resulting in vertigo.

Epidemiology BPPV is a common vestibular disorder, especially among older adults. While it can occur at any age, it is most frequent in individuals aged 50 and above. Women are slightly more affected than men. The condition accounts for approximately 20-30% of all cases of dizziness seen by healthcare professionals and is the commonest cause of vertigo.

Diagnosis

Clinical features:

• The primary symptom is a brief, intense sensation of vertigo triggered by changes in head position, such as rolling over in bed, tilting the head up or down.
• Nausea and less frequently, vomiting may accompany the dizziness.
• There is no hearing loss associated with BPPV.

Investigations:

• Diagnosis is primarily clinical, based on history and physical examination.
• The Dix-Hallpike test is commonly used to diagnose posterior canal BPPV, while the supine roll test is used for horizontal canal BPPV.
• Typical abnormalities found during these tests include a burst of nystagmus which is usually torsional for posterior canal BPPV and can be horizontal for horizontal canal BPPV.

Treatment Treatment mainly involves canalith repositioning procedures such as the Epley manoeuvre. These manoeuvres are designed to move the otoconia from the semicircular canal to a less sensitive location in the ear. In refractory cases, vestibular rehabilitation therapy may be recommended. Medications are generally not effective for treating BPPV but may be used to alleviate symptoms like nausea.

Prognosis The prognosis for BPPV is generally very good. The condition often resolves on its own within weeks or months. Recurrences are common, but the manoeuvres used in treatment can be easily repeated. Most patients respond well to the canalith repositioning procedures, with a high rate of symptom resolution. However, some individuals may experience lingering balance issues and dizziness.