Benign Paroxysmal Positional Vertigo

Benign paroxysmal positional vertigo (BPPV) is characterized by brief recurrent episodes of vertigo triggered by head position changes. BPPV is one of the most common causes of recurrent vertigo. BPPV results from abnormal stimulation of the cupula within any of the three semicircular canals by free-floating otoliths (canalithiasis) or otoliths adhered to the cupula (cupulolithiasis). Typical symptoms and signs of BPPV are evoked when the head is positioned so that the plane of the affected semicircular canal is spatially vertical and thus aligned with gravity. Paroxysm of vertigo and nystagmus develops after a brief latency during Dix-Hallpike maneuver in posterior canal BPPV and supine roll test in horizontal canal BPPV. Usually positioning the head in the opposite direction reverses the direction of the nystagmus. The duration, frequency, and intensity of symptoms of BPPV vary depending on the involved canals and the nature of otolithic debris. Spontaneous recovery occurs frequently even with conservative treatment, however, canalith repositioning maneuvers are believed to be the best way to treat BPPV by moving the canaliths from the semicircular canal to the vestibule.