Diagnosing and Managing Benign Paroxysmal Positional Vertigo (BPPV)
Established Symptoms of BPPV
- The American Academy of Otolaryngology-Head and Neck Surgery recommends that vertigo/spinning sensations triggered by specific head position changes are a key symptom of BPPV 1
- The American Academy of Otolaryngology-Head and Neck Surgery guidelines state that nausea, sometimes with vomiting, is a common symptom of BPPV 2, 3
- Severe disorientation in space is a symptom of BPPV, according to the American Academy of Otolaryngology-Head and Neck Surgery clinical practice guidelines 1
- Instability or imbalance is a symptom of BPPV, as stated in the American Academy of Otolaryngology-Head and Neck Surgery guidelines 2
- Dizziness, particularly in elderly patients, is a symptom of BPPV, according to the American Academy of Otolaryngology-Head and Neck Surgery clinical practice guidelines 3
What BPPV Does NOT Cause
- The American Academy of Otolaryngology-Head and Neck Surgery guidelines explicitly state that BPPV does not cause constant severe dizziness unaffected by position 3
- BPPV does not cause hearing loss, as stated in the American Academy of Otolaryngology-Head and Neck Surgery guidelines 4
- Fainting/syncope is not a symptom of BPPV, according to the American Academy of Otolaryngology-Head and Neck Surgery clinical practice guidelines 1
Clinical Implications
- If a patient presents with positional vertigo plus diaphoresis, the American Academy of Otolaryngology-Head and Neck Surgery recommends considering alternative or concurrent diagnoses, such as central nervous system pathology, vertebrobasilar insufficiency, vestibular migraine, or panic disorder/anxiety 5, 6
- The presence of diaphoresis with vertigo warrants investigation for neurologic signs, atypical nystagmus patterns, or failure to respond to canalith repositioning maneuvers, as stated in the American Academy of Otolaryngology-Head and Neck Surgery guidelines 6, 7