Current knowledge in the diagnostics and treatment of benign paroxysmal positional vertigo

Benign Paroxysmal Positional Vertigo (BPPV) is the most common disorder of the peripheral part of the balance system. BPPV is caused by fragments of damaged utricular otolithic membrane which, when displaced into the membranous semicircular canals, or stuck to the cupula, are responsible for incorrect cupula movements due to gravity forces when the position of the head is being changed. The principles of diagnosis and treatment are focused on BPPV with canal pathology localized within the posterior semicircular canal; however, BPPV may also be due to a lateral and, less commonly, an anterior canal pathology which requires different diagnostic methods and treatment. The clinical presentation of BPPV may also be distorted due to its coexistence with other diseases of the balance system; this, however, does not exclude the treatment being targeted at BPPV. The treatment of BPPV is based on reposition maneuvers, selected and correctly applied in accordance to the canal location, so as to relocate otolithic debris back to the utriculus. As a complementary treatment of BPPV, vestibular rehabilitation, psychology support and rarely surgery are taken into consideration. Although the immediate efficacy of BPPV treatment is high, recurrences may occur quite often. BPPV may also be a self-limiting disease, making it difficult to evaluate the efficacy of treatment. The key issues in clinical practice include the correct criteria of BPPV definition, the extent of diagnostic methods required, and appropriate selection of treatment methods. The paper presents a review of current recommendations in this matter.