Benign paroxysmal positional vertigo

Epidemiology

Etiology

Pathophysiology

Although incompletely understood, BPPV is thought to occur due to dislodged or abnormally adherent otoconia, causing semicircular canal dysfunction.

Otoconia (otoliths): physiological calcium carbonate crystals present within the utricle and saccule that serve to maintain balance and spatial orientation
Canalithiasis
- Dislodged, free-floating otoconia (endolymphatic debris).

Clinical features

Episodic vertigo (spinning sensation)
- Sudden (“paroxysmal”) and recurrent episodes
- Lasts several seconds (typically ≤ 1 minute)
- Triggered by certain head movements (positional vertigo) after a latency of a few seconds.
- Associated with:
  - Nystagmus
Triggers: Quick rotation of the head relative to gravity is the main trigger of BPPV

BPPV vs Ménière disease

BPPV
- Recurrent, brief episodes (seconds)
- Positional, Dix-Hallpike (+)
- Only vertigo, without cochlear (e.g., hearing loss or tinnitus) or neurological symptoms.
Ménière disease
- Recurrent episodes (minutes–hours)
- Vertigo, ear fullness/pain, unilateral hearing loss & tinnitus

Diagnostics

Dix-Hallpike maneuver

First-line test for suspected BPPV

Treatment