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Benign Paroxysmal Positional Vertigo

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Page 16 of 21

17 Figure 8. Algorithm Patient with History/Symptoms Consistent with BPPV Differentiate BPPV from other causes of vertigo Perform Dix- Hallpike maneuver for posterior canal BPPV KAS1A EXIT GUIDELINE NO Characteristic direction changing nystagmus KAS2A YES Torsional, up-beating nystagmus? YES KAS3A Still consistent with BPPV Not Consistent with BPPV Perform supine roll test for lateral canal BPPV KAS1B Do NOT obtain radiographic imaging NO EXIT GUIDELINE Do NOT order vestibular testing Do NOT routinely prescribe medications Educate patients regarding safety, disease recurrence and follow-up Assess for modifying factors KAS3B KAS6 KAS8 KAS2B Do NOT prescribe post-CRP postural restrictions Perform CRP based on type of BPPV Contraindication to CRP or patient refusal NO KAS7A KAS4A YES Offer observation or vestibular rehabilitation Symptoms still present at one (1) month YES Re-evaluate or refer for unresolved BPPV or other causes NO EXIT GUIDELINE Reassess for treatment response at one (1) month KAS7B KAS4C or 5 KAS4B

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