All information is correct at time of printing and is subject to change without notice. The Devon Formulary and Referral Website is not in any way liable for the accuracy of any information printed and stored by users. For the most up-to-date information, please refer to the website.
Referral
Contact us about this page
Benign Paroxysmal Positional Vertigo
Scope
This guidance covers benign paroxysmal positional vertigo: recurrent severe rotational vertigo provoked by positional changes, not associated with hearing loss, tinnitus or headache. Each episode of vertigo lasts less than 30 seconds.
Out of scope
Other pathologies causing vertigo e.g. labyrinthitis (vestibular neuronitis).
History and Examination
- Hallpike's positional test is diagnostic
- Otherwise normal examination of ears and cranial nerves
Differential Diagnoses
- If Hallpike negative or atypical response consider other pathologies
Immediate, single plane or non fatiguing nystagmus in response to Hallpike indicates possible central pathology. Refer to ENT.
Epley manoeuvre – see supporting information section
Referral Criteria
Consider referral to ENT if:
- Hallpike's negative or atypical (even if history suggests BPPV)
- Epley manoeuvre unsuccessful
- Epley manoeuvre not possible e.g. severe cervical spondylosis
Note- Patients may not be fit to drive themselves home after an Epley manoeuvre
Referral Instructions
e-Referral Service Selection
-
- Specialty: Ear, Nose & Throat
- Clinic Type: Balance/Dizziness
- Service: DRSS-Western-AQP-Audiology-Devon ICB-15N
Referral Form
How to do the Manoeuvres:
Medscape Article - Benign Positional Vertigo in emergency medicine
and
Epley's video
Benign Paroxysmail Positional Vertigo
Pathway Group
This guideline has been signed off on behalf of NHS Devon.
Publication date: March 2016
