Epidemiology

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Etiology

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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).

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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

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Diagnostics

Dix-Hallpike maneuver

• First-line test for suspected BPPV

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Treatment

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