Benign Paroxysmal Positional Vertigo Guidelines

Updated: Mar 09, 2017
  • Author: John C Li, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Guidelines

Guidelines Summary

In 2017, the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF)released an update to a 2008 guideline regarding benign paroxysmal positional vertigo (BPPV). The update included recommendations that clinicians do as follows [8, 9, 10] :

  • Diagnose posterior semicircular canal BPPV when vertigo associated with torsional, upbeating nystagmus is provoked by the Dix-Hallpike maneuver, performed by bringing the patient from an upright to a supine position with the head turned 45° to one side, the neck extended 20°, and the affected ear aimed downward
  • Treat, or refer to a clinician who can treat, patients with posterior canal BPPV with a canalith repositioning procedure
  • Not impose postprocedural postural restrictions after canalith repositioning procedure for posterior canal BPPV
  • Perform, or refer the patient to a clinician who can perform, a supine roll test to assess for lateral semicircular canal BPPV if the patient has a history compatible with BPPV and the Dix-Hallpike test results in horizontal or no nystagmus
  • Differentiate, or refer the patient to a clinician who can differentiate, BPPV from other causes of imbalance, dizziness, and vertigo
  • Assess patients with BPPV for factors that modify management, including impaired mobility or balance, central nervous system disorders, a lack of home support, and/or increased risk for falling
  • Reassess patients within 1 month after an initial period of observation or treatment to document resolution or persistence of symptoms
  • Evaluate, or refer to a clinician who can evaluate, patients with persistent symptoms for unresolved BPPV and/or underlying peripheral vestibular or CNS disorders
  • Educate patients regarding the impact of BPPV on their safety, the potential for disease recurrence, and the importance of follow-up
  • Not perform radiographic imaging in a patient who meets diagnostic criteria for BPPV in the absence of additional signs and/or symptoms inconsistent with BPPV that warrant imaging
  • Not perform vestibular testing in a patient who meets diagnostic criteria for BPPV in the absence of additional vestibular signs and/or symptoms inconsistent with BPPV that warrant testing
  • Not routinely treat BPPV with vestibular suppressant medications such as antihistamines and/or benzodiazepines