Diagnosis and Management of Benign Paroxysmal Positional Vertigo

Benign paroxysmal positional vertigo (BPPV) is characterised by brief episodes of vertigo triggered by changes in head position relative to gravity. Its pathophysiology centres on dislodged otoconia—microscopic calcium carbonate crystals—from the utricular macula that migrate into the semicircular canals, provoking abnormal endolymph movement and resultant nystagmus. Diagnosis rests on clinical history coupled with positional testing, notably the Dix–Hallpike and the supine roll tests, to elicit characteristic eye movements. Differential diagnosis must exclude central causes of positional dizziness, requiring thorough neurological and audiological evaluation. Management is dominated by canalith repositioning procedures, such as the Epley and Semont manoeuvres, which aim to guide canaliths back to the vestibule. While these manoeuvres achieve high initial success rates, recurrence is common and may be influenced by factors such as age, inner-ear mineral metabolism and comorbidities. Adjunctive strategies include vestibular rehabilitation for persistent imbalance, supplementation in patients with documented mineral deficiencies and ongoing monitoring to address residual dizziness and reduce fall risk. The global burden of BPPV underscores the importance of standardised algorithms for rapid diagnosis, tailored repositioning techniques and preventive measures to limit recurrence.

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Diagnosis and Management of Benign Paroxysmal Positional Vertigo publication trend

The graph below shows the total number of articles in diagnosis and management of benign paroxysmal positional vertigo across all publications each year (not limited to Nature Index journals).

Technical terms

Benign paroxysmal positional vertigo (BPPV): Episodic vertigo caused by dislodged otoconia in the semicircular canals.

Nystagmus: Involuntary rhythmic oscillation of the eyes, indicative of vestibular dysfunction.

Otoconia: Calcium carbonate crystals in the utricle that contribute to gravity sensing; their displacement underlies BPPV.

Canalith repositioning procedure (CRP): Manual manoeuvres designed to guide displaced otoconia back to the utricular chamber.

References

1. Multimodal deep learning-based diagnostic model for BPPV. BMC Medical Informatics and Decision Making (2024).
2. Vitamin D Supplementation and Recurrence of Benign Paroxysmal Positional Vertigo. Nutrients (2024).
3. Serum Otoconin-90 and Otolin-1 Concentrations in Benign Paroxysmal Positional Vertigo. Biomolecules (2024).