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.

• Impaired Balance

  These patients suffer from impaired balance. Treatment with the Epley maneuver improves both static and dynamic stability [14],[15]. [ejo.eg.net]

• Nausea

  Nausea is commonly associated. BPPV is one of the most common causes of vertigo. [dbpedia.org]

  Share on Pinterest A person should see a doctor if they experience frequent episodes of vertigo, nausea, or vomiting. [medicalnewstoday.com]

  Peripheral vestibular disorders result in vertigo, disequilibrium, and frequently nausea and vomiting. [ncbi.nlm.nih.gov]

  Vertigo can cause the person to feel quite ill with nausea and vomiting. [hopkinsmedicine.org]

• Vomiting

  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 [symptoma.com]

  Antiemetic medicines, such as promethazine (Promethegan), may be used if you have severe nausea or vomiting. [uofmhealth.org]

  Antiemetic medicines, such as promethazine (Histantil), may be used if you have severe nausea or vomiting. [healthlinkbc.ca]

  Share on Pinterest A person should see a doctor if they experience frequent episodes of vertigo, nausea, or vomiting. [medicalnewstoday.com]

  Peripheral vestibular disorders result in vertigo, disequilibrium, and frequently nausea and vomiting. [ncbi.nlm.nih.gov]

• Left Ventricular Dysfunction

  Takotsubo cardiomyopathy, also known as left ventricular apical ballooning syndrome, ampulla cardiomyopathy, or transient left ventricular dysfunction is characterized by chest pain, electrocardiographic changes, transient left ventricular apical aneurysm [ncbi.nlm.nih.gov]

• Mastoid Pain

  Symptoms such as hearing loss, tinnitus, ear or mastoid pain, headache and photophobia point towards alternative diagnoses. Light-headedness and imbalance are sometimes reported after the attack and may last for several minutes or hours [ 3 ]. [patient.info]

• Benign Paroxysmal Positional Vertigo

  Benign paroxysmal positional vertigo is characterized by brief episodes of mild to intense dizziness. [web.archive.org]

  BACKGROUND: Benign paroxysmal positional vertigo and migraine-associated dizziness are common. The prevalence of benign paroxysmal positional vertigo seems to be higher in patients with migraine-associated dizziness than in those without migraine. [ncbi.nlm.nih.gov]

  Benign paroxysmal positional vertigo causes brief episodes of mild to intense dizziness. Benign paroxysmal positional vertigo is usually triggered by specific changes in the position of your head. [mayoclinic.org]

  positional vertigo Left benign paroxysmal positional vertigo Right benign paroxysmal positional vertigo Vertigo (spinning sensation), benign positional Vertigo, benign paroxysmal positional Applies To Benign paroxysmal positional nystagmus ICD-9-CM Volume [icd9data.com]

  Abstract Benign paroxysmal positional vertigo is the most common peripheral vestibular disorder. It can be defined as transient vertigo induced by a rapid head position change, associated with a characteristic paroxysmal positional nystagmus. [doi.org]

• Tinnitus

  A 69-year-old woman, with no history of vertigo attacks, presented with the classical triad of symptoms for Ménière's disease in the right ear (vertigo, tinnitus, fullness). [ncbi.nlm.nih.gov]

  Hearing is not affected and tinnitus is not a feature. Symptoms such as hearing loss, tinnitus, ear or mastoid pain, headache and photophobia point towards alternative diagnoses. [patient.info]

  Nausea and vomiting may occur, but hearing loss and tinnitus do not. [merckmanuals.com]

• Hearing Impairment

  Impairment Clinic, Nagasaki 852-8132, Japan. 5 Department of Otorhinolaryngology - Head and Neck Surgery, University of Toyama, Toyama 930-0194, Japan. 6 Ohsawano Rehabilitation Facility for the Elderly Kagayaki, Toyama 939-2224, Japan. 7 Department [ncbi.nlm.nih.gov]

  One study included patients with "vertebrobasilar ischaemia", defined in this study as vertigo with at least two of impaired hearing, impaired vision, tinnitus or headache and "typical abnormalities" on test, which were not specified ( Otto 2008 ). [doi.org]

• Vertigo

  RESULTS: The percentage of patients with dizziness or vertigo who met criteria for migraine was 33.7 per cent, with a prevalence of benign paroxysmal positional vertigo of 42.3 per cent. [ncbi.nlm.nih.gov]

