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Otolaryngology (ENT)1107 papers

Central positional vertigo

Last edited: 4/14/2026

Overview

Benign paroxysmal positional vertigo (BPPV) is a common inner ear disorder characterized by brief episodes of vertigo triggered by specific changes in head position relative to gravity. It involves displaced otoconia (calcium carbonate crystals) within the semicircular canals.

Diagnosis

  • Key Diagnostic Criteria: Positive Dix-Hallpike or supine positional nystagmus test 10.
  • Recommended Tests: Vestibular function tests (e.g., electronystagmography) to rule out other causes 22.
  • Grading: Typically not graded but severity can be assessed by frequency and duration of episodes 2.

    • Management

  • First-Line Treatments: Canalith repositioning maneuvers (e.g., Epley maneuver) 1022.
  • Adjunctive Treatments: Vitamin D supplementation for recurrent cases, particularly in those with deficiency 14914 (2000 IU daily for 13 weeks followed by maintenance dose).
  • Drug Classes: Betahistine may be used to enhance vestibular compensation 13.

    • Special Populations

  • Elderly: Higher prevalence of vitamin D deficiency; supplementation may reduce recurrence 14914.
  • Comorbidities: Cardiovascular risk factors may be associated but evidence is mixed 8.

    • Key Recommendations

  • Implement Canalith Repositioning Maneuvers for initial treatment of BPPV 1022 (Evidence: Strong).
  • Screen for and Treat Vitamin D Deficiency in patients with recurrent BPPV to potentially reduce recurrence rates 14914 (Evidence: Moderate).
  • Consider Vitamin D Supplementation at 2000 IU daily for 13 weeks followed by maintenance dose in elderly patients with recurrent BPPV 19 (Evidence: Moderate).

