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Belign Paraxysmal Postonal vertigo (BPPV)

Spinning world: Benign Paroxysmal Positional Vertigo


Dizziness, a common cause of referral to otolaryngology clinic, includes a broad range of sensations from severe vertigo to momentary light-headedness , and Vertigo most common of dizziness is an illusion of movement of the body or environment.

Vertigo may be because of otologic, neurologic, or systemic reasons.

Causes of Otologic dizziness

  • Benign paroxysmal positional vertigo) – about 50% of otologic, 20% all
  •  Meniere’s disease – about 20%
  •  Vestibular neuritis and related conditions (15%)
  •  Bilateral vestibular loss (about 1%)
  •  SCD and Fistula (rare)

What is Benign Paroxysmal Positional Vertigo?

  • Benign paroxysmal positional vertigo (BPPV) is the most common underlying cause of vertigo accounting for about 20% of all dizziness and 50% of otologic dizziness.
  • Benign paroxysmal positional vertigo is defined as a disorder of the inner ear characterized by repeated episodes of positional vertigo.
  • Positional vertigo— means a spinning sensation produced by changes in head position relative to gravity.
  • Benign— means not due to any serious brain or CNS (Central Nervous System)disorder  and the overall prognosis for recovery is favorable. (However, undiagnosed and untreated BPPV may have health, and quality of life impacts).
  • Paroxysmal—  means Rapid and sudden onset of the vertigo
Symptoms of BPPV
Dizziness, Imbalance, Nausea, light-headedness

That is
  • Brief and strong
  • Provoked by change of head position
  • Definitively diagnosed by Hallpike test
  • Many patients wake up with the condition, noticing the vertigo while trying to sit up suddenly.
  • People do not usually feel dizzy all the time. Dizziness attacks triggered by head movements (classically with lying down or rolling over in bed) and between episodes patients usually have few or no symptoms.
  • Classic BPPV is usually triggered by the sudden action of moving from the erect position to the supine position while angling the head 45° toward the side of the affected ear.
The pathophysiology of BPPV
Diagnosis of BPPV
Dix-Hallpike maneuver– Standard clinical test for BPPV
Workup for BPPV
Management of BPPV
Surgical Care

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Dr. Nitish Jhawar

M.S., FMAS, FIAGES, FALS, FACRSI
Fellow Advance Laparoscopic Surgery
Fellow Colorectal Surgery USA
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