517:. There is a direct link between the kind of nystagmus and which of the three semicircular canals is affected. With horizontal nystagmus (left-right eye movement) the horizontal (also called lateral) canal is affected, with vertical nystagmus (up-down eye movement) the superior (also called anterior) canal is affected, and with diagonal nystagmus (diagonal or rotational eye movement) the posterior canal is affected. Diagonal eye movement is easily confused with horizontal movement. This is important since it might result in selecting a wrong and thus ineffective cure maneuver.
974:(scopolamine), respectively. The medical management of vestibular syndromes has become increasingly popular over the last decade, and numerous novel drug therapies (including existing drugs with new indications) have emerged for the treatment of vertigo/dizziness syndromes. These drugs vary considerably in their mechanisms of action, with many of them being receptor- or ion channel-specific. Among them are
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examiner then quickly rotates the head 90° to the right side and checks again for vertigo and nystagmus. In this roll test, the person may experience vertigo and nystagmus on both sides, but rotating toward the affected side will trigger a more intense vertigo. Similarly, when the head is rotated toward the affected side, the nystagmus will beat toward the ground and be more intense.
908:
following step, the patient remains lying but lifts their head with the chin close to the chest. In the last step, the patient sits upright with the head in the normal position. Before going to the next step, one has to wait until the nystagmus fully resides ( typical 30 to 60 seconds ) and progression from one step to the next has to happen in a fluid movement.
891:, resulting in horizontal nystagmus, the Lempert maneuver has been used for productive results. It is unusual for the lateral canal to respond to the canalith repositioning procedure used for the posterior canal BPPV. Treatment is therefore geared toward moving the canalith from the lateral canal into the vestibule.
827:); rather it changes their location. The maneuvers aim to move these particles from some locations in the inner ear that cause symptoms such as vertigo and reposition them to where they do not cause these problems. These maneuvers are easily performed at home and online resources are available to patients.
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may also be of value. These drug therapies offer symptomatic treatment, and do not affect the disease process or resolution rate. Medications may be used to suppress symptoms during the positioning maneuvers if the person's symptoms are severe and intolerable. More dose-specific studies are required,
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who begins seated at the head of the examination table with the person supine. There are four stages, each a minute apart, and at the third position the horizontal canal is oriented in a vertical position with the person's neck flexed and on forearm and elbows. When all four stages are completed, the
834:
Using the appropriate maneuver for the affected canal is essential. The maneuvers may be uncomfortable for the patient as they might induce strong vertigo and the patient might then resist performing them. Though some treatments, such as the Epley, are much more uncomfortable than others, such as the
830:
The Epley maneuver is popular because it is designed to address posterior canal BPPV (PC-BPPV), which is caused by particles in the posterior semicircular canal, the most common cause of BPPV. This might give the wrong impression that PC-BPPV is the only kind of BPPV. Misdiagnosing which semicircular
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or the roll test, or both. The patient can also be asked to induce vertigo by performing a movement that the patient knows to induce vertigo. The eyes of the patient can then easily be observed for which kind (horizontal, vertical, or diagonal) of nystagmus is present, to determine which semicircular
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Many people will report a history of vertigo as a result of fast head movements. Many are also capable of describing the exact head movements that provoke their vertigo. Purely horizontal nystagmus and symptoms of vertigo lasting more than one minute can also indicate BPPV occurring in the horizontal
275:
When untreated, it might resolve in days to months; however, it may recur in some people. One can needlessly suffer from BPPV for years despite there being a simple and very effective cure. Short-term self-resolution of BPPV is unlikely because the effective cure maneuvers induce strong vertigo which
944:
The Brandt–Daroff exercises may be prescribed by the clinician as a home treatment method, usually in conjunction with particle-repositioning maneuvers or in lieu of the particle-repositioning maneuver. The exercise is a form of habituation exercise, designed to allow the person to become accustomed
878:
The Half
Somersault Maneuver (HSM) is a patient-performed alternative to the Epley for posterior canal BPPV (PC-BPPV). Like the Epley, it uses gravity to move the calcium crystal build-up from the posterior semicircular canal that causes the condition. Compared to the Epley, HSM has better long-term
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All the maneuvers consist of a series of steps in which the head is held in a specific position, typically for 30 to 60 seconds until any nystagmus stops. Movement from one position to the position of the next step has to be done fluently to give the particles enough momentum to move. A position has
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is involved. The roll test requires the person to be in a supine position with their head in 30° of cervical flexion. Then the examiner quickly rotates the head 90° to the left side, and checks for vertigo and nystagmus. This is followed by gently bringing the head back to the starting position. The
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The spinning sensation experienced from BPPV is usually triggered by movement of the head, will have a sudden onset, and can last anywhere from a few seconds to several minutes. The most common movements people report triggering a spinning sensation are tilting their heads upward in order to look at
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their head extending off the examination table, such as with Dix–Hallpike. The head is rotated 45 degrees away from the side being tested, and the eyes are examined for nystagmus. A positive test is indicated by the patient report of a reproduction of vertigo and clinician observation of nystagmus.
