Most people can safely drive their car as long as they are careful not to tip their head back when checking their blind spot. With the eyes in the mid neutral position, the nystagmus has a slight vertical component, the fast phase of which is upbeating. There is a stronger torsional component, the fast phase of which has the superior pole of the eye beating toward the affected dependent ear. The direction of the nystagmus reverses when the patient is brought into the upright position and the nystagmus will fatigue with repeat testing.
Along with the nystagmus, the patient will describe feeling vertiginous, the intensity of which parallels the nystagmus response. It should be emphasized that the 2 posterior canals are tested independently, the right with the head turned right and the left with the head turned left. The patient is seated and positioned so that the patient's head will extend over the top edge of the table when supine. The patient's head is held in this position and the examiner observes the patient's eyes for nystagmus.
In this case with the right side being tested, the physician should expect to see a fast-phase counter-clockwise nystagmus. To complete the manoeuvre, the patient is returned to the seated position position A and the eyes are observed for reversal nystagmus, in this case a fast-phase clockwise nystagmus. Testing for lateral canal BPPV is done by laying the patient supine and then quickly turning the patient's head and body laterally toward the side being tested.
Overall, the history and eye-findings during positional testing are the gold standards for diagnosing BPPV. Additional testing is not normally necessary. More recently, infrared videography has allowed for direct eye observation during the testing manoeuvres, but 3-dimensional eye movement analysis 30 is not common in clinical practice. Rotational-chair testing and posturography have no role to play in this disorder. Imaging with CT scanning or MRI is unnecessary unless there are atypical or unusual features to the assessment.
A certain subset of patients may not demonstrate the typical nystagmus during the Dix—Hallpike manoeuvre, but they may still experience the classic vertigo during positioning.
Proposed theories to explain the lack of nystagmus in patients with BPPV during the Dix—Hallpike manoeuvre include the following: subtle nystagmus missed by the observer, fatigued nystagmus from repeat testing before the manoeuvre and a less noxious form of BPPV that elicits vertigo but with an inadequate neural signal to stimulate the vestibulo-ocular pathway.
There are very few conditions that can even remotely resemble BPPV. Furthermore, there is accompanying tinnitus and hearing loss. The vertigo in labyrinthitis or vestibular neuronitis usually persists for days.
The vertigo may be aggravated by head movements in any direction, and this needs to be carefully extracted from the history so as to not confuse it with specific position change—evoked vertigo. Very rarely, posterior fossa tumours can mimic BPPV, but there have been no reports in the literature of a tumour that has perfectly replicated all of the features of a positive Dix—Hallpike manoeuvre.
Furthermore, being so common, BPPV can often be a coincidental finding with other disorders. The management of BPPV has changed dramatically in the past 20 years as our understanding of the condition has progressed. Traditionally, patients were instructed to avoid positions that induced their vertigo. Medications were prescribed for symptomatic relief, but 1 double-blind study showed that they were largely ineffective.
As the theories of cupulolithiasis and canalithiasis emerged, several noninvasive techniques were developed to correct the pathology directly. An earlier method used habituation exercises and, although some benefit was achieved, the effect was not long-lasting and the exercises proved to be too burdensome for many patients.
It was believed that this series of rapid changes of head position freed deposits that were attached to the cupula.
The manoeuvre begins with the patient in the sitting position and the head turned away from the affected side. The patient is then quickly put into a position lying on his or her side, toward the affected side, with his or her head turned upward. After about 5 minutes, the patient is quickly moved back through the sitting position to the opposite position lying on his or her side with his or her head now facing downward.
The patient remains in this second position for 5—10 minutes before slowly being brought back to the sitting position. The top panel shows the effect of the manoeuvre on the labyrinth as viewed from the front and the induced movement of the canaliths from blue to black. This manoeuvre relies on inertia, so that the transition from position 2 to 3 must be made very quickly. Mechanical skull vibration is routinely used and the patient's head is moved sequentially through 5 separate positions.
Epley postulated that the procedure enabled the otolithic debris to move under the influence of gravity from the posterior semicircular canal into the utricle.
Most clinicians today are thought to use a modified version of the CRP. One modified CRP is the particle repositioning manoeuvre PRM which is a 3-position manoeuvre that eliminates the need for sedation and mastoid vibration 43 , 44 Fig. With proper understanding of inner ear anatomy and the pathophysiology of BPPV, various appropriately trained health professionals, including family doctors and physiotherapists, should be able to successfully carry out the PRM in most straightforward cases.
