Chapter-03 Differential Diagnosis of Benign Paroxysmal Positional Vertigo

BOOK TITLE: Understanding Benign Paroxysmal Positional Vertigo

1. Roberts Richard A
Publishing Year
Author Affiliations
1. Alabama Hearing and Balance Associates, Foley, Alabama, USA
Chapter keywords
Benign paroxysmal positional vertigo, BPPV, semicircular canal involvement, nystagmus, vertigo, central nervous system, cervicogenic dizziness, positioning technique, modified Hallpike, horizontal canal BPPV


It is well established that the most commonly diagnosed vestibular problem is benign paroxysmal positional vertigo (BPPV). The clinician must bear in mind that although BPPV impacts the life of the individual patient to this magnitude, it is highly treatable. The symptoms of BPPV, primarily intense vertigo with rotary nystagmus, are caused by an abnormal interaction of the semicircular canal cupula and displaced otoconia from the utricle. The presence of otoconial debris was directly observed as an operative finding and reported by Parnes and McClure. In this more common variant, the mass of otoconia moves within the semicircular canal after change in head position. This movement of the otoconia displaces the endolymphatic fluid, deflecting the cupula of the involved canal and eliciting nystagmus and vertigo. By far, the majority of cases of BPPV involve the posterior canal. Most assume this is related to the inferior orientation of the posterior semicircular canal relative to the utricle. Another interesting finding with BPPV is that it is most commonly unilateral. Bilateral BPPV is only observed in 4% to upward of 25% of cases. It is evident that most patients with BPPV present with a history of transient, positionally provoked vertigo. A detailed description on positioning techniques for eliciting BPPV has been presented in this chapter covering posterior/anterior semicircular canal and horizontal canal BPPV.

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