Benign Paroxysmal Positional Vertigo.

Purpose of Chapter: This chapter discusses the recent progress made in understanding the pathophysiology, diagnosis, and treatment of benign paroxysmal positional vertigo (BPPV). Recent Findings: Recent evidence supports the canalolithiasis model as the pathophysiological mechanism and predominant subtype of BPPV. Scanning electron micrographs of extracted posterior semicircular canal contents show free-floating otoconia of utricular origin. Calcium homeostasis has also been shown to contribute to the pathogenesis of the disorder by creating an environment in which otoconia are more prone to dislodging from their native gelatinous substrate. Recent findings have served to identify variant-specific provocative tests with the greatest diagnostic utility while simultaneously maximizing their diagnostic yield. Current data have also helped elucidate the efficacy of repositioning maneuvers and surgical interventions. Summary: BPPV is a disease of altered endolymph and cupular mechanics secondary to dislodged otoconia. It is amenable to particle repositioning maneuvers in most instances or surgical occlusion for intractable cases.