Atypical cases or cases that do not respond to this manoeuvre should be referred to a tertiary care dizziness clinic. The patient is seated on a table as viewed from the right side A. The remaining parts show the sequential head and body positions of a patient lying down as viewed from the top. Patient in normal Dix—Hallpike head-hanging position B. Particles gravitate in an ampullofugal direction and induce utriculofugal cupular displacement and subsequent counter-clockwise rotatory nystagmus.
This position is maintained for 1—2 minutes. The patient's head is then rotated toward the opposite side with the neck in full extension through position C and into position D in a steady motion by rolling the patient onto the opposite lateral side. The change from position B to D should take no longer than 3—5 seconds. Particles continue gravitating in an ampullofugal direction through the common crus into the utricle. The patient's eyes are immediately observed for nystagmus.
Position D is maintained for another 1—2 minutes, and then the patient sits back up to position A. Move the patient to the head-hanging Dix—Hallpike position of the affected ear. The change from position B, through C, into D, should take no longer than 3—5 seconds.
If the particles continue moving in the same ampullofugal direction, that is, through the common crus into the utricle, this secondary stage nystagmus should beat in the same direction as the primary stage nystagmus.
This position is maintained for 30—60 seconds and then the patient is asked to sit up. With a successful manoeuvre, there should be no nystagmus or vertigo when the patient returns to the sitting position because the particles will have already been repositioned into the utricle. Overall, the PRM should take less than 5 minutes to complete.
Patients are then typically asked to remain upright for the next 24—48 hours in order to allow the otoliths to settle, so as to prevent a recurrence of the BPPV.
It is difficult to compare studies that use the repositioning manoeuvres, because they vary considerably in the length of follow-up, number of treatment sessions, number of manoeuvres per session, the use of sedation and the use of mastoid vibration. The efficacy and treatment protocols of many trials in the literature are summarized in Table 2. Most of these studies are case series, but Lynn and colleagues 46 and Steenerson and Cronin 45 provide good evidence from randomized studies.
Several positioning techniques to treat lateral canal BPPV have been developed. Six of their patients converted to posterior canal BPPV for which they were successfully treated using standard repositioning manoeuvres.
This is believed to move the particles out of the involved canal into the utricle. Only 2 patients were in the study, but both were completely relieved of their vertigo. Despite the excellent results from repositioning manoeuvres, there has been some controversy as to whether they actually have an effect other than central habituation, that is, when the brain adapts to repeated vestibular stimuli over time.
In , Blakley 48 published a trial of 38 patients randomly assigned to a particle repositioning group and a no-treatment group. Blakley concluded that the manoeuvre was safe but did not provide any treatment benefit for BPPV. Buckingham 56 examined human temporal bones and attempted to demonstrate the possible paths taken by loose otoliths under the influence of gravity in different positions of the head.
He found that although loose macular otoliths would tend to fall into the lumen of the utricle, they would not be returned to their original position in the macula of the utricle, which has a higher position in the vestibule. He concluded that a mechanism other than the repositioning of otoliths is responsible for the relief of BPPV seen in repositioning manoeuvres.
Although most cases of BPPV are self-limited, a number of randomized studies have shown that repositioning manoeuvres are highly effective. Lynn and colleagues 46 randomly allocated 36 patients to either a PRM group or placebo treatment group with assessment at 1 month by an audiologist who was unaware of the patients' treatment allocation. Steenerson and Cronin 45 randomly allocated 20 patients into either a PRM or vestibular habituation group and 20 patients into a no-treatment group.
There are variations in the literature regarding how many repositioning manoeuvres are performed in each treatment session Table 2. Some performed a set number of repositioning manoeuvres regardless of response. Our objection to repeating the manoeuvre until there is a negative Dix—Hallpike response is not knowing whether the response is abolished because of a successful manoeuvre or because of a fatigued response that occurs naturally with repeat testing.
From the literature review, there does not appear to be any significant difference between these approaches in terms of short-term effectiveness and long-term recurrence. Therefore, in our clinic, repeat manoeuvres are reserved for those patients who do not demonstrate an ipsidirectional secondary stage nystagmus or those who have a reverse-direction nystagmus at position D 24 Fig. In Epley's original description of the CRP, 42 he used mechanical vibration of the mastoid skull bone thinking that it would help loosen otolithic debris adherent to the membrane of the semicircular canal.
