Benign paroxysmal positional vertigo interventions

Benign paroxysmal positional vertigo Microchapters
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Fahimeh Shojaei, M.D.

Indications

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The mainstay of treatment for BPPV is office maneuvers.

• Posterior canal BPPV
  • The Epley maneuver:
    • The patient begins in an upright sitting posture, with the legs fully extended and the head rotated 45 degrees towards the side in the same direction that gives a positive Dix–Hallpike test.
    • The patient is then quickly lowered into a supine position with the head held approximately in a 30-degree neck extension (Dix-Hallpike position), with the head still rotated to the side.
    • The clinician observes the patient's eyes for “primary stage” nystagmus.
    • The patient remains in this position for approximately 1–2 minutes.
    • The patient's head is then rotated 90 degrees in the opposite direction so that the opposite ear faces the floor while maintaining 30 degrees of neck extension.
    • The patient remains in this position for approximately 1–2 minutes.
    • Keeping the head and neck in a fixed position relative to the body, the individual rolls onto their shoulder, rotating the head another 90 degrees in the direction that they are facing. The patient is now looking downwards at a 45-degree angle.
    • The eyes should be immediately observed by the clinician for “secondary stage” nystagmus (this secondary stage nystagmus should be in the same direction as the primary stage nystagmus). The patient remains in this position for approximately 1–2 minutes.
    • Finally, the patient is slowly brought up to an upright sitting posture, while maintaining the 45-degree rotation of the head.
    • The patient holds a sitting position for up to 30 seconds.
  • The Semont maneuver:
    • Turn your head 45 degrees horizontally toward the unaffected ear.
    • Then tilt 105 degrees so that you are lying on the side of the affected ear with your head hanging and your nose pointed upward. After dizziness stops, hold this position for 5 minutes.
    • Then move quickly via the seated position, holding your head in place, until you are lying on the side of the unaffected ear with your nose pointed to the ground. After dizziness stops,hold this position for 5 minutes.
    • Then slowly move back to the seated position.

• Horizental canal BPPV
  • Lempert roll maneuver:
    • stepwise rotations of the non-tilted head in the supine position moving 360° from the affected to the unaffected ear
• Superior canal BPPV
  • Epley maneuver