Benign paroxysmal positional vertigo - Revision history

Bobzmac: /* Management */

2026-03-09T17:27:57Z

Management

← Revisión anterior		Revisión del 17:27 9 mar 2026
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	*May require multiple attempts, but you can discharge patient home with daily exercises		*May require multiple attempts, but you can discharge patient home with daily exercises
	**Improvement after x1 in 47% of patients, after x2 an additional 16%, and after x3 an additional 21%<ref>Hughes D, Shakir A, Goggins S, et al. How many Epley manoeuvres are required to treat benign paroxysmal positional vertigo? J Laryngol Otol. 2015; 129(5):421-424.</ref>		**Improvement after x1 in 47% of patients, after x2 an additional 16%, and after x3 an additional 21%<ref>Hughes D, Shakir A, Goggins S, et al. How many Epley manoeuvres are required to treat benign paroxysmal positional vertigo? J Laryngol Otol. 2015; 129(5):421-424.</ref>

			===Other maneuvers for BPPV===
			**Sermont Maneuver
			**Lempert maneuver (also known as BBQ Roll maneuver)

	===Medical management===		===Medical management===

Rossdonaldson1: /* Background */

2023-01-04T23:10:54Z

Background

← Revisión anterior		Revisión del 23:10 4 ene 2023
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	==Background==		==Background==
			[[File:Balance Disorder Illustration A.png\|thumb\|Exterior of labyrinth of the inner ear.]]
	*Abbreviation: BPPV		*Abbreviation: BPPV
	*Due to canalolithiasis (migration of otoconia into one of the semicircular canals)		*Due to canalolithiasis (migration of otoconia into one of the semicircular canals)

Beren85: /* Dix-Hallpike Maneuver */

2022-06-01T15:16:05Z

Dix-Hallpike Maneuver

← Revisión anterior		Revisión del 15:16 1 jun 2022
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	===Dix-Hallpike Maneuver===		===Dix-Hallpike Maneuver===
	*''50-85% Sensitive for BPPV<ref>Sacco RR et al. Management of Benign Paroxysmal Posi- tional Vertigo: A Randomized Controlled Trial. J Emerg Med. 2014 Apr;46(4):575-81</ref>''		*''50-85% Sensitive for BPPV<ref>Sacco RR et al. Management of Benign Paroxysmal Posi- tional Vertigo: A Randomized Controlled Trial. J Emerg Med. 2014 Apr;46(4):575-81</ref>''
			*Do not attempt provocative maneuvers if the patient is symptomatic with nystagmus at rest
	====Procedure====		====Procedure====
	*Patient sits upright		*Patient sits upright

ClaireLewis at 20:31, 30 September 2019

2019-09-30T20:31:53Z

← Revisión anterior		Revisión del 20:31 30 sep 2019
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	==Clinical Features==		==Clinical Features==
	*Sudden-onset vertigo and associated nystagmus precipitated by head movements		*Sudden-onset [[vertigo]] and associated [[nystagmus]] precipitated by head movements
	**Latency period <30s between provocative head position and onset of nystagmus		**Latency period <30s between provocative head position and onset of nystagmus
	**Intensity of nystagmus increases to a peak before slowly resolving		**Intensity of nystagmus increases to a peak before slowly resolving
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	*[[Nausea/vomiting]] common		*[[Nausea/vomiting]] common
	*Symptoms worse in the morning (symptoms fatigue as day goes on)		*Symptoms worse in the morning (symptoms fatigue as day goes on)
	*No associated hearing loss or tinnitus		*No associated [[hearing loss]] or [[tinnitus]]
	*MUST distinguish from central vertigo ([[Vertigo#HINTS Exam\|HINTS Exam]], [[Cerebellar stroke]])		*MUST distinguish from central vertigo ([[Vertigo#HINTS Exam\|HINTS Exam]], [[Cerebellar stroke]])