  Abstract Benign paroxysmal positional vertigo is the most common peripheral vestibular disorder. It can be defined as transient vertigo induced by a rapid head position change, associated with a characteristic paroxysmal positional nystagmus. [doi.org]

  […] positional vertigo Left benign paroxysmal positional vertigo Right benign paroxysmal positional vertigo Vertigo (spinning sensation), benign positional Vertigo, benign paroxysmal positional Applies To Benign paroxysmal positional nystagmus ICD-9-CM Volume [icd9data.com]

  Overview Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of vertigo — the sudden sensation that you're spinning or that the inside of your head is spinning. [mayoclinic.org]

• Nystagmus

  The provocative positions usually trigger specific eye movements (ie, nystagmus). The character and direction of the nystagmus are specific to the part of the inner ear affected and the pathophysiology. [emedicine.com]

  All patients presented with geotropic nystagmus in the first phase, and ageotropic nystagmus in the second phase. [ncbi.nlm.nih.gov]

• Dizziness

  We analyzed how various general factors and ocular vestibular evoked myogenic potentials related to residual dizziness. [ncbi.nlm.nih.gov]

  The dizziness of BPPV can make you unsteady, which may put you at greater risk of falling. [mayoclinic.org]

• Headache

  International Headache Society Classification Subcommittee (2004) International classification of headache disorders. 2nd edition. Cephalalgia 24(Suppl 1):1–160 Google Scholar 29. [doi.org]

  Symptoms included spinning vertigo lasting for 30's, headache, visual vertigo and disorientation. [ncbi.nlm.nih.gov]

  Call 911 if the person loses consciousness or has: Has non-stop vomiting Cannot stand or walk due to dizziness Has symptoms inconsistent with benign positional vertigo including: A head injury Convulsions Loss of consciousness Fever Headache or stiff [webmd.com]

• Episodic Vertigo

  This patient was seen in a tertiary vestibular clinic for episodic vertigo. He exhibited robust corrective refixation saccades on HTT to the right and evidence of active contralateral LSCC BPPV on positional testing. [ncbi.nlm.nih.gov]

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.

1. Bhattacharyya N, Baugh RF, Orvidas L, Barrs D, Bronston L, Cass S, Chalian A, Desmond A, Earll J (2008). Clinical Practice Guideline: benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 139 (5 Suppl 4):S47-81.
2. Nedzelski JM, Barber HO, McIlmoyl L. Diagnosis in a dizziness unit. J Otolaryngol 1986;15:101.
3. Hughes CA, Proctor L. Benign paroxysmal positional vertigo. Laryngoscope 1997;107:607.
4. Wiener-Vacher SR. Vestibular disorders in children. Int J Audiol. 2008;47:578.
5. Crane BT, Schessal DA, Nedzelski J, Minor LB. Peripheral vestibular disorders. In: Cummings CW, Flint PW, Haughey BH, et al, eds. Otolaryngology. Head and Neck Surgery. 5th ed. Philadelphia. Pa: Moseby Elsevier 2010:chap 165.
6. Korres SG, Balatsouras DG, (2004). Diagnostic, pathophysiologic and therapeutic aspects of benign paroxysmal positional vertigo. Otolaryngology- Head and Neck Surgery 131(4):438-44. doi: 10.1016/j.otohns.2004.02.046. PMID 15467614.
7. Schubert M.C (2007). Vestibular Disorders. In: S.O'Sullivan & T Smchidz, eds. Physical Rehabilitation. 5th ed. Philadelphia. Pa: FA Davis Company. pp999-1029.
8. Post RE, Dickerson LM. Dizziness:a diagnostic approach. Am Fam Physician. 2010;82:361-369.
9. Glasziou P, Bennett J, Greenberg P, et al. The Epley Maneuver: for benign paroxysmal positional vertigo. Aust Fam Physician. 2013 Jan-Feb;42(1-2):36-7.
10. Shim DB, Kim JH, Park KC, Song MH, Park HJ. Correlation between the head-lying side during sleep and the affected side by benign paroxysmal positional vertigo involving the posterior or horizontal semicircular canal. Laryngoscope. Feb 16 2012 [Medline].