Benign Paroxysmal Positional Vertigo (BPPV) is one of the most prevalent peripheral vestibular disorders, accounting for approximately 20% of all cases of vertigo. It typically affects individuals aged 50 years and older, although it can occur at any age. The characteristic symptom of BPPV is a sudden, intense spinning sensation (vertigo) triggered by specific head movements, such as rolling over in bed or looking up. Despite its benign nature, BPPV can significantly impact a person's quality of life. Early diagnosis and appropriate evidence-based treatment are essential for effective management.
Diagnosing BPPV requires a thorough history taking and a physical examination, including a Dix-Hall-pike test or a roll test to elicit characteristic vertigo and nystagmus (involuntary eye movements). Additionally, other examinations maybe necessary to rule out other potential causes of vertigo. Diagnostic accuracy is crucial for the appropriate treatment.
The Epley Manoeuvre is the most widely used and evidence-based treatment for BPPV. It involves a series of head movements that aim to relocate dislodged otoconia within the affected semi-circular canal. Several randomized controlled trials (RCTs) and meta-analyses have shown the Epley Manoeuvre to be highly effective, with success rates ranging from 70% to 95%. Patients may experience immediate relief or a gradual reduction in symptoms over several days.
Recurrence rates for BPPV can be as high as 50%, and patients should be informed about this possibility. Therefore, follow-up evaluations are essential to monitor treatment effectiveness and provide additional management if necessary. In cases of persistent or recurrent BPPV, further repositioning manoeuvres or a combination of treatments may be considered.