949:
symptoms. The Brandt–Daroff exercises are performed in a similar fashion to the Semont maneuver; however, as the person rolls onto the unaffected side, the head is rotated toward the affected side. The exercise is typically performed 3 times a day with 5–10 repetitions each time, until symptoms of
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crystal build-up from the posterior semicircular canal (resulting in diagonal nystagmus) that causes the condition. This maneuver can be performed during a clinic visit by health professionals, or taught to people to perform at home, or both. Postural restriction after the Epley maneuver increases
746:
Although rare, disorders of the central nervous system can sometimes present as BPPV. A practitioner should be aware that if a person whose symptoms are consistent with BPPV, but does not show improvement or resolution after undergoing different particle repositioning maneuvers — detailed in the
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As mentioned above, both the Dix–Hallpike and roll test provoke the signs and symptoms in subjects with archetypal BPPV. The signs and symptoms people with BPPV experience are typically a short-lived vertigo and observed nystagmus. In some people, although rarely, vertigo can persist for years.
42:
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For the superior (also called anterior) semicircular canal, resulting in vertical nystagmus, the Deep head hanging maneuver is used. The patient lays down on their back on a bed with their head overhanging the bed. In the first step the head is turned as backward (hanging) as possible. In the
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The crystals may dislodge from the utricle (an otolith organ) and settle within the semicircular canals. When there is motion, the displaced otoconia shift within the endolymph of semicircular canals, causing an unbalanced (with respect to the opposite ear) stimulus, causing symptoms of BPPV.
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Surgical treatments, such as a semi-circular canal occlusion, exist for severe and persistent cases that fail vestibular rehabilitation (including particle repositioning and habituation therapy). As they carry the same risks as any neurosurgical procedure, they are reserved as last resorts.
416:—a diagnostic symptom where the top of the eye rotates toward the affected ear in a beating or twitching fashion, which has a latency and can be fatigued (vertigo should lessen with deliberate repetition of the provoking maneuver): nystagmus should only last for 30 seconds to one minute
927:
The person is then quickly moved so they are lying on the unaffected side with their head in the same position (now facing downward 45 degrees). This position is also held for 3 minutes. The purpose of this position is to allow the debris to move toward the exit of the semicircular
687:. Such people include those who are too anxious about eliciting the uncomfortable symptoms of vertigo, and those who may not have the range of motion necessary to comfortably be in a supine position. The modification involves the person moving from a seated position to side-lying
923:
The therapist then quickly tilts the person so they are lying on the affected side. The head position is maintained, so their head is turned up 45 degrees. This position is maintained for 3 minutes. The purpose is to allow the debris to move to the apex of the semicircular
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is most commonly affected due to its anatomical position). When the head is reoriented relative to gravity, the gravity-dependent movement of the heavier otoconial debris (colloquially "ear rocks") within the affected semicircular canal causes abnormal (pathological)
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Although BPPV can occur at any age, it is most often seen in people older than the age of 60. Besides aging, there are no major risk factors known for BPPV, although previous episodes of head trauma, preexisting disorders, or the inner ear infection
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When practiced at home, the Epley maneuver is more effective than the Semont maneuver. An effective repositioning treatment for posterior canal BPPV is the therapist-performed Epley combined with home-practiced Epley maneuvers. Devices such as the
2826:
Kaya I, Eraslan S, Tarhan C, Bilgen C, Kirazli T, Gokcay F, et al. (September 2019). "Can verapamil be effective in controlling vertigo and headache attacks in vestibular migraine accompanied with
Meniere's disease? A preliminary study".
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Some people will only need one treatment, but others may need multiple treatments, depending on the severity of their BPPV. In the Semont maneuver, as with the Epley maneuver, people are able to achieve canalith repositioning by themselves.
