BPPV

Benign paroxysmal positional vertigo (BPPV) is a common inner ear disorder characterized by brief episodes of vertigo triggered by changes in head position relative to gravity. It is caused by displaced otoconia from the utricle that enter one of the semicircular canals, most often the posterior canal, where they stimulate the canal’s hair cells during head movements. A related variant, cupulolithiasis, involves heavier particles adherent to the canal’s cupula and can cause longer-lasting vertigo.

Clinical features typically include brief (seconds to about a minute) spells of spinning vertigo provoked by lying down, turning over in bed, or looking up. Nausea may accompany the sensation. On examination, a Dix-Hallpike maneuver may reproduce vertigo and elicit a characteristic nystagmus. Symptoms may resolve spontaneously but often recur with head movements or over time.

Diagnosis is clinical, supported by positive Dix-Hallpike testing. Differential diagnosis includes Menière disease, vestibular neuritis, migraine-associated vertigo, and central causes of vertigo; evaluation may include history, examination, and sometimes audiometry or imaging to exclude other conditions.

Management focuses on repositioning maneuvers that move the loose otoconia back to the utricle. The most common are the Epley maneuver and the Semont maneuver, performed by a clinician and sometimes repeated in several sessions. Home exercises may be taught for self-treatment. Additional measures include vestibular rehabilitation, safety precautions during attacks, and, in rare cases, alternative maneuvers or surgical options for refractory cases.

Prognosis is generally favorable with treatment; many patients improve after one or a few sessions, though recurrences are common. BPPV is a leading cause of vertigo in adults and is frequently treated in primary care and ENT settings.