    • References

    1 Chua KW, Huang X, Koh XH, Soh JFJY, Barrera VC, Anaikatti P et al.. Randomized Controlled Trial Assessing Vitamin D's Role in Reducing BPPV Recurrence in Older Adults. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 2025. link 2 Rhim G, Kim MJ. Vitamin D Supplementation and Recurrence of Benign Paroxysmal Positional Vertigo. Nutrients 2024. link 3 Ren YY, Wang YJ, Li JL, Liu M, Xia F. Low vitamin D and uric acid status in patients with benign paroxysmal positional vertigo. Science progress 2023. link 4 Pecci R, Mandalà M, Marcari A, Bertolai R, Vannucchi P, Santimone R et al.. Vitamin D Insufficiency/Deficiency in Patients with Recurrent Benign Paroxysmal Positional Vertigo. The journal of international advanced otology 2022. link 5 Yildiz MG, Bilal N, Kara I, Sagiroglu S, Orhan I, Doganer A. Characteristics of Benign Paroxysmal Positional Vertigo Following an Earthquake. The Annals of otology, rhinology, and laryngology 2021. link 6 Han DG, Kim DJ. The evolutionary hypothesis of benign paroxysmal positional vertigo. Medical hypotheses 2020. link 7 Bashir K, Thomas S. Educational Approach of Blended Learning in Teaching Benign Paroxysmal Positional Vertigo in an Emergency Department. Journal of the College of Physicians and Surgeons--Pakistan : JCPSP 2020. link 8 Singh JM, Corser WD, Monsell EM. Cardiovascular Risk Factors and Benign Paroxysmal Positional Vertigo in Community Otolaryngology-Head and Neck Surgery. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 2020. link 9 Jeong SH, Kim JS, Kim HJ, Choi JY, Koo JW, Choi KD et al.. Prevention of benign paroxysmal positional vertigo with vitamin D supplementation: A randomized trial. Neurology 2020. link 10 Maranhão-Filho P, Nandi R, Maranhão ET. Margaret Dix, Charles Hallpike and the 'Lagerungs' Manoeuvre. Arquivos de neuro-psiquiatria 2018. link 11 Dunlap PM, Khoja SS, Whitney SL, Freburger JK. Assessment of Physician Adherence to Guidelines for the Diagnosis and Treatment of Benign Paroxysmal Positional Vertigo in Ambulatory Care Settings. JAMA otolaryngology-- head & neck surgery 2018. link 12 Dlugaiczyk J, Thiemer M, Neubert C, Schorn BA, Schick B. The aVOR App Increases Medical Students' Competence in Treating Benign Paroxysmal Positional Vertigo (BPPV). Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 2018. link 13 Kaur J, Shamanna K. Management of Benign Paroxysmal Positional Vertigo: A Comparative Study between Epleys Manouvre and Betahistine. The international tinnitus journal 2017. link 14 Talaat HS, Kabel AM, Khaliel LH, Abuhadied G, El-Naga HA, Talaat AS. Reduction of recurrence rate of benign paroxysmal positional vertigo by treatment of severe vitamin D deficiency. Auris, nasus, larynx 2016. link 15 Fujisaka M, Akaogi K, Shojaku H. A tangible head model showing semicircular canals for demonstrating the physical treatment for BPPV. Acta oto-laryngologica 2015. link 16 Kirschen MP, Friedlander JA. Grounded for an ethical dilemma: disequilibrium in a commercial airline pilot. Continuum (Minneapolis, Minn.) 2012. link 17 Obrist D, Hegemann S, Kronenberg D, Häuselmann O, Rösgen T. In vitro model of a semicircular canal: design and validation of the model and its use for the study of canalithiasis. Journal of biomechanics 2010. link 18 Inukai K, Koizuka I, Takahashi S. Investigation into dizziness before and after Epley's maneuver for benign paroxysmal positional vertigo using stabilometry. Auris, nasus, larynx 2007. link 19 White JA, Coale KD, Catalano PJ, Oas JG. Diagnosis and management of lateral semicircular canal benign paroxysmal positional vertigo. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 2005. link 20 Chiou WY, Lee HL, Tsai SC, Yu TH, Lee XX. A single therapy for all subtypes of horizontal canal positional vertigo. The Laryngoscope 2005. link 21 Kaplan DM, Nash M, Niv A, Kraus M. Management of bilateral benign paroxysmal positional vertigo. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 2005. link 22 von Brevern M, Lempert T. Benign paroxysmal positional vertigo. Archives of neurology 2001. link 23 Pulec JL. Ablation of posterior semicircular canal for benign paroxysmal positional vertigo. Ear, nose, & throat journal 1997. link 24 Lempert T, Wolsley C, Davies R, Gresty MA, Bronstein AM. Three hundred sixty-degree rotation of the posterior semicircular canal for treatment of benign positional vertigo: a placebo-controlled trial. Neurology 1997. link