524:, rendering it heavier than the surrounding endolymph. Upon reorientation of the head relative to gravity, the cupula is weighted down by the dense particles, thereby inducing an immediate and sustained excitation of semicircular canal
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The Dix–Hallpike test is a common test performed by examiners to determine whether the posterior semicircular canal is involved. It involves a reorientation of the head to align the posterior semicircular canal (at its entrance to the
283:. Approximately 2.4% of people are affected at some point in time. Among those who live until their 80s, 10% have been affected. BPPV affects females twice as often as males. Onset is typically in people between the ages of 50 and 70.
1747:
Sammartino G, Mariniello M, Scaravilli MS (June 2011). "Benign paroxysmal positional vertigo following closed sinus floor elevation procedure: mallet osteotomes vs. screwable osteotomes. A triple blind randomized controlled trial".
820:. Both the Epley and the Semont maneuvers are equally effective. The HSM can have better long-term success than the Epley, is more comfortable to experience, and has less risk of causing subsequent horizontal canal BPPV (H-BPPV).
200:
with movement, characterized by a spinning sensation upon changes in the position of the head. This can occur with turning in bed or changing position. Each episode of vertigo typically lasts less than one minute.
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canal is affected, typically by confusing horizontal and diagonal nystagmus, or simply ignoring the identification of the affected canal, and then using the wrong treatment maneuver, regularly results in no cure.
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may help with vertigo, but its use is not generally needed. BPPV is not a serious medical condition, but may present serious risks of injury through falling or other spatial disorientation-induced accidents.
251:(in case of diagonal/rotational nystagmus), the Lempert maneuver (in case of horizontal nystagmus), the deep head hanging maneuver (in case of vertical nystagmus) or sometimes the less effective
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Chen Y, Zhuang J, Zhang L, Li Y, Jin Z, Zhao Z, et al. (September 2012). "Short-term efficacy of Semont maneuver for benign paroxysmal positional vertigo: a double-blind randomized trial".
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Finally, the person is slowly brought back to an upright seated position. The debris should then fall into the utricle of the canal and the symptoms of vertigo should decrease or end completely.
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Rotatory/torsional component is present, or (in the case of lateral canal involvement) the nystagmus beats in either a geotropic (toward the ground) or ageotropic (away from the ground) fashion
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The roll maneuver or its variations are used, and involve rolling the person 360 degrees in a series of steps to reposition the particles. This maneuver is generally performed by a trained
762:, accounts for about six million clinic visits in the United States every year; between 17 and 42% of these people are eventually diagnosed with BPPV. Other causes of vertigo include:
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Both the Dix–Hallpike and the side-lying testing position have yielded similar results, and as such the side-lying position can be used if the Dix–Hallpike cannot be performed easily.
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Medical treatment with anti-vertigo medications may be considered in acute, severe exacerbation of BPPV, but in most cases are not indicated. These primarily include drugs of the
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The person is seated on a treatment table with their legs hanging off the side of the table. The therapist then turns the person's head 45 degrees toward the unaffected side.
683:, with the neck extended by the person performing the maneuver. For some people, this maneuver may not be indicated, and a modification may be needed that also targets the
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The most significant symptom is nystagmus as it is essential to determine the kind of nystagmus ( horizontal, vertical, or diagonal ) to select the correct cure maneuver.
2146:
Foster CA, Ponnapan A, Zaccaro K, Strong D (December 2012). "A comparison of two home exercises for benign positional vertigo: Half somersault versus Epley
Maneuver".
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Bhattacharyya N, Baugh RF, Orvidas L, Barrs D, Bronston LJ, Cass S, et al. (November 2008). "Clinical practice guideline: benign paroxysmal positional vertigo".
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or simply occur among those who are older. Often, a specific cause is not identified. When found, the underlying mechanism typically involves a small calcified
639:, which contain fluids and fine hairlike sensors that act as a monitor to the rotations of the head. Other important structures in the inner ear includes the
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HSM. If the maneuver is not uncomfortable then it is possible the wrong maneuver has been selected by a misdiagnosis of the affected semicircular canal.
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to be held until any nystagmus has completely resided, which indicates that the particles have stopped moving, before one proceeds to the next step.
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551:, transmits percussive and vibratory forces capable of detaching otoliths from their normal location and thereby leading to the symptoms of BPPV.
333:
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Beyea JA, Wong E, Bromwich M, Weston WW, Fung K (January 2008). "Evaluation of a particle repositioning maneuver Web-based teaching module".
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Treatment section below — need to have a detailed neurological assessment and imaging performed to help identify the pathological condition.
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Korres SG, Balatsouras DG (October 2004). "Diagnostic, pathophysiologic, and therapeutic aspects of benign paroxysmal positional vertigo".
