Benign paroxysmal positional vertigo.

PURPOSE OF REVIEW: To review benign paroxysmal positional vertigo (BPPV) and some of the recent literature. As BPPV is such a common diagnosis, it is important to understand the disorder and treatment considerations.

RECENT FINDINGS: Although BPPV is typically an easy diagnosis to make, one must be aware of the differential diagnosis. An unusual entity, convergence spasm, is recently presented and discussed as an addition to the differential diagnosis. The recent literature confirms the efficacy of treatment of BPPV. Large studies of horizontal canal BPPV support the success of the barbeque roll and present the simple head shake as a possible treatment in the apogeotropic form. There is reported success with the less often discussed Gufoni (and its variations) maneuver. The presence of orthoptic nystagmus during treatment has positive predictive value for the success of the maneuver. Although uncommon, canal conversion is important to recognize during treatment as it can be readily treated.

SUMMARY: BPPV is a very common cause of dizziness and generally straightforward to identify and treat. Awareness of possible horizontal canal variants and nonvestibular differential diagnosis possibilities is important. Repositioning maneuvers of various types are typically successful and understanding the nuances is important in assuring successful outcomes.