4
Key Points
Table 2. Summary of Key Action Statements (KAS)
Statement Action Grade
1a. Diagnosis of
posterior canal
BPPV
Clinicians should diagnose posterior semicircular
canal BPPV when vertigo associated with torsional,
up-beating nystagmus is provoked by the Dix-
Hallpike maneuver, performed by bringing the
patient from an upright to supine position with the
head turned 45º to one side and neck extended 20º
with the affected ear down. e maneuver should
be repeated with the opposite ear down if the initial
maneuver is negative.
S-B
1b. Diagnosis
of lateral
(horizontal) canal
BPPV
If the patient has a history compatible with BPPV
and the Dix-Hallpike test exhibits horizontal or no
nystagmus, the clinician should perform, or refer to a
clinician who can perform, a supine roll test to assess
for lateral semicircular canal BPPV.
R-B
2a. Differential
diagnosis
Clinicians should differentiate, or refer to a clinician
who can differentiate, BPPV from other causes of
imbalance, dizziness, and vertigo.
R-C
2b. Modifying factors Clinicians should assess patients with BPPV
for factors that modify management, including
impaired mobility or balance, central nervous system
disorders, a lack of home support, and/or increased
risk for falling.
R-C
3a. Radiographic
testing
Clinicians should NOT obtain radiographic imaging
in a patient who meets diagnostic criteria for BPPV
in the absence of additional signs and/or symptoms
inconsistent with BPPV that warrant imaging.
R-C
(against)
3b. Vestibular testing Clinicians should NOT order vestibular testing in
a patient who meets diagnostic criteria for BPPV
in the absence of additional vestibular signs and/
or symptoms inconsistent with BPPV that warrant
testing.
R-C
(against)
4a. Repositioning
procedures as
initial therapy
Clinicians should treat, or refer to a clinician who
can treat, patients with posterior canal BPPV with a
canalith repositioning procedure.
S-A
4b. Postprocedural
restrictions
Clinicians should NOT recommend postprocedural
postural restrictions aer canalith repositioning
procedure for posterior canal BPPV.
S-A
(against)
4c. Observation as
initial therapy
Clinicians may offer observation with follow-up as
initial management for patients with BPPV.
O-B