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2210:"The Efficacy of the Half Somersault Maneuver in Comparison to the Epley Maneuver in Patients with Benign Paroxysmal Positional Vertigo"
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however, in order to determine the most-effective drug(s) for both acute symptom relief and long-term remission of the condition.
2527:"Effectiveness of particle repositioning maneuvers in the treatment of benign paroxysmal positional vertigo: a systematic review"
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is implicated in idiopathic cases. Proposed mechanisms linking the two are genetic factors and vascular damage to the labyrinth.
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2478:"Modifications of the Epley (canalith repositioning) manoeuvre for posterior canal benign paroxysmal positional vertigo (BPPV)"
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The nystagmus associated with BPPV has several important characteristics that differentiate it from other types of nystagmus.
3359:
1915:
Baloh RW, Honrubia V, Jacobson K (March 1987). "Benign positional vertigo: clinical and oculographic features in 240 cases".
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Primary Care ENT, An Issue of
Primary Care: Clinics in Office Practice, Volume 41, Issue 1 of The Clinics: Internal Medicine
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Neuro-Ophthalmology
Virtual Education Library (NOVEL): Daniel Gold Collection. Spencer S. Eccles Health Sciences Library
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2437:"Self-treatment of benign paroxysmal positional vertigo: Semont maneuver vs Epley procedure [with video clips]"
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Repeated stimulation, including via Dix–Hallpike maneuvers, cause the nystagmus to fatigue or disappear temporarily
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organs, the utricle and saccule, that contain calcium carbonate crystals(otoconia) that are sensitive to gravity.
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217:
137:
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Huppert D, Strupp M, MĂĽckter H, Brandt T (March 2011). "Which medication do I need to manage dizzy patients?".
2688:"Benign Paroxysmal Positional Vertigo (BPPV): History, Pathophysiology, Office Treatment and Future Directions"
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236:(a specific movement pattern of the eyes) and other possible causes have been ruled out. In typical cases,
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Cohen HS (March 2004). "Side-lying as an alternative to the Dix-Hallpike test of the posterior canal".
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success, with less discomfort, and less risk of causing subsequent horizontal canal BPPV (H-BPPV).
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BPPV can be triggered by any action that stimulates the posterior semi-circular canal including:
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can help users conduct the Epley maneuver at home, and are available for the treatment of BPPV.
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Radtke A, von
Brevern M, Tiel-Wilck K, Mainz-Perchalla A, Neuhauser H, Lempert T (July 2004).
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816:, the Half Somersault Maneuver (HSM), the Semont maneuver, and to a lesser degree the non-CRP
769:/motion intolerance: a disjunction between visual stimulation, vestibular stimulation, and/or
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588:
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62:
2334:"Self-Treatment of Posterior Canal Benign Paroxysmal Positional Vertigo: A Preliminary Study"
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BPPV is one of the most common vestibular disorders in people presenting with dizziness; a
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237:
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Hall SF, Ruby RR, McClure JA (April 1979). "The mechanics of benign paroxysmal vertigo".
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465:. If those symptoms are present, a more serious etiology, such as posterior circulation
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von
Brevern M, Seelig T, Radtke A, Tiel-Wilck K, Neuhauser H, Lempert T (August 2006).
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1293:"The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo"
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492:. In people with BPPV, the otoconia are dislodged from their usual position within the
445:—is common, depending on the strength of vertigo itself and the causes for this illness
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BPPV may be made worse by any number of modifiers which may vary among individuals:
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1135:"ENT doctors release national guideline on treatment for common cause of dizziness"
400:—appears suddenly, and in episodes of short duration: lasts only seconds to minutes
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1785:"Benign paroxysmal positional vertigo as a complication of sinus floor elevation"
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Neuro-Ophthalmology
Virtual Education Library (NOVEL): Daniel Gold Collection
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1958:
Palmeri R, Kumar A (December 2022). "Benign
Paroxysmal Positional Vertigo".
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2385:"Short-term efficacy of Epley's manoeuvre: a double-blind randomised trial"
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An episode of BPPV may be triggered by dehydration, such as that caused by
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moving around loose in the inner ear. Diagnosis is typically made when the
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1936:
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The Semont maneuver has a cure rate of 90.3%. It is performed as follows:
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Latency of onset: there is a 5–10 second delay prior to onset of nystagmus
655:
The condition is diagnosed by the person's history, and by performing the
520:
In rare cases, the crystals themselves can adhere to a semicircular canal
205:
is commonly associated. BPPV is one of the most common causes of vertigo.