In , a study by Li 47 randomly assigned 27 patients to receive the PRM with mastoid vibration and 10 patients to receive the PRM without mastoid vibration. These results do not, however, compare well with the literature Table 2 where the majority of authors who did not use mastoid vibration achieved much higher success rates.
In , a larger study by Hain and colleagues 58 reviewed 44 patients who had the PRM with mastoid vibration and 50 patients who had the PRM without mastoid vibration. Another area of divergence among experts involves the use of activity limitations after repositioning manoeuvres.
Epley 42 asked his patients to remain upright for 48 hours after the CRP. In addition to remaining upright, certain investigators also request that their patients avoid lying on their affected side for 7 days. A study by Nuti and colleagues 40 examined 2 sets of patients following the liberatory manoeuvre.
One group of patients were asked to remain upright for 48 hours, whereas a second group of patients were not given any postmanoeuvre instructions. These 2 groups were compared retrospectively and no difference was found in short-term vertigo control. This finding is consistent with an earlier prospective study by Massoud and Ireland, 59 who also demonstrated that post—liberatory manoeuvre instructions were not efficacious.
BPPV is a benign disease and, therefore, surgery should only be reserved for the most intractable or multiply recurrent cases. Furthermore, before considering surgery, the posterior fossa should be imaged to rule out central lesions that might mimic BPPV. Singular neurectomy, or section of the posterior ampullary nerve, which sends impulses exclusively from the posterior semicircular canal to the balance part of the brain, was popularized by Gacek 61 in the s. Although initial reports by Gacek 62 demonstrated high efficacy, there was a significant risk of sensorineural hearing loss, 63 and the procedure has been found to be technically demanding.
It has largely been replaced by the simpler posterior semicircular canal occlusion. Obstruction of the semicircular canal lumen is thought to prevent endolymph flow. This effectively fixes the cupula and renders it unresponsive to normal angular acceleration forces and, more importantly, to stimulation from either free-floating particles within the endolymph or a fixed cupular deposit.
Until the advent of this procedure, invasive inner ear surgery was felt to be too risky to otherwise normal- hearing ears. However, Parnes and McClure 67 laid the groundwork for this procedure in an animal model by demonstrating its negligible effect on hearing.
The procedure is performed under general anesthetic and should take no longer than 2—3 hours. Using a 5—6-cm postauricular incision, the posterior canal is accessed through a mastoidectomy. A plug, fashioned from bone dust and fibrinogen glue, is used to occlude the canal. Most patients stay in hospital for 2—3 days after this procedure. Because the occlusion also impairs the normal inner ear physiology, all patients are expected to have postoperative imbalance and disequilibrium. For most people, the brain adapts to this after a few days to a few weeks, with vestibular physiotherapy hastening this process.
In , Agrawal and Parnes 8 published a series of cases of 44 occluded posterior canals in 42 patients. All 44 ears were relieved of BPPV, with only 1 having a late atypical recurrence. Of the 40 ears with normal preoperative hearing, 1 had a delayed 3-month sudden and permanent profound loss, whereas another had mild 20 dB hearing loss.
Further studies by Pace-Balzan and Rutka, 68 Dingle and colleagues, 69 Hawthorne and el-Naggar, 70 Anthony, 71 and Walsh and colleagues 72 have supported the safety and efficacy of this procedure. In most otology clinics, posterior semicircular canal occlusion has become the surgical procedure of choice for intractable BPPV.
Patients with BPPV present with a history of brief, episodic, position-provoked vertigo with characteristic findings on Dix—Hallpike testing. Whereas a variety of positional manoeuvres have been described, PRM Fig. Current evidence does not support the routine use of skull vibration with repositioning. Although most clinicians are still advising patients to remain upright for 24—48 hours after repositioning, recent evidence suggests that this is unnecessary.
In addition, the literature is equivocal regarding the ideal number of repositioning manoeuvres to perform per treatment session. To date, no factors have been identified to indicate an increased risk of BPPV recurrence after successful repositioning, however, the association between BPPV recurrence and migraine warrants further investigation.
For the small group of patients with classic posterior canal BPPV who do not respond to repositioning, posterior canal occlusion is a safe and highly efficacious procedure.
