Benign Paroxysmal Positional Vertigo
Parnes and Nabi (2009) present a review and update on the diagnosis and management of Benign Paroxysmal Positional Vertigo (BPPV). In the United States, some 200,000 new cases annually are reported, with a higher incidence in women.
Parnes and Nabi report BPPV may have considerable impact on quality of life (QOL). BPPV is among the most common etiologies of dizziness and vertigo--experienced by some 10 percent of the elderly population. Most BPPV cases result from migration of "free-floating" canalith particles usually within the posterior (most common) or horizontal/lateral (less common) semi-circular canals. Anterior canal BPPV is very rare. Fifty to seventy percent of all BPPV cases do not have a specifically identified etiology and are thus referred to as "idiopathic BPPV" or "primary BPPV." Primary BPPV is most often diagnosed in patients between the ages of 50 and 70 years. Secondary BPPV is associated with known underlying conditions such as head trauma, Meniere's Disease, labyrinthitis, migraines, etc. The two primary pathophysiologic mechanisms of BPPV are canalithiasis (more common) and cupulolithiasis (less common).
The nystagmus profile is key to the diagnosis of BPPV. The posterior semicircular canal responds to vertical and lateral motion. Thus, the resultant nystagmus has torsional (rotatory) and vertical/up-beating components. The anterior/superior canal also has a torsional component but the vertical component is down-beating. The lateral/horizontal canal is not associated with a torsional component but may demonstrate a horizontal component. The Dix-Hallpike Maneuver remains the definitive diagnostic tool. Vertigo associated with BPPV is of sudden onset and usually lasts less than 30 seconds.
Parnes and Nabi state all patients with posterior canal BPPV should be offered particle repositioning maneuvers unless a specific contraindication is present. Particle repositioning maneuvers are simple to perform and can easily be mastered. The authors state vestibular suppressant medications are not an effective treatment option for people with BPPV and for some severe and intractable cases, surgical solutions may include posterior canal occlusion.
For More Information, References, and Recommendations:
Parnes LS, Nabi S. (2009) The Diagnosis and Management of Benign Paroxysmal Positional Vertigo. Seminars in Hearing 30(4):287-303.