Posterior Canal BPPV
by Dr. Christopher Chang, last modified on
DISCLAIMER: We do NOT consider ourselves "dizzy" experts, but provide the following info as a service to patients. Incorrect self-diagnosis is a risk that may lead to injury and further balance problems. Use of the following information is only meant as an educational tool. Please see your doctor to be formally diagnosed and treated. Please keep in mind that this flowchart is a general guide and that there are subtleties that are not addressed here.
If Dix-Hallpike Produces Torsional Nystagmus...
When the Dix-Hallpike is performed and a patient exhibits a torsional nystagmus that weakens with repeated maneuvers, the patient most likely is suffering from posterior canal BPPV. Posterior canal BPPV is the most common type of BPPV accounting for over 80% of all BPPV dizziness.
The affected ear is the side that the head is turned to that causes the nystagmus to occur. For example, when the Dix-Hallpike is performed such that the head is turned over the right shoulder and nystagmus is seen, the patient is suffering from a RIGHT ear posterior canal BPPV.
Treatment is the Epley maneuver. Watch the video below that demonstrates the Epley maneuver for a patient whose right ear is affected. (For patients in which the left ear is affected, the Epley is performed the opposite direction with the head first turned to the left.) Alternative maneuvers to the Epley are the Foster Half-Somersault as well as the Semont maneuver also shown below.
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