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	====Contraindications<ref>Humphriss, Rachel; Baguley D; Sparks V; Peerman S; Mofat D (2003). "Contraindications to the Dix-Hallpike manoeuvre : a multidisciplinary review". International Journal of Audiology 42 (3): 166–173.</ref>====		====Contraindications<ref>Humphriss, Rachel; Baguley D; Sparks V; Peerman S; Mofat D (2003). "Contraindications to the Dix-Hallpike manoeuvre : a multidisciplinary review". International Journal of Audiology 42 (3): 166–173.</ref>====
	*Concern for [[Cervical Artery Dissection]]		*Concern for [[Cervical Artery Dissection]]
	*Cerebrovascular disease		*[[CVA\|Cerebrovascular disease]]
	*Concern for vertebrobasilar insufficiency, See [[Stroke syndromes]]		*Concern for [[vertebrobasilar insufficiency]], See [[Stroke syndromes]]
	*Spinal injury		*Spinal injury
	*Cervical spondylosis		*Cervical spondylosis
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	==Management==		==Management==
	===Epley Maneuver<ref>Hilton, Malcolm P; Pinder, Darren K (2004). "The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo". In Hilton, Malcolm P. Cochrane Database of Systematic Reviews </ref>===		===Epley Maneuver<ref>Hilton, Malcolm P; Pinder, Darren K (2004). "The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo". In Hilton, Malcolm P. Cochrane Database of Systematic Reviews </ref>===
	[[File:Epley.jpg\|thumb\|~~Eply~~ manuver]]		[[File:Epley.jpg\|thumb\|Epley manuver]]
	*Epley begins after the last step of the Dix Hallpike		*Epley begins after the last step of the Dix Hallpike
	*Patient remains in the position with exacerbated nystagmus for approximately 1–2 minutes.		*Patient remains in the position with exacerbated nystagmus for approximately 1–2 minutes.
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	===Medical management===		===Medical management===
	*Antihistamines		*[[Antihistamines]]
	**[[Diphenhydramine]] (Benadryl) 25-50mg IM/IV/PO q4hr		**[[Diphenhydramine]] (Benadryl) 25-50mg IM/IV/PO q4hr
	**[[Meclizine]](Antivert, Antrizine, Dramamine) 25mg PO QID		**[[Meclizine]](Antivert, Antrizine, Dramamine) 25mg PO QID
	**[[Promethazine]](Phenergan, Anergan, Prorex) 12.5-25mg PO/IM/IV q4-6hr		**[[Promethazine]](Phenergan, Anergan, Prorex) 12.5-25mg PO/IM/IV q4-6hr
	*Anticholinergic		*[[Anticholinergic]]
	**[[Scopolamine]] transdermal patch 0.5mg (behind ear) QID		**[[Scopolamine]] transdermal patch 0.5mg (behind ear) QID
	*Benzodiazepines		*[[Benzodiazepines]]
	**[[Lorazepam]] (Ativan), [[diazepam]] (Valium) or Klonopin ([[clonazepam]])		**[[Lorazepam]] (Ativan), [[diazepam]] (Valium) or Klonopin ([[clonazepam]])

ClaireLewis: /* Medical management */

2019-08-19T17:53:24Z

Medical management

← Revisión anterior		Revisión del 17:53 19 ago 2019
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	**[[Scopolamine]] transdermal patch 0.5mg (behind ear) QID		**[[Scopolamine]] transdermal patch 0.5mg (behind ear) QID
	*Benzodiazepines		*Benzodiazepines
	**[[Lorazepam]] (Ativan), [[diazepam]] (Valium) or Klonopin (~~Clonazepam~~)		**[[Lorazepam]] (Ativan), [[diazepam]] (Valium) or Klonopin ([[clonazepam]])

	==Disposition==		==Disposition==

Kxl328: /* Procedure */

2018-10-19T15:05:53Z

Procedure

← Revisión anterior		Revisión del 15:05 19 oct 2018
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	*Maintain the head in 45 degree rotation but also 20 degrees of extension off the end of the table.		*Maintain the head in 45 degree rotation but also 20 degrees of extension off the end of the table.
	*Observe the eyes for 45 seconds for nystagmus. There is often 15 seconds of latency prior to symptoms.		*Observe the eyes for 45 seconds for nystagmus. There is often 15 seconds of latency prior to symptoms.
	**Immediate symptoms ~~suggests~~ central etiology		**Immediate symptoms requires consideration for central etiology
	*'''A positive test for BPPV is evidenced by the rotational nystagmus		*'''A positive test for BPPV is evidenced by the rotational (torsional) nystagmus
	**~~fast~~ phase of the rotatory nystagmus is toward the affected ear, which is the ear closest to the ground		**Fast phase of the rotatory nystagmus is toward the affected ear (geotropic nystagmus), which is the ear closest to the ground
			**Rotational nystagmus away from affected ear (ageotropic nystagmus) requires consideration for central lesion

