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
