Benign Paroxysmal Positional Vertigo

Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo. The risk of BPPV increases with age, female gender, low vitamin D levels, osteoporosis, and a history of head trauma. Cupulolithiasis and canalithiasis are the main underlying pathophysiological mechanisms. Typical symptoms, medical history, and positional testing are sufficient for evaluation; further audiometric or vestibular testing is not helpful. The posterior semicircular canal (SCC) is the most commonly affected subsite, followed by the lateral and anterior canals. In the majority of cases, the condition gradually resolves on its own over time. However, canalith repositioning maneuvers (CRMs) are the mainstay of treatment, as even a single maneuver can be effective in resolving symptoms, and most remaining cases are effectively cured by repeated maneuvers, significantly reducing the duration of symptoms. If the episodes recur, they are treated similarly to the initial treatment, with positional testing first, followed by CRMs. BPPV is predominantly a disease of the elderly, and the very factors that predispose patients to their first encounter with the disease may also predispose them to its recurrence. Although most patients can be cured with CRMs, vestibular rehabilitation exercises and, rarely, SCC plugging surgery still hold value for the extremely rare recalcitrant cases.