Benign paroxysmal positional vertigo: mechanism and management

Benign paroxysmal positional vertigo of the posterior semicircular canal is a common vestibular disorder. Symptoms include brief, episodic, position-provoked vertigo with characteristic nystagmus on Dix–Hallpike testing. Benign paroxysmal positional vertigo is believed to be the result of free-floating otoconial debris in the posterior canal endolymph. Several repositioning maneuvers that attempt to correct these aberrant particles have been described. Currently, the particle repositioning maneuver is the most widely used of these techniques. Current evidence would suggest that mastoid vibration during repositioning and postmaneuver activity limitations are unnecessary adjuncts to the particle repositioning maneuver. Several investigators have demonstrated excellent initial resolution of vertigo after repositioning; however, long-term recurrences still limit this treatment.