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 e.g. labyrinthitis (vestibular neuronitis).

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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 for specialist assessment.

Epley manoeuvre – see supporting information section

Consider referral for specialist assessment 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: Diagnostic Physiological Measurement
Clinic Type: Audiology – Hearing Asses/ Reassess
Service: DRSS-Northern-Ear Nose and Throat - Devon ICB- 15N

Referral Form

DRSS Referral Form

How to do the Manoeuvres

Hallpike's video

Epley's video

Benign Paroxysmail Positional Vertigo

Pathway Group

This guideline has been signed off on behalf of NHS Devon.

Publication date: November 2017

Reviewed: April 2024

Referral