Referral

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