Download PDF
Semin Neurol 2013; 33(03): 204-211
DOI: 10.1055/s-0033-1354590
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Benign Paroxysmal Positional Vertigo

Michael von Brevern
1   Department for Neurology, Park-Klinik Weissensee, Berlin, Germany
2   Vestibular Research Group, Berlin, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
21 September 2013 (online)

    Permissions and Reprints

Abstract

Benign paroxysmal positional vertigo (BPPV) is the most common and the most effectively treated vestibular disorder. The prevailing pathomechanism is canalolithiasis, which is otoconia falling in one of the semicircular canals where they move in response to changes of the head position, triggering excitation of the vestibular receptors of the affected canal. In the majority of patients with BPPV, the posterior canal is affected by canalolithiasis and there are two highly effective therapeutic maneuvers for treatment. About 20% of patients present with lithiasis of the horizontal or anterior canal. The author focuses on recent advances in diagnosis and treatment of the more rare variants of BPPV.

Keywords

positional vertigo - paroxysmal vertigo - dizziness - canalolithiasis - cupulolithiasis
 

  • References

  • 1 Imai T, Ito M, Takeda N , et al. Natural course of the remission of vertigo in patients with benign paroxysmal positional vertigo. Neurology 2005; 64 (5) 920-921
    CrossrefPubMedGoogle Scholar
  • 2 Nunez RA, Cass SP, Furman JM. Short- and long-term outcomes of canalith repositioning for benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 2000; 122 (5) 647-652
    CrossrefPubMedGoogle Scholar
  • 3 von Brevern M, Radtke A, Lezius F , et al. Epidemiology of benign paroxysmal positional vertigo: a population based study. J Neurol Neurosurg Psychiatry 2007; 78 (7) 710-715
    PubMedGoogle Scholar
  • 4 Kollén L, Frändin K, Möller M, Fagevik Olsén M, Möller C. Benign paroxysmal positional vertigo is a common cause of dizziness and unsteadiness in a large population of 75-year-olds. Aging Clin Exp Res 2012; 24 (4) 317-323
    PubMedGoogle Scholar
  • 5 Oghalai JS, Manolidis S, Barth JL, Stewart MG, Jenkins HA. Unrecognized benign paroxysmal positional vertigo in elderly patients. Otolaryngol Head Neck Surg 2000; 122 (5) 630-634
    CrossrefPubMedGoogle Scholar
  • 6 Baloh RW, Honrubia V, Jacobson K. Benign positional vertigo: clinical and oculographic features in 240 cases. Neurology 1987; 37 (3) 371-378
    CrossrefPubMedGoogle Scholar
  • 7 Brandt T, Steddin S. Current view of the mechanism of benign paroxysmal positioning vertigo: cupulolithiasis or canalolithiasis?. J Vestib Res 1993; 3 (4) 373-382
    PubMedGoogle Scholar
  • 8 Baloh RW, Yue Q, Jacobson KM, Honrubia V. Persistent direction-changing positional nystagmus: another variant of benign positional nystagmus?. Neurology 1995; 45 (7) 1297-1301
    CrossrefPubMedGoogle Scholar
  • 9 Otsuka K, Suzuki M, Furuya M. Model experiment of benign paroxysmal positional vertigo mechanism using the whole membranous labyrinth. Acta Otolaryngol 2003; 123 (4) 515-518
    CrossrefPubMedGoogle Scholar
  • 10 Büttner U, Helmchen CH, Brandt T. Diagnostic criteria for central versus peripheral positioning nystagmus and vertigo: a review. Acta Otolaryngol 1999; 119 (1) 1-5
    CrossrefPubMedGoogle Scholar
  • 11 Bhattacharyya N, Baugh RF, Orvidas L , et al; American Academy of Otolaryngology-Head and Neck Surgery Foundation. Clinical practice guideline: benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 2008; 139 (5) (Suppl. 04) S47-S81
    CrossrefPubMedGoogle Scholar
  • 12 Honrubia V, Baloh RW, Harris MR, Jacobson KM. Paroxysmal positional vertigo syndrome. Am J Otol 1999; 20 (4) 465-470
