2022 Volume 158 Pages 29-36
Benign paroxysmal positional vertigo (BPPV) caused by a peripheral vestibular lesion is the most commonly encountered type of vertigo in clinical practice. BPPV has been classified according to the canal of origin, as posterior canal BPPV, anterior canal BPPV, and horizontal canal BPPV. In most cases of BPPV, the underlying pathophysiology is canalolithiasis, with a free-floating otolith in the semi-circular canal. Movement of the canalolithiasis with changes of the head position induces endolymphatic flow in the canal, resulting in the accompanying nystagmus. The rotation axis of the nystagmus is perpendicular to the affected canal. Torsional nystagmus can be induced by the Dix-Hallpike maneuver in patients with posterior BPPV. Direction-changing horizontal nystagmus can be induced by the supine roll maneuver in patients with horizontal BPPV. The direction-changing horizontal geotropic nystagmus is caused by canalolithiasis in the horizontal canal and the direction-changing horizontal ageotropic nystagmus is caused by cupulolithiasis. The canalith repositioning procedure is recommended for the treatment of BPPV. The purpose of this procedure is to relocate free-floating otolith from the posterior canal into the vestibule of the vestibular labyrinth. In this review, we provide the classification, pathophysiology, risk factors, natural course, and treatments of BPPV.
