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CMAJ • September 30, 2003; 169 (7)
© 2003 Canadian Medical Association or its licensors

Review
Synthèse

Diagnosis and management of benign paroxysmal positional vertigo (BPPV)

Lorne S. Parnes, Sumit K. Agrawal and Jason Atlas

All authors are with the Department of Otolaryngology, University of Western Ontario, London, Ont.

Correspondence to: Dr. Lorne S. Parnes, London Health Sciences Centre – University Campus, 339 Windermere Rd., London ON N6A 5A5; fax 519 663-3916; parnes{at}uwo.ca

Abstract

THERE IS COMPELLING EVIDENCE THAT FREE-FLOATING endolymph particles in the posterior semicircular canal underlie most cases of benign paroxysmal positional vertigo (BPPV). Recent pathological findings suggest that these particles are otoconia, probably displaced from the otolithic membrane in the utricle. They typically settle in the dependent posterior canal and render it sensitive to gravity. Well over 90% of patients can be successfully treated with a simple outpatient manoeuvre that moves the particles back into the utricle. We describe the various techniques for this manoeuvre, plus treatments for uncommon variants of BPPV such as that of the lateral canal. For the rare patient whose BPPV is not responsive to these manoeuvres and has severe symptoms, posterior canal occlusion surgery is a safe and highly effective procedure.




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