Benign paroxysmal positional vertigo is a frequent vestibular disorder that can occur at different ages but is particularly common among older adults. Patients typically report short episodes of spinning sensations when turning in bed, looking upward, bending forward, or changing head position. These symptoms may lead to nausea, impaired balance, fear of falling, and limitations in everyday activities. Diagnosis can be complicated by atypical clinical presentations, coexisting vestibular disorders, cervical spine limitations, and failure to perform appropriate positional tests. In addition, the recurrence of symptoms may require repeated evaluation and treatment. Optimizing the diagnostic pathway and applying evidence-based repositioning maneuvers are therefore essential for improving clinical outcomes and reducing the burden of unnecessary investigations and prolonged pharmacological treatment.
To evaluate an optimized diagnostic and rehabilitation approach for patients with benign paroxysmal positional vertigo, focusing on accurate identification of the affected semicircular canal, selection of appropriate repositioning maneuvers, and assessment of treatment outcomes.
A clinical assessment framework may include patients presenting with positional vertigo and suspected BPPV. The initial evaluation should document symptom onset, duration, provoking movements, associated nausea, previous episodes, medication use, and relevant neurological or otological history. The Dix–Hallpike test is recommended for suspected posterior-canal BPPV, while the supine roll test is used to assess suspected horizontal-canal involvement. Nystagmus direction, latency, duration, and fatigability should be documented where observable. Treatment should be selected according to the affected canal: the Epley or Semont maneuver may be used for posterior-canal BPPV, while appropriate horizontal-canal repositioning maneuvers should be selected according to the specific nystagmus pattern and canalithiasis or cupulolithiasis presentation. Treatment response can be assessed through symptom resolution, repeat positional testing when indicated, balance assessment, and validated questionnaires such as the Dizziness Handicap Inventory. Patients with persistent, atypical, or neurological symptoms should undergo further evaluation for alternative diagnoses. Follow-up should document recurrence, residual dizziness, functional recovery, and the need for additional maneuvers.
An optimized diagnostic pathway is expected to improve recognition of the affected semicircular canal and support selection of the most appropriate repositioning maneuver. Positional testing provides clinically valuable information that can distinguish typical BPPV from other causes of dizziness. Canalith repositioning maneuvers are the principal treatment for canalithiasis and can produce substantial symptom improvement when correctly selected and performed. Some patients may nevertheless experience residual dizziness, imbalance, or recurrent episodes after successful treatment. In these cases, reassessment of vestibular function, evaluation for coexisting conditions, and individualized balance or vestibular rehabilitation may be beneficial. Routine vestibular-suppressant medication does not correct the underlying mechanical problem and should not replace repositioning maneuvers. As this thesis presents a clinical assessment framework rather than original patient data, quantitative treatment effects require confirmation in a prospective clinical study.
Optimization of BPPV management requires accurate history-taking, appropriate positional testing, identification of the affected semicircular canal, and timely application of evidence-based repositioning maneuvers. Follow-up assessment is important for detecting persistent symptoms, residual imbalance, and recurrence. Individualized vestibular rehabilitation may be considered when residual dizziness or balance impairment remains after successful repositioning. A structured diagnostic and treatment pathway can improve the consistency of clinical care, reduce unnecessary investigations, and support faster functional recovery. Further prospective studies are needed to compare standardized diagnostic and rehabilitation protocols and determine their effects on symptom resolution, recurrence, and quality of life.
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