This article has been peer reviewed. Contributors: Dr. Atlas was responsible for the initial literature review and first draft. Agrawal performed a more in-depth review and major manuscript revision. Parnes supervised and finalized the manuscript and, with the illustrator, created the figures.
All authors gave final approval to the published version. Correspondence to: Dr. Lorne S. National Center for Biotechnology Information , U. Parnes , Sumit K. Agrawal , and Jason Atlas. Author information Copyright and License information Disclaimer. This article has been cited by other articles in PMC. Anatomy and physiology The vestibular system monitors the motion and position of the head in space by detecting angular and linear acceleration.
Open in a separate window. Mechanism BPPV can be caused by either canalithiasis or cupulolithiasis and can theoretically affect each of the 3 semicircular canals, although superior canal involvement is exceedingly rare.
Table 1. Epidemiology BPPV is the most common disorder of the peripheral vestibular system. Diagnosis History Patients describe sudden, severe attacks of either horizontal or vertical vertigo, or a combination of both, precipitated by certain head positions and movements. Subjective versus objective BPPV A certain subset of patients may not demonstrate the typical nystagmus during the Dix—Hallpike manoeuvre, but they may still experience the classic vertigo during positioning.
Nonsurgical management The management of BPPV has changed dramatically in the past 20 years as our understanding of the condition has progressed. Table 2. Controversy Despite the excellent results from repositioning manoeuvres, there has been some controversy as to whether they actually have an effect other than central habituation, that is, when the brain adapts to repeated vestibular stimuli over time. Factors that affect repositioning manoeuvres Number of manoeuvres per session There are variations in the literature regarding how many repositioning manoeuvres are performed in each treatment session Table 2.
Skull vibration In Epley's original description of the CRP, 42 he used mechanical vibration of the mastoid skull bone thinking that it would help loosen otolithic debris adherent to the membrane of the semicircular canal. Postmanoeuvre instructions Another area of divergence among experts involves the use of activity limitations after repositioning manoeuvres. Surgical treatment BPPV is a benign disease and, therefore, surgery should only be reserved for the most intractable or multiply recurrent cases.
Posterior semicircular canal occlusion Parnes and McClure 64 , 65 , 66 introduced the concept of posterior semicircular canal occlusion for BPPV. Conclusion Patients with BPPV present with a history of brief, episodic, position-provoked vertigo with characteristic findings on Dix—Hallpike testing. Footnotes This article has been peer reviewed. Competing interests: None declared. References 1. Katsarkas A. Benign paroxysmal positional vertigo BPPV : idiopathic versus post-traumatic.
Acta Otolaryngol ; 7 Diagnose von Krankheitserschernungen in Bereiche des Otolithenapparates. Acta Otolaryngol Stockh ; Dohlman G. Investigators in the function of the semicurcular canals. Acta Otolaryngol Suppl Stockh ; The mechanics of benign paroxysmal vertigo. J Otolaryngol ;8 2 Free-floating endolymph particles: a new operative finding during posterior semicircular canal occlusion. Laryngoscope ; 9 Schuknecht HF. Arch Otolaryngol ; Adv Otorhinolaryngol ; Human experience with canal plugging.
Ann N Y Acad Sci ; Epley JM. New dimensions of benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg ; Human experience with canalith repositioning maneuvers. Eye movements from semicircular canal nerve stimulation in the cat.
Ann Otolaryngol ; Nippon Jibiinkoka Gakkai Kaiho ; Diagnoses in a dizziness unit. J Otolaryngol ; Epidemiological studies on benign paroxysmal positional vertigo in Japan. Acta Otolaryngol Suppl ; Benign positional vertigo: clinical and oculographic features in cases.
Neurology ; Bourgeois PM, Dehaene I. Benign paroxysmal positional vertigo BPPV. The efficacy and treatment protocols of many trials in the literature are summarized in Table 2. Most of these studies are case series, but Lynn and colleagues 46 and Steenerson and Cronin 45 provide good evidence from randomized studies. Several positioning techniques to treat lateral canal BPPV have been developed.
Six of their patients converted to posterior canal BPPV for which they were successfully treated using standard repositioning manoeuvres. This is believed to move the particles out of the involved canal into the utricle. Only 2 patients were in the study, but both were completely relieved of their vertigo. Despite the excellent results from repositioning manoeuvres, there has been some controversy as to whether they actually have an effect other than central habituation, that is, when the brain adapts to repeated vestibular stimuli over time.
