Neurologic Manifestations of Benign Positional Vertigo Follow-up

Updated: Jul 23, 2018
  • Author: John C Li, MD; Chief Editor: Robert A Egan, MD  more...
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Further Inpatient Care

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  • Inpatient care usually is not required.

  • Severe cases may require supportive therapy for nausea and vomiting.



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  • Complications of canalith repositioning procedure are rare.

    • Nausea/vomiting: Usually, this is not a problem if the procedure is done slowly with mastoid oscillation. In severely symptomatic or anxious patients, premedication with diazepam (Valium) or prochlorperazine (Compazine) may be used.

    • Failure: Although rare, failure is seen in about 3-5% of all patients.

    • No effect: Repeating the procedure is recommended. If it is not successful, other diagnostic possibilities should be considered.

    • Residual benign paroxysmal positional vertigo: This usually indicates that purging of canalithiasis is not complete, so the procedure should be repeated.

  • If vertigo is worse after canalith repositioning procedure, the differential diagnosis is as follows:

    • Canal jam: This occurs when the bolus of canalithiasis gets stuck at the relatively narrower distal canal (near the apex area). Patients experience vertigo when moving between position 5 and position 6. Reversing canalith repositioning procedure back to position 3 is recommended. This attempts to dislodge the canaliths.

    • Symptoms of contralateral benign paroxysmal positional vertigo or other forms of benign paroxysmal positional vertigo: This occurs when the bolus of canaliths gets sidetracked into another semicircular canal. Involvement of the semicircular canal mimics benign paroxysmal positional vertigo of the contralateral posterior semicircular canal.

    • Cupulolithiasis: The loose canal particles get stuck on the cupula and cause a paradoxical nystagmus profile. This type of nystagmus does not fatigue easily, and can beat in the opposite direction. These particles have to be shaken loose, converted back to canal particles, and then repositioned properly.

    • Dispersion: Once shaken, canaliths conceivably are suspended into solution much like dirt in muddy water. As long as they remain suspended, the patients have no symptoms. When they finally settle, the vertigo can return.



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  • Prognosis is usually good.

  • Spontaneous remission can occur within 6 weeks, although some cases never remit.

  • Once treated, benign paroxysmal positional vertigo recurrence rate is between 5% and 15%.


Patient Education

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