BPPV presents with the following symptoms:

• Dizziness and a feeling of spinning
• Feeling that the surroundings are spinning around
• Nausea
• Vomiting
• Loss of balance
• Tinnitus 
• Visual problems
• Head ache
• Limited duration of symptoms: usually <20 seconds/episode 
• Reversal of symptoms once upright position is maintained.

Symptoms appear suddenly, such as when the patient tries to sit up after sleep, when there is sudden tilting of the head to see something above, etc. and go away rapidly too.

Work up consists of a detailed history and physical examination.

Laboratory Tests

• Dix-Hallpike manoeuvre: It is a common test performed by examiners to determine whether the posterior semicircular canal is involved [6]. This test will reproduce vertigo and nystagmus characteristic of BPPV [7].
• Roll test: This test can be performed to check the involvement of the horizontal semicircular canal. In this test, the patient lies in a supine position with his head cervically flexed at 20 degrees. The examiner then quickly rotates the patients head 90 degrees to one side. Nystagmus and other symptoms are checked. Then the examiner brings the patient's head back to initial position and rotates the head 90 degrees to the opposite side this time. Symptoms associated with BPPV are checked again.
• Electronystagmography may also be performed.

Imaging 

Imaging studies are not required to diagnose BPPV. A CT scan [8], however, may be conducted if needed to check for other suspected pathologies.

Test results

A physical examination and history are sufficient to diagnose BPPV.

Canalith repositioning procedure

The Epley maneuver is done by a series of 4 movements of the head. After each movement, the head is held at the same place for 30 seconds or so [9]. This is a highly effective, risk-free and non invasive mode of treatment and considered the treatment of choice for BPPV. There are other maneuvers also that are included in the CRP but are less effective and less popular than the Epley maneuver.

Vestibulosuppressant medications

These are not very effective as they do not treat the condition but just provide temporary relief.

Surgery

This is the last mode of treatment reserved only for those patients in whom CRP (canalith repositioning procedure) has completely failed and who suffer from very severe episode of vertigo that greatly compromise quality of life.

As the name indicates, BPPV comes and goes. It may get triggered due to movement and an episode of vertigo may occur. In most cases, BPPV can be treated by the Epley maneuver and prognosis is very good. In some cases, episodic recurrence may happen.

Complications

Complications are extremely uncommon. Rare cases may include dehydration due to repeated episodes of vomiting and trauma secondary to loss of balance due to BPPV.

BPPV occurs due to a defect in the inner ear. Recall that the inner ear has fluid filled semicircular canals and otoliths. A small fragment of the otolith may break apart and its motion brought upon by movement of the head, may send inappropriate signals to the brain regarding the body's balance and position.

Other causes include age related wear and tear of the inner ear, trauma to the ear which damages the vestibular organs, ear diseases such as otosclerosis, otitis media and Meniere disease. CNS diseases may cause secondary BPPV. However, up to 39% of cases are idiopathic.

Incidence

Approximately 18% of patients seen in dizziness clinics [2] and 25% of patients seen for vestibular testing have BPPV [3].

Age

Although BPPV can occur at any age, it most commonly presents in patients aged 60 and above. BPPV also accounts for about 20% of paediatric referrals [4].

Sex
BPPV shows a distinct predisposition in females (up to 64% some studies reveal).

Race

BPPV has no known predisposition to any race or ethnic group.

BPPV is an abnormal sensation of motion that is brought upon by certain movements of the head and/or eyes. These movements or positions may lead to nystagmus which then leads to dizziness and vertigo.

The sensation of fluid moving in the semicircular tubes tells the brain the position of the body [5]. If these sensations are abnormal, they may send wrong or mixed signals to the brain and dizziness and vertigo may be triggered.

Patients may want to adjust their sleeping positions accordingly to prevent recurrence [10]. Rehabilitation may prove to be helpful and slight changes in daily behaviour and routine may help in preventing recurrence of BPPV.

Benign paroxysmal positional vertigo (BPPV) is the most common form of vertigo. Its symptoms are repeated episodes of positional vertigo, that is of a spinning sensation caused by changes in the position of the head [1]. It is due to a defect in the inner ear which may occur due to a number of causes and this condition may act as a source of discomfort for a life time in some cases.

Definition

BPPV is the most common type of vertigo that occurs due to inner ear defects.

Cause

It is mostly idiopathic but it can also occur due to trauma, ear diseases, CNS diseases, old age, etc.

Symptoms

BPPV presents with characteristic nystagmus, dizziness, nausea, vomiting, headache and loss of balance.

Treatment

BPPV can be treated by physical maneuvers performed by trained professionals and in severe cases, surgery can provide relief.

Prevention

BPPV is triggered due to unprecedented movement of the head and/or eyes so it can be prevented by modifying movements and sleeping positions.

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