    PubMedGoogle Scholar
  • 13 Nakayama M, Epley JM. BPPV and variants: improved treatment results with automated, nystagmus-based repositioning. Otolaryngol Head Neck Surg 2005; 133 (1) 107-112
    CrossrefPubMedGoogle Scholar
  • 14 Yacovino DA, Hain TC, Gualtieri F. New therapeutic maneuver for anterior canal benign paroxysmal positional vertigo. J Neurol 2009; 256 (11) 1851-1855
    CrossrefPubMedGoogle Scholar
  • 15 Jackson LE, Morgan B, Fletcher Jr JC, Krueger WW. Anterior canal benign paroxysmal positional vertigo: an underappreciated entity. Otol Neurotol 2007; 28 (2) 218-222
    CrossrefPubMedGoogle Scholar
  • 16 Cambi J, Astore S, Mandalà M, Trabalzini F, Nuti D. Natural course of positional down-beating nystagmus of peripheral origin. J Neurol 2013; 260 (6) 1489-1496 [Epub ahead of print]
    CrossrefPubMedGoogle Scholar
  • 17 Lopez-Escamez JA, Molina MI, Gamiz MJ , et al. Multiple positional nystagmus suggests multiple canal involvement in benign paroxysmal vertigo. Acta Otolaryngol 2005; 125 (9) 954-961
    CrossrefPubMedGoogle Scholar
  • 18 Katsarkas A. Benign paroxysmal positional vertigo (BPPV): idiopathic versus post-traumatic. Acta Otolaryngol 1999; 119 (7) 745-749
    CrossrefPubMedGoogle Scholar
  • 19 Imai T, Takeda N, Ito M , et al. 3D analysis of benign positional nystagmus due to cupulolithiasis in posterior semicircular canal. Acta Otolaryngol 2009; 129 (10) 1044-1049
    CrossrefPubMedGoogle Scholar
  • 20 Baloh RW, Jacobson K, Honrubia V. Horizontal semicircular canal variant of benign positional vertigo. Neurology 1993; 43 (12) 2542-2549
    CrossrefPubMedGoogle Scholar
  • 21 Choung YH, Shin YR, Kahng H, Park K, Choi SJ. 'Bow and lean test' to determine the affected ear of horizontal canal benign paroxysmal positional vertigo. Laryngoscope 2006; 116 (10) 1776-1781
    CrossrefPubMedGoogle Scholar
  • 22 Bisdorff AR, Debatisse D. Localizing signs in positional vertigo due to lateral canal cupulolithiasis. Neurology 2001; 57 (6) 1085-1088
    CrossrefPubMedGoogle Scholar
  • 23 Nuti D, Vannucchi P, Pagnini P. Benign paroxysmal positional vertigo of the horizontal canal: a form of canalolithiasis with variable clinical features. J Vestib Res 1996; 6 (3) 173-184
    CrossrefPubMedGoogle Scholar
  • 24 Fife TD. Recognition and management of horizontal canal benign positional vertigo. Am J Otol 1998; 19 (3) 345-351
    CrossrefPubMedGoogle Scholar
  • 25 Imai T, Takeda N, Sato G , et al. Changes in slow phase eye velocity and time constant of positional nystagmus at transform from cupulolithiasis to canalolithiasis. Acta Otolaryngol 2008; 128 (1) 22-28
    CrossrefPubMedGoogle Scholar
  • 26 Bertholon P, Bronstein AM, Davies RA, Rudge P, Thilo KV. Positional down beating nystagmus in 50 patients: cerebellar disorders and possible anterior semicircular canalithiasis. J Neurol Neurosurg Psychiatry 2002; 72 (3) 366-372
    CrossrefPubMedGoogle Scholar
  • 27 Aw ST, Todd MJ, Aw GE, McGarvie LA, Halmagyi GM. Benign positional nystagmus: a study of its three-dimensional spatio-temporal characteristics. Neurology 2005; 64 (11) 1897-1905
    CrossrefPubMedGoogle Scholar
  • 28 Imai T, Takeda N, Ito M , et al. Three-dimensional analysis of benign paroxysmal positional nystagmus in a patient with anterior semicircular canal variant. Otol Neurotol 2006; 27 (3) 362-366
    CrossrefPubMedGoogle Scholar
  • 29 Brantberg K, Bergenius J. Treatment of anterior benign paroxysmal positional vertigo by canal plugging: a case report. Acta Otolaryngol 2002; 122 (1) 28-30
    CrossrefPubMedGoogle Scholar
  • 30 Casani AP, Cerchiai N, Dallan I, Sellari-Franceschini S. Anterior canal lithiasis: diagnosis and treatment. Otolaryngol Head Neck Surg 2011; 144 (3) 412-418