	====Contraindications<ref>Humphriss, Rachel; Baguley D; Sparks V; Peerman S; Mofat D (2003). "Contraindications to the Dix-Hallpike manoeuvre : a multidisciplinary review". International Journal of Audiology 42 (3): 166–173.</ref>====		====Contraindications<ref>Humphriss, Rachel; Baguley D; Sparks V; Peerman S; Mofat D (2003). "Contraindications to the Dix-Hallpike manoeuvre : a multidisciplinary review". International Journal of Audiology 42 (3): 166–173.</ref>====

Kxl328: /* Procedure */

2018-10-19T14:59:46Z

Procedure

← Revisión anterior		Revisión del 14:59 19 oct 2018
Línea 30:		Línea 30:
	*Maintain the head in 45 degree rotation but also 20 degrees of extension off the end of the table.		*Maintain the head in 45 degree rotation but also 20 degrees of extension off the end of the table.
	*Observe the eyes for 45 seconds for nystagmus. There is often 15 seconds of latency prior to symptoms.		*Observe the eyes for 45 seconds for nystagmus. There is often 15 seconds of latency prior to symptoms.
			**Immediate symptoms suggests central etiology
	*'''A positive test for BPPV is evidenced by the rotational nystagmus		*'''A positive test for BPPV is evidenced by the rotational nystagmus
	**fast phase of the rotatory nystagmus is toward the affected ear, which is the ear closest to the ground		**fast phase of the rotatory nystagmus is toward the affected ear, which is the ear closest to the ground

ClaireLewis: /* Medical management */

2017-04-03T15:13:06Z

Medical management

← Revisión anterior		Revisión del 15:13 3 abr 2017
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	**[[Promethazine]](Phenergan, Anergan, Prorex) 12.5-25mg PO/IM/IV q4-6hr		**[[Promethazine]](Phenergan, Anergan, Prorex) 12.5-25mg PO/IM/IV q4-6hr
	*Anticholinergic		*Anticholinergic
	**Scopolamine transdermal patch 0.5mg (behind ear) QID		**[[Scopolamine]] transdermal patch 0.5mg (behind ear) QID
	*Benzodiazepines		*Benzodiazepines
	**[[Lorazepam]] (Ativan), [[diazepam]] (Valium) or Klonopin (Clonazepam)		**[[Lorazepam]] (Ativan), [[diazepam]] (Valium) or Klonopin (Clonazepam)

Alvarez13 at 06:21, 27 November 2016

2016-11-27T06:21:06Z

← Revisión anterior		Revisión del 06:21 27 nov 2016
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	*Antihistamines		*Antihistamines
	**[[Diphenhydramine]] (Benadryl) 25-50mg IM/IV/PO q4hr		**[[Diphenhydramine]] (Benadryl) 25-50mg IM/IV/PO q4hr
	**Meclizine (Antivert, Antrizine, Dramamine) 25mg PO QID		**[[Meclizine]](Antivert, Antrizine, Dramamine) 25mg PO QID
	**Promethazine (Phenergan, Anergan, Prorex) 12.5-25mg PO/IM/IV q4-6hr		**[[Promethazine]](Phenergan, Anergan, Prorex) 12.5-25mg PO/IM/IV q4-6hr
	*Anticholinergic		*Anticholinergic
	**Scopolamine transdermal patch 0.5mg (behind ear) QID		**Scopolamine transdermal patch 0.5mg (behind ear) QID

Alvarez13 at 06:20, 27 November 2016

2016-11-27T06:20:08Z

← Revisión anterior		Revisión del 06:20 27 nov 2016
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	===Dix-Hallpike Maneuver===		===Dix-Hallpike Maneuver===
	''50-85% Sensitive for BPPV<ref>Sacco RR et al. Management of Benign Paroxysmal Posi- tional Vertigo: A Randomized Controlled Trial. J Emerg Med. 2014 Apr;46(4):575-81</ref>''		*''50-85% Sensitive for BPPV<ref>Sacco RR et al. Management of Benign Paroxysmal Posi- tional Vertigo: A Randomized Controlled Trial. J Emerg Med. 2014 Apr;46(4):575-81</ref>''
	====Procedure====		====Procedure====
	*Patient sits upright		*Patient sits upright