Benign paroxysmal positional vertigo interventions

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

Overview

The mainstay of treatment for BPPV is office maneuvers. For posterior canal BPPV we perform Epley maneuver or Semon maneuver. For horizental canal BPPV we perform Lempert roll maneuver. For superior canal BPPV we perform Epley maneuver.

Indications

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The mainstay of treatment for BPPV is office maneuvers:

• Posterior canal BPPV
  • The Epley maneuver:
    • Upright sitting posture, with extended legs and the head rotated 45 degrees towards the side that have positive Dix-Hall pike result.
    • Quickly lowering the patient into a supine position with 30-degree neck extension, with keeping the 45 degree head rotation.
    • Observes the patient's eyes for primary nystagmus.
    • Remaining in this position for 1–2 minutes.
    • Rotating the patient head 90 degrees toward the opposite side and face the opposite ear toward the floor while maintaining 30 degrees of neck extension.
    • Remaining in this position for 1–2 minutes.
    • Rolling the patient onto their shoulder while keeping the head and neck fixed, rotating the head another 90 degrees in the direction that they are facing in a way that they look downward at a 45-degree angle.
    • Observed by the clinician for secondary nystagmus (in the same direction as the primary nystagmus). Remaining in this position for 1–2 minutes.
    • Bringing the patient slowly into 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 might be better (video):
    • Turning the patient's head 45 degrees horizontally toward the unaffected ear.
    • Tilting the patient 105 degrees so that the patient lays on the side of the affected ear with head hanging while nose is pointing upward. holding this position for 5 minutes after dizziness stops.
    • 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.
    • Slowly moving the patient into the seated position.

• Horizental canal BPPV
  • Lempert roll maneuver:
    • Rotating the head while the patient is supine and moving from affected to unaffected ear for 360 degree.
• Superior canal BPPV
  • Epley maneuver