    CrossrefPubMedGoogle Scholar
  • 31 Korres S, Riga M, Balatsouras D, Sandris V. Benign paroxysmal positional vertigo of the anterior semicircular canal: atypical clinical findings and possible underlying mechanisms. Int J Audiol 2008; 47 (5) 276-282
    CrossrefPubMedGoogle Scholar
  • 32 Chang WC, Yang YR, Hsu LC, Chern CM, Wang RY. Balance improvement in patients with benign paroxysmal positional vertigo. Clin Rehabil 2008; 22 (4) 338-347
    CrossrefPubMedGoogle Scholar
  • 33 Fife TD, Iverson DJ, Lempert T , et al; Quality Standards Subcommittee, American Academy of Neurology. Practice parameter: therapies for benign paroxysmal positional vertigo (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2008; 70 (22) 2067-2074
    CrossrefPubMedGoogle Scholar
  • 34 Mandalà M, Santoro GP, Asprella Libonati G , et al. Double-blind randomized trial on short-term efficacy of the Semont maneuver for the treatment of posterior canal benign paroxysmal positional vertigo. J Neurol 2012; 259 (5) 882-885
    CrossrefPubMedGoogle Scholar
  • 35 Chen Y, Zhuang J, Zhang L , et al. Short-term efficacy of Semont maneuver for benign paroxysmal positional vertigo: a double-blind randomized trial. Otol Neurotol 2012; 33 (7) 1127-1130
    CrossrefPubMedGoogle Scholar
  • 36 Hunt WT, Zimmermann EF, Hilton MP. Modifications of the Epley (canalith repositioning) manoeuvre for posterior canal benign paroxysmal positional vertigo (BPPV). Cochrane Database Syst Rev 2012; 4: CD008675
    PubMedGoogle Scholar
  • 37 Tirelli G, D'Orlando E, Giacomarra V, Russolo M. Benign positional vertigo without detectable nystagmus. Laryngoscope 2001; 111 (6) 1053-1056
    CrossrefPubMedGoogle Scholar
  • 38 Haynes DS, Resser JR, Labadie RF , et al. Treatment of benign positional vertigo using the Semont maneuver: efficacy in patients presenting without nystagmus. Laryngoscope 2002; 112 (5) 796-801
    CrossrefPubMedGoogle Scholar
  • 39 Radtke A, Neuhauser H, von Brevern M, Lempert T. A modified Epley's procedure for self-treatment of benign paroxysmal positional vertigo. Neurology 1999; 53 (6) 1358-1360
    CrossrefPubMedGoogle Scholar
  • 40 Kim JS, Oh SY, Lee SH , et al. Randomized clinical trial for geotropic horizontal canal benign paroxysmal positional vertigo. Neurology 2012; 79 (7) 700-707
    CrossrefPubMedGoogle Scholar
  • 41 Mandalà M, Pepponi E, Santoro GP , et al. Double-blind randomized trial on the efficacy of the Gufoni maneuver for treatment of lateral canal BPPV. Laryngoscope 2013; 123 (7) 1782-1786 10.1002/lary.23918 [Epub ahead of print]
    CrossrefPubMedGoogle Scholar
  • 42 Oh SY, Kim JS, Jeong SH , et al. Treatment of apogeotropic benign positional vertigo: comparison of therapeutic head-shaking and modified Semont maneuver. J Neurol 2009; 256 (8) 1330-1336
    CrossrefPubMedGoogle Scholar
  • 43 Kim JS, Oh SY, Lee SH , et al. Randomized clinical trial for apogeotropic horizontal canal benign paroxysmal positional vertigo. Neurology 2012; 78 (3) 159-166
    CrossrefPubMedGoogle Scholar
  • 44 Sakaida M, Takeuchi K, Ishinaga H, Adachi M, Majima Y. Long-term outcome of benign paroxysmal positional vertigo. Neurology 2003; 60 (9) 1532-1534
    CrossrefPubMedGoogle Scholar
  • 45 Helminski JO, Janssen I, Kotaspouikis D , et al. Strategies to prevent recurrence of benign paroxysmal positional vertigo. Arch Otolaryngol Head Neck Surg 2005; 131 (4) 344-348
    CrossrefPubMedGoogle Scholar
  • 46 Helminski JO, Janssen I, Hain TC. Daily exercise does not prevent recurrence of benign paroxysmal positional vertigo. Otol Neurotol 2008; 29 (7) 976-981
    CrossrefPubMedGoogle Scholar