Vertigo: A Balanced Approach To Diagnosing And Treating Benign Paroxysmal Positional Vertigo (BPPV)


Benign Paroxysmal Positional Vertigo (BPPV) is the most common form of vertigo and occurs most often in the elderly population. Symptoms include brief episodes of dizziness, lightheadedness, imbalance, and occasionally even nausea in response to positional changes. BPPV occurs when detached otoliths, often referred to as “crystals” or “ear rocks,” cause a deflection of the sensory hair cells in one of the semicircular canals. This sends false messages to the brain that the patient is spinning. Head movement such as getting out of bed, or rolling over may provoke rapid eye movements (nystagmus) and associated vertigo.

Clinical Features

The Dix-Hallpike maneuver, which involves rapidly moving the patient from sitting to head-hanging position, is used for clinical diagnosis. Once in the provocative head position, the following are general characteristics of BPPV:

  • Patient experiences true vertigo with a rotary sensation
  • Latent symptoms and eye movements usually occur within 30 seconds of the patient moving into the provoking position
  • Duration of symptoms are usually 5-30 seconds
  • Fatigability of symptoms upon repetition of the provoking head position
  • Reversal of nystagmus upon rising to the sitting position, which is also fatigable


While BPPV can be preceded by head trauma or other inner ear disorders such as a Meniere’s attack or viral labyrinthitis, it often occurs for unknown reasons. Fortunately, it is very easy to treat once diagnosed. Through the use of direct observation or video recording of nystagmus, the audiologists and physicians of Cornerstone Ear, Nose and Throat are able to diagnose the presence of BPPV and identify the ear involved. We do not recommend Meclizine as a treatment, especially with the elderly. Our physicians utilize in-office vestibular repositioning techniques designed to move the offending crystals to a location where they will not cause improper deflection of the vestibular fluids. These techniques are highly effective (80% on the first treatment) at alleviating BPPV symptoms.

William A. McClelland, MD, FACS - Board Certified Otolaryngologist (ENT)
About the Author
Otolaryngologist (ENT) at CornerStone Ear, Nose & Throat, PA
Dr. McClelland is a Board Certified Otolaryngologist (ENT) as well as the Founding Partner of CornerStone Ear, Nose & Throat, PA. His particular clinical interest is minimally invasive sinus surgery.
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