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Benign Paroxysmal Positional Vertigo Workup

  • Author: John C Li, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
 
Updated: May 06, 2016
 

Laboratory Studies

Because the Dix-Hallpike maneuver is pathognomonic, laboratory tests are not needed to make the diagnosis of benign paroxysmal positional vertigo (BPPV). However, since a high association with inner ear disease exists, laboratory workup may be needed to delineate these other pathologies.

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Imaging Studies

Imaging studies are not needed in the workup of a patient in whom BPPV is suspected.

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Other Tests

See the list below:

  • The Dix-Hallpike maneuver is the standard clinical test for BPPV (see Physical).
  • Electronystagmography
    • Torsional eye movement cannot be demonstrated directly, but occasionally electronystagmography (ENG) is helpful in detecting the presence and timing of nystagmus.
    • Caloric test results can be normal or hypofunctional.
    • According to Mohammed Hamid, MD, a reduced vestibular response can occur secondary to the sluggishness of the particle-laden endolymph.
    • BPPV can originate in an ear with an absent caloric response because the nervous and vascular supply to the horizontal canal is separate from that of the PSCs.
  • Infrared nystagmography: Torsional eye movement can be demonstrated directly.
  • Audiogram: The result of an audiogram may be normal.
  • Posturography: Posturography results are often abnormal but follow no predictable or diagnostic pattern.
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Contributor Information and Disclosures
Author

John C Li, MD Private Practice in Otology and Neurotology; Medical Director, Balance Center

John C Li, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Neurotology Society, American College of Surgeons, American Medical Association, American Tinnitus Association, Florida Medical Association, North American Skull Base Society

Disclosure: Received consulting fee from Synthes Power Tools for consulting.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Peter S Roland, MD Professor, Department of Neurological Surgery, Professor and Chairman, Department of Otolaryngology-Head and Neck Surgery, Director, Clinical Center for Auditory, Vestibular, and Facial Nerve Disorders, Chief of Pediatric Otology, University of Texas Southwestern Medical Center; Chief of Pediatric Otology, Children’s Medical Center of Dallas; President of Medical Staff, Parkland Memorial Hospital; Adjunct Professor of Communicative Disorders, School of Behavioral and Brain Sciences, Chief of Medical Service, Callier Center for Communicative Disorders, University of Texas School of Human Development

Peter S Roland, MD is a member of the following medical societies: Alpha Omega Alpha, American Auditory Society, The Triological Society, North American Skull Base Society, Society of University Otolaryngologists-Head and Neck Surgeons, American Neurotology Society, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American Otological Society

Disclosure: Received honoraria from Alcon Labs for consulting; Received honoraria from Advanced Bionics for board membership; Received honoraria from Cochlear Corp for board membership; Received travel grants from Med El Corp for consulting.

Chief Editor

Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan;RxRevu;SymbiaAllergySolutions<br/>Received income in an amount equal to or greater than $250 from: Symbia<br/>Received from Allergy Solutions, Inc for board membership; Received honoraria from RxRevu for chief medical editor; Received salary from Medvoy for founder and president; Received consulting fee from Corvectra for senior medical advisor; Received ownership interest from Cerescan for consulting; Received consulting fee from Essiahealth for advisor; Received consulting fee from Carespan for advisor; Received consulting fee from Covidien for consulting.

Additional Contributors

Michael E Hoffer, MD Director, Spatial Orientation Center, Department of Otolaryngology, Naval Medical Center of San Diego

Michael E Hoffer, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery

Disclosure: Received royalty from American biloogical group for other.

Acknowledgements

John Epley, MD Director, Portland Otologic Clinic

John Epley, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, and Oregon Medical Association

Disclosure: Nothing to disclose.

References
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  2. Epley JM. New dimensions of benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg. 1980 Sep-Oct. 88(5):599-605. [Medline].

  3. Yetiser S, Ince D. Diagnostic Role of Head-Bending and Lying-Down Tests in Lateral Canal Benign Paroxysmal Positional Vertigo. Otol Neurotol. 2015 May 1. [Medline].

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  8. [Guideline] 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 May 27. 70(22):2067-74. [Medline]. [Full Text].

  9. [Guideline] Bhattacharyya N, Baugh RF, Orvidas L, Barrs D, Bronston LJ, Cass S, et al. Clinical practice guideline: benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg. 2008 Nov. 139(5 Suppl 4):S47-81. [Medline]. [Full Text].

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  12. Herdman SJ, Tusa RJ, Zee DS, et al. Single treatment approaches to benign paroxysmal positional vertigo. Arch Otolaryngol Head Neck Surg. 1993 Apr. 119(4):450-4. [Medline].

  13. Li JC. Mastoid oscillation: a critical factor for success in canalith repositioning procedure. Otolaryngol Head Neck Surg. 1995 Jun. 112(6):670-5. [Medline].

  14. Li JC, Epley J. The 360-degree maneuver for treatment of benign positional vertigo. Otol Neurotol. 2006 Jan. 27(1):71-7. [Medline]. [Full Text].

  15. Massoud EA, Ireland DJ. Post-treatment instructions in the nonsurgical management of benign paroxysmal positional vertigo. J Otolaryngol. 1996 Apr. 25(2):121-5. [Medline].

  16. Roberts RA. Efficacy of a new treatment maneuver for posterior canal benign paroxysmal positional vertigo.

  17. Roberts RA. Efficacy of a new treatment maneuver for posterior canal benign paroxysmal positional vertigo.

  18. Smouha EE, Roussos C. Atypical forms of paroxysmal positional nystagmus. Ear Nose Throat J. 1995 Sep. 74(9):649-56. [Medline].

  19. Weider DJ, Ryder CJ, Stram JR. Benign paroxysmal positional vertigo: analysis of 44 cases treated by the canalith repositioning procedure of Epley. Am J Otol. 1994 May. 15(3):321-6. [Medline].

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The patient is placed in a sitting position with the head turned 45° towards the affected side and then reclined past the supine position.
The patient is then brought back up to the sitting position.
Next, the patient is rolled 180° from the affected side to the opposite side. Note that the position of the head is 45° toward the affected side before the roll. The head winds up facing down, 180° away from the starting position.
 
 
 
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