Superior (Anterior) Canal BPPV

by Dr. Christopher Chang, last modified on 4/13/21

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 Vertical Nystagmus...

When the Dix-Hallpike is performed and a patient exhibits a vertical nystagmus that weakens with repeated maneuvers, the patient most likely is suffering from superior (or anterior) canal BPPV. Patients with superior canal BPPV are usually very dizzy when their head moves in "yes" motion such as bending head up to look at the ceiling or sky. This is very different than posterior canal BPPV where one is typically dizzy when turning the head to look over the shoulder or rolling over in bed.

With superior canal BPPV, it does not really matter knowing which side is the "bad" ear because treatment is the same regardless of whether the bad ear is on the right or left side.

Treatment is the Deep Head-Hanging maneuver. Watch the video below that demonstrates this maneuver for a patient with superior canal BPPV.

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