Based on Nystagmus, Which BPPV Maneuver to Perform to Treat Vertigo Dizziness?

BPPV, or benign paroxysmal positional vertigo, accounts for about 20% of all dizzy patients seen in an ENT clinic. It is also very easy to treat by moving the head in discrete steps and angles in under 5 minutes. As such, there has been a proliferation of online videos (including videos made by our office) to show how to perform these maneuvers at home in order to avoid a doctor's visit. 

Unfortunately, there is not one single maneuver that works for all BPPV. Indeed, there are 3 main types of BPPV which each require their own maneuvers and when you take into consideration the side, there are 6 different forms of BPPV... each with their own distinct maneuver for treatment.

The video above tries to simplify the diagnostic process to at least diagnosing the correct BPPV type and narrowing down which maneuvers would work based on direction of the nystagmus or eye twitching.

The standard maneuver to trigger the nystagmus is the Dix-Hallpike maneuver which should be the very first test anybody suspected of BPPV should perform prior to a treatment maneuver. For a more general approach to diagnose most causes of dizziness, use this flowchart.

Assuming BPPV, and based on the results of the Dix-Hallpike, the maneuvers to treat are as follows:

POSTERIOR canal BPPV (causing a torsional, diagonal nystagmus):

• Epley
• Semont
• Half-Somersault

SUPERIOR canal BPPV (causing a vertical nystagmus):

• Deep-Head Hanging

LATERAL canal BPPV (causing a horizontal nystagmus):

• BBQ Roll or Lempert

• Gufoni