    Original source

    1. [1]
      Randomized Controlled Trial Assessing Vitamin D's Role in Reducing BPPV Recurrence in Older Adults. — Chua KW, Huang X, Koh XH, Soh JFJY, Barrera VC, Anaikatti P et al. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2025)
    2. [2]
      Vitamin D Supplementation and Recurrence of Benign Paroxysmal Positional Vertigo. — Rhim G, Kim MJ Nutrients (2024)
    3. [3]
      Low vitamin D and uric acid status in patients with benign paroxysmal positional vertigo. — Ren YY, Wang YJ, Li JL, Liu M, Xia F Science progress (2023)
    4. [4]
      Vitamin D Insufficiency/Deficiency in Patients with Recurrent Benign Paroxysmal Positional Vertigo. — Pecci R, Mandalà M, Marcari A, Bertolai R, Vannucchi P, Santimone R et al. The journal of international advanced otology (2022)
    5. [5]
      Characteristics of Benign Paroxysmal Positional Vertigo Following an Earthquake. — Yildiz MG, Bilal N, Kara I, Sagiroglu S, Orhan I, Doganer A The Annals of otology, rhinology, and laryngology (2021)
    6. [6]
      The evolutionary hypothesis of benign paroxysmal positional vertigo. — Han DG, Kim DJ Medical hypotheses (2020)
    7. [7]
      Educational Approach of Blended Learning in Teaching Benign Paroxysmal Positional Vertigo in an Emergency Department. — Bashir K, Thomas S Journal of the College of Physicians and Surgeons--Pakistan : JCPSP (2020)
    8. [8]
      Cardiovascular Risk Factors and Benign Paroxysmal Positional Vertigo in Community Otolaryngology-Head and Neck Surgery. — Singh JM, Corser WD, Monsell EM Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2020)
    9. [9]
      Prevention of benign paroxysmal positional vertigo with vitamin D supplementation: A randomized trial. — Jeong SH, Kim JS, Kim HJ, Choi JY, Koo JW, Choi KD et al. Neurology (2020)
    10. [10]
      Margaret Dix, Charles Hallpike and the 'Lagerungs' Manoeuvre. — Maranhão-Filho P, Nandi R, Maranhão ET Arquivos de neuro-psiquiatria (2018)
    11. [11]
      Assessment of Physician Adherence to Guidelines for the Diagnosis and Treatment of Benign Paroxysmal Positional Vertigo in Ambulatory Care Settings. — Dunlap PM, Khoja SS, Whitney SL, Freburger JK JAMA otolaryngology-- head & neck surgery (2018)
    12. [12]
      The aVOR App Increases Medical Students' Competence in Treating Benign Paroxysmal Positional Vertigo (BPPV). — Dlugaiczyk J, Thiemer M, Neubert C, Schorn BA, Schick B Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology (2018)
    13. [13]
      Management of Benign Paroxysmal Positional Vertigo: A Comparative Study between Epleys Manouvre and Betahistine. — Kaur J, Shamanna K The international tinnitus journal (2017)
    14. [14]
      Reduction of recurrence rate of benign paroxysmal positional vertigo by treatment of severe vitamin D deficiency. — Talaat HS, Kabel AM, Khaliel LH, Abuhadied G, El-Naga HA, Talaat AS Auris, nasus, larynx (2016)
    15. [15]
      A tangible head model showing semicircular canals for demonstrating the physical treatment for BPPV. — Fujisaka M, Akaogi K, Shojaku H Acta oto-laryngologica (2015)
    16. [16]
      Grounded for an ethical dilemma: disequilibrium in a commercial airline pilot. — Kirschen MP, Friedlander JA Continuum (Minneapolis, Minn.) (2012)
    17. [17]
      In vitro model of a semicircular canal: design and validation of the model and its use for the study of canalithiasis. — Obrist D, Hegemann S, Kronenberg D, Häuselmann O, Rösgen T Journal of biomechanics (2010)
    18. [18]
      Investigation into dizziness before and after Epley's maneuver for benign paroxysmal positional vertigo using stabilometry. — Inukai K, Koizuka I, Takahashi S Auris, nasus, larynx (2007)
    19. [19]
      Diagnosis and management of lateral semicircular canal benign paroxysmal positional vertigo. — White JA, Coale KD, Catalano PJ, Oas JG Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2005)
    20. [20]
      A single therapy for all subtypes of horizontal canal positional vertigo. — Chiou WY, Lee HL, Tsai SC, Yu TH, Lee XX The Laryngoscope (2005)
    21. [21]
      Management of bilateral benign paroxysmal positional vertigo. — Kaplan DM, Nash M, Niv A, Kraus M Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery (2005)
    22. [22]
      Benign paroxysmal positional vertigo. — von Brevern M, Lempert T Archives of neurology (2001)
    23. [23]
      Ablation of posterior semicircular canal for benign paroxysmal positional vertigo. — Pulec JL Ear, nose, & throat journal (1997)
    24. [24]
      Three hundred sixty-degree rotation of the posterior semicircular canal for treatment of benign positional vertigo: a placebo-controlled trial. — Lempert T, Wolsley C, Davies R, Gresty MA, Bronstein AM Neurology (1997)
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