In , Blakley 48 published a trial of 38 patients randomly assigned to a particle repositioning group and a no-treatment group. Blakley concluded that the manoeuvre was safe but did not provide any treatment benefit for BPPV.
Buckingham 56 examined human temporal bones and attempted to demonstrate the possible paths taken by loose otoliths under the influence of gravity in different positions of the head. He found that although loose macular otoliths would tend to fall into the lumen of the utricle, they would not be returned to their original position in the macula of the utricle, which has a higher position in the vestibule. He concluded that a mechanism other than the repositioning of otoliths is responsible for the relief of BPPV seen in repositioning manoeuvres.
Although most cases of BPPV are self-limited, a number of randomized studies have shown that repositioning manoeuvres are highly effective. Lynn and colleagues 46 randomly allocated 36 patients to either a PRM group or placebo treatment group with assessment at 1 month by an audiologist who was unaware of the patients' treatment allocation. Steenerson and Cronin 45 randomly allocated 20 patients into either a PRM or vestibular habituation group and 20 patients into a no-treatment group.
There are variations in the literature regarding how many repositioning manoeuvres are performed in each treatment session Table 2. Some performed a set number of repositioning manoeuvres regardless of response. Our objection to repeating the manoeuvre until there is a negative Dix—Hallpike response is not knowing whether the response is abolished because of a successful manoeuvre or because of a fatigued response that occurs naturally with repeat testing.
From the literature review, there does not appear to be any significant difference between these approaches in terms of short-term effectiveness and long-term recurrence. Therefore, in our clinic, repeat manoeuvres are reserved for those patients who do not demonstrate an ipsidirectional secondary stage nystagmus or those who have a reverse-direction nystagmus at position D 24 Fig.
In Epley's original description of the CRP, 42 he used mechanical vibration of the mastoid skull bone thinking that it would help loosen otolithic debris adherent to the membrane of the semicircular canal. In , a study by Li 47 randomly assigned 27 patients to receive the PRM with mastoid vibration and 10 patients to receive the PRM without mastoid vibration.
These results do not, however, compare well with the literature Table 2 where the majority of authors who did not use mastoid vibration achieved much higher success rates. In , a larger study by Hain and colleagues 58 reviewed 44 patients who had the PRM with mastoid vibration and 50 patients who had the PRM without mastoid vibration.
Another area of divergence among experts involves the use of activity limitations after repositioning manoeuvres. Epley 42 asked his patients to remain upright for 48 hours after the CRP. In addition to remaining upright, certain investigators also request that their patients avoid lying on their affected side for 7 days.
A study by Nuti and colleagues 40 examined 2 sets of patients following the liberatory manoeuvre. One group of patients were asked to remain upright for 48 hours, whereas a second group of patients were not given any postmanoeuvre instructions. These 2 groups were compared retrospectively and no difference was found in short-term vertigo control. This finding is consistent with an earlier prospective study by Massoud and Ireland, 59 who also demonstrated that post—liberatory manoeuvre instructions were not efficacious.
BPPV is a benign disease and, therefore, surgery should only be reserved for the most intractable or multiply recurrent cases. Furthermore, before considering surgery, the posterior fossa should be imaged to rule out central lesions that might mimic BPPV.
Singular neurectomy, or section of the posterior ampullary nerve, which sends impulses exclusively from the posterior semicircular canal to the balance part of the brain, was popularized by Gacek 61 in the s.
Although initial reports by Gacek 62 demonstrated high efficacy, there was a significant risk of sensorineural hearing loss, 63 and the procedure has been found to be technically demanding. It has largely been replaced by the simpler posterior semicircular canal occlusion. Obstruction of the semicircular canal lumen is thought to prevent endolymph flow.
This effectively fixes the cupula and renders it unresponsive to normal angular acceleration forces and, more importantly, to stimulation from either free-floating particles within the endolymph or a fixed cupular deposit. Until the advent of this procedure, invasive inner ear surgery was felt to be too risky to otherwise normal- hearing ears.
However, Parnes and McClure 67 laid the groundwork for this procedure in an animal model by demonstrating its negligible effect on hearing. The procedure is performed under general anesthetic and should take no longer than 2—3 hours. Using a 5—6-cm postauricular incision, the posterior canal is accessed through a mastoidectomy. A plug, fashioned from bone dust and fibrinogen glue, is used to occlude the canal. Most patients stay in hospital for 2—3 days after this procedure.
