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Auris Nasus Larynx. 2017 Feb;44(1):1-6. doi: 10.1016/j.anl.2016.03.013. Epub 2016 May 9.

Classification, diagnostic criteria and management of benign paroxysmal positional vertigo.

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Department of Otorhinolaryngology - Head and Neck Surgery, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan. Electronic address:
Department of Otolaryngology, University of Tokushima School of Medicine, Tokushima 770-8503, Japan.
Department of Otolaryngology, Saitama Medical University Hospital, Saitama 350-0495, Japan.
Shigeno Otolaryngology Vertigo-Hearing Impairment Clinic, Nagasaki 852-8132, Japan.
Department of Otorhinolaryngology - Head and Neck Surgery, University of Toyama, Toyama 930-0194, Japan.
Ohsawano Rehabilitation Facility for the Elderly Kagayaki, Toyama 939-2224, Japan.
Department of Otolaryngology, Tokyo Medical University Hospital, Tokyo 160-0023, Japan.


Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vertigo and the posterior and/or lateral semicircular canals are usually affected. BPPV is characterized by brief attacks of rotatory vertigo associated with positional and/or positioning nystagmus, which are elicited by specific head positions or changes in head position relative to gravity. In patients with the posterior-canal-type of BPPV, torsional nystagmus is induced by the Dix-Hallpike maneuver. In patients with the lateral-canal-type of BPPV, horizontal geotropic or apogeotropic nystagmus is induced by the supine roll test. The pathophysiology of BPPV is canalolithiasis comprising free-floating otoconial debris within the endolymph of a semicircular canal, or cupulolithiasis comprising otoconial debris adherent to the cupula. The observation of positional and/or positioning nystagmus is essential for the diagnosis of BPPV. BPPV is treated with the canalith repositioning procedure (CRP). Through a series of head position changes, the CRP moves otoconial debris from the affected semicircular canal to the utricle. In this review, we provide the classification, diagnostic criteria, and examinations for the diagnosis, and specific and non-specific treatments of BPPV in accordance with the Japanese practical guidelines on BPPV published by the Japan Society for Equilibrium Research.


Benign paroxysmal positional vertigo; Canalith repositioning procedure; Canalolithiasis; Cupulolithiasis

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