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Benign Paroxysmal Positional Vertigo
Scope
This guidance covers benign paroxysmal positional vertigo (BPPV): recurrent severe rotational vertigo provoked by positional changes, not associated with hearing loss, tinnitus or headache. Each episode of vertigo lasts less than 30 seconds.
Out of scope
Other pathologies causing vertigo.
Signs and Symptoms
- Associated with positional change
- Brief or no latency following positional change
- Nystagmus fatigues within 1 minute
- Not necessarily associated with hearing loss or tinnitus
- May experience rotary sensation
History and Examination
- Hallpike's positional test is diagnostic
- Otherwise normal examination of ears and cranial nerves
Differential Diagnoses
- If Hallpike negative or atypical response consider other pathologies
Immediate, single plane or non fatiguing nystagmus in response to Hallpike indicates possible central pathology. Refer to ENT.
- Epley manoeuvre
Refer to ENT if
- Hallpike's negative or atypical (even if history suggests BPPV)
- Epley manoeuvre unsuccessful
- Epley manoeuvre not possible e.g. severe cervical spondylosis
Note - Patients may not be fit to drive themselves home after an Epley manoeuvre
Referral Instructions
e-Referral Service Selection
- Specialty: Ear, Nose & Throat
- Clinic Type: Balance/Dizziness
- Service: DRSS-Eastern-Ear Nose and Throat-Devon ICB- 15N
Referral Form
How to do the Manoeuvres
Benign Paroxysmail Positional Vertigo
Pathway Group
This guideline has been signed off on behalf of NHS Devon.
Publication date: April 2017
Reviewed: April 2024