Because the occlusion also impairs the normal inner ear physiology, all patients are expected to have postoperative imbalance and disequilibrium. For most people, the brain adapts to this after a few days to a few weeks, with vestibular physiotherapy hastening this process. In , Agrawal and Parnes 8 published a series of cases of 44 occluded posterior canals in 42 patients. All 44 ears were relieved of BPPV, with only 1 having a late atypical recurrence.
Of the 40 ears with normal preoperative hearing, 1 had a delayed 3-month sudden and permanent profound loss, whereas another had mild 20 dB hearing loss. Further studies by Pace-Balzan and Rutka, 68 Dingle and colleagues, 69 Hawthorne and el-Naggar, 70 Anthony, 71 and Walsh and colleagues 72 have supported the safety and efficacy of this procedure.
In most otology clinics, posterior semicircular canal occlusion has become the surgical procedure of choice for intractable BPPV. Patients with BPPV present with a history of brief, episodic, position-provoked vertigo with characteristic findings on Dix—Hallpike testing. Whereas a variety of positional manoeuvres have been described, PRM Fig. Current evidence does not support the routine use of skull vibration with repositioning. Although most clinicians are still advising patients to remain upright for 24—48 hours after repositioning, recent evidence suggests that this is unnecessary.
In addition, the literature is equivocal regarding the ideal number of repositioning manoeuvres to perform per treatment session. To date, no factors have been identified to indicate an increased risk of BPPV recurrence after successful repositioning, however, the association between BPPV recurrence and migraine warrants further investigation.
For the small group of patients with classic posterior canal BPPV who do not respond to repositioning, posterior canal occlusion is a safe and highly efficacious procedure.
This article has been peer reviewed. Contributors: Dr. Atlas was responsible for the initial literature review and first draft. Agrawal performed a more in-depth review and major manuscript revision. Parnes supervised and finalized the manuscript and, with the illustrator, created the figures.
All authors gave final approval to the published version. Correspondence to: Dr. Lorne S. National Center for Biotechnology Information , U. Parnes , Sumit K. Agrawal , and Jason Atlas. Author information Copyright and License information Disclaimer. This article has been cited by other articles in PMC. Anatomy and physiology The vestibular system monitors the motion and position of the head in space by detecting angular and linear acceleration. Open in a separate window. Mechanism BPPV can be caused by either canalithiasis or cupulolithiasis and can theoretically affect each of the 3 semicircular canals, although superior canal involvement is exceedingly rare.
Table 1. Epidemiology BPPV is the most common disorder of the peripheral vestibular system. Diagnosis History Patients describe sudden, severe attacks of either horizontal or vertical vertigo, or a combination of both, precipitated by certain head positions and movements. Subjective versus objective BPPV A certain subset of patients may not demonstrate the typical nystagmus during the Dix—Hallpike manoeuvre, but they may still experience the classic vertigo during positioning.
Nonsurgical management The management of BPPV has changed dramatically in the past 20 years as our understanding of the condition has progressed. Table 2. Controversy Despite the excellent results from repositioning manoeuvres, there has been some controversy as to whether they actually have an effect other than central habituation, that is, when the brain adapts to repeated vestibular stimuli over time.
Factors that affect repositioning manoeuvres Number of manoeuvres per session There are variations in the literature regarding how many repositioning manoeuvres are performed in each treatment session Table 2. Skull vibration In Epley's original description of the CRP, 42 he used mechanical vibration of the mastoid skull bone thinking that it would help loosen otolithic debris adherent to the membrane of the semicircular canal.
Postmanoeuvre instructions Another area of divergence among experts involves the use of activity limitations after repositioning manoeuvres.
Surgical treatment BPPV is a benign disease and, therefore, surgery should only be reserved for the most intractable or multiply recurrent cases. Posterior semicircular canal occlusion Parnes and McClure 64 , 65 , 66 introduced the concept of posterior semicircular canal occlusion for BPPV. Conclusion Patients with BPPV present with a history of brief, episodic, position-provoked vertigo with characteristic findings on Dix—Hallpike testing.
