ENT

Benign paroxysmal positional vertigo

Brief, position-triggered vertigo caused by displaced otoconia in a semicircular canal; diagnose with positional testing and treat posterior-canal disease with a canalith-repositioning manoeuvre.

Definition

Benign paroxysmal positional vertigo is a peripheral vestibular disorder caused by displaced otoconia entering a semicircular canal, producing brief episodes of vertigo triggered by head position.

First principles

BPPV is a mechanical problem in the inner ear

Otoconia that normally sit in the utricle can enter a semicircular canal. Head movement then makes the particles move under gravity, producing an abnormal vestibular signal and a short burst of vertigo. The posterior canal is most often involved, but horizontal and anterior canal variants need different positional findings and manoeuvres.

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