Footnotes This article has been peer reviewed. Competing interests: None declared. References 1. Katsarkas A. Benign paroxysmal positional vertigo BPPV : idiopathic versus post-traumatic. Acta Otolaryngol ; 7 Diagnose von Krankheitserschernungen in Bereiche des Otolithenapparates. Acta Otolaryngol Stockh ; Dohlman G. Investigators in the function of the semicurcular canals. Acta Otolaryngol Suppl Stockh ; The mechanics of benign paroxysmal vertigo.
J Otolaryngol ;8 2 Free-floating endolymph particles: a new operative finding during posterior semicircular canal occlusion.
Laryngoscope ; 9 Schuknecht HF. Arch Otolaryngol ; Adv Otorhinolaryngol ; Human experience with canal plugging. Ann N Y Acad Sci ; Epley JM. New dimensions of benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg ; Human experience with canalith repositioning maneuvers. Eye movements from semicircular canal nerve stimulation in the cat. Ann Otolaryngol ; Nippon Jibiinkoka Gakkai Kaiho ; Diagnoses in a dizziness unit. J Otolaryngol ; Epidemiological studies on benign paroxysmal positional vertigo in Japan.
Acta Otolaryngol Suppl ; Benign positional vertigo: clinical and oculographic features in cases. Neurology ; Bourgeois PM, Dehaene I. Benign paroxysmal positional vertigo BPPV. Clinical features in 34 cases and review of literature. Acta Neurol Belg ; Oas JG. Benign paroxysmal positional vertigo: a clinician's perspective. Unrecognized benign paroxysmal positional vertigo in elderly patients. What inner ear diseases cause benign paroxysmal positional vertigo? Acta Otolaryngol ; Hughes CA, Proctor L.
Benign paroxysmal positional vertigo. Laryngoscope ; Migraine and benign positional vertigo. Ann Otol Rhinol Laryngol ; Benign paroxysmal positional vertigo: mechanism and management. Benign paroxysmal positional vertigo after stapedectomy.
Collison PJ, Kolberg A. Canalith repositioning procedure for relief of post-stapedectomy benign paroxysmal positional vertigo. SDJ Med ;51 3 Kentala E, Pyykko I. Vertigo in patients with benign paroxysmal positional vertigo. Pathology, symptomatology and diagnosis of certain disorders of the vestibular system. Proc R Soc Med ; In: Cummings, editor. Louis: Mosby; Benign positioning vertigo BPV and three-dimensional 3-D eye movement analysis. Acta Otorhinolaryngol Belg ; Treatment of benign postional vertigo using the semont maneuver: efficacy in patients presenting without nystagmus.
Benign positional vertigo without detectable nystagmus. Benign paroxysmal positional vertigo: analysis of 44 cases treated by the canalith repositioning procedure of Epley. Am J Otol ; Lorazepam and diazepam in the treatment of benign paroxysmal vertigo. Brandt T, Daroff RB. Physical therapy for benign paroxysmal positional vertigo. Does vestibular habituation still have a place in the treatment of benign paroxysmal positional vertigo? J Laryngol Otol ; Curing the BPPV with a liberatory maneuver.
Norre ME, Beckers A. Comparative study of two types of exercise treatment for paroxysmal positioning vertigo. Single treatment approaches to benign paroxysmal positional vertigo. Arch Otolaryngol Head Neck Surg ; Treatment of benign paroxysmal positional vertigo: no need for postmaneuver restrictions. Cohen HS, Jerabek J. Efficacy of treatments for posterior canal benign paroxysmal positional vertigo. The canalith repositioning procedure: for treatment of benign paroxysmal positional vertigo.
Particle repositioning maneuver for benign paroxysmal positional vertigo. Parnes LS, Robichaud J. Further observations during the particle repositioning maneuver for benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg ; Comparison of the canalith repositioning procedure and vestibular habituation training in forty patients with benign paroxysmal positional vertigo.
Randomized trial of the canalith repositioning procedure. Otolaryngol Head Neck Surg ;; Li JC. Mastoid oscillation: a critical factor for success in canalith repositioning procedure. Blakley BW. A randomized, controlled assessment of the canalith repositioning maneuver. Smouha EE. Time course of recovery after Epley maneuvers for benign paroxysmal positional vertigo.
Success of the modified Epley maneuver in treating benign paroxysmal positional vertigo. Laryngoscope ; Modified liberatory maneuver: effective treatment for benign paroxysmal positional vertigo. Treatment of horizontal semicircular canal benign paroxysmal positional vertigo.
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