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2543:
2526:
1928:
1628:"Diagnosis and management of benign paroxysmal positional vertigo (BPPV)"
1609:
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National
Institute for Deafness and Other Communication Disorders (NIDCD)
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for the treatment of episodic ataxia type 2 and both downbeat and upbeat
1027:
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605:
462:
458:
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Gan Z, Zhou S, Yang H, He F, Wei D, Bai Y, et al. (29 April 2021).
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When performing the Dix–Hallpike test, people are lowered quickly to a
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585:– people may feel increased symptoms up to two days before rain or snow
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People with BPPV do not experience other neurological deficits such as
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321: in this section. Unsourced material may be challenged and removed.
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BPPV is easily treated with a number of simple movements such as the
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The first medical description of the condition occurred in 1921 by
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1573:. PubMed Health, U.S. National Library of Medicine. Archived from
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823:
None of these maneuvers addresses the presence of the particles (
2916:
2611:"New methods for diagnosis and treatment of vestibular diseases"
808:
A number of maneuvers have been found to be effective including
535:
There is evidence in the dental literature that malleting of an
276:
the patient will naturally resist and not accidentally perform.
3006:
2208:
Khaftari MD, Ahadi M, Maarefvand M, Jalaei B (September 2021).
899:
head roll test is repeated, and if negative, treatment ceases.
758:, a distinct process sometimes confused with the broader term,
290:
1702:
Schuknecht HF, Ruby RR (19 October 1973). "Cupulolithiasis".
708:
skilled in the management of dizziness disorders, commonly a
409:—a spinning dizziness, which must have a rotational component
2662:"Horizontal Canal - BPPV: BBQ Roll to treat the right side"
1834:"Epidemiology of vertigo, migraine and vestibular migraine"
733:
Positional: the nystagmus occurs only in certain positions
668:) with the direction of gravity. This test will reproduce
403:
Positional—is induced by a change in position, even slight
631:
The inside of the ear is composed of an organ called the
660:
canal (horizontal, superior, or posterior) is affected.
775:
Visual exposure to nearby moving objects (examples of
2525:
Helminski JO, Zee DS, Janssen I, Hain TC (May 2010).
1537:(6th ed.). Philadelphia, PA: Elsevier Saunders.
1455:"Meclizine Hydrochloride Monograph for Professionals"
433:, making it difficult to read or see during an attack
2863:
2183:"Posterior Canal - BPPV: Epley and Semont maneuvers"
623:, may predispose to the future development of BPPV.
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2389:Journal of Neurology, Neurosurgery, and Psychiatry
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1667:Schuknecht HF (December 1969). "Cupulolithiasis".
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2476:Hunt WT, Zimmermann EF, Hilton MP (April 2012).
2116:. New York: Workman Publishing. pp. 74–75.
1996:. In O'Sullivan SB, Schmitz TJ, Fulk GD (eds.).
1560:
1558:
1404:"Update on benign paroxysmal positional vertigo"
742:Visual fixation suppresses nystagmus due to BPPV
509:fluid displacement and a resultant sensation of
1964:. Treasure Island (FL): StatPearls Publishing.
1461:. American Society of Health-System Pharmacists
1344:NORD (National Organization for Rare Disorders)
496:, and over time, migrate into one of the three
123:after other possible causes have been ruled out
1783:Kim MS, Lee JK, Chang BS, Um HS (April 2010).
1480:Murdin L, Hussain K, Schilder AG (June 2016).
1286:
1284:
1282:
1280:
779:stimuli include passing cars and falling snow)
192:) is a disorder arising from a problem in the
3018:
2214:The Journal of International Advanced Otology
2000:(7th ed.). F.A. Davis. pp. 918–49.
1884:"Benign paroxysmal positional vertigo (BPPV)"
704:Assessment of BPPV is best done by a medical
488:lie collections of calcium crystals known as
8:
1789:Journal of Periodontal & Implant Science
817:
248:
2482:The Cochrane Database of Systematic Reviews
2430:
2428:
2305:
2303:
2189:. Spencer S. Eccles Health Sciences Library
1987:
1985:
1983:
1981:
1979:
1486:The Cochrane Database of Systematic Reviews
1297:The Cochrane Database of Systematic Reviews
950:vertigo have resolved for at least 2 days.
812:Repositioning Procedures (CRP) such as the
3247:
3094:
3051:
3025:
3011:
3003:
2864:
2280:
2278:
1449:
1447:
1334:
1332:
1218:
1216:
1156:
1154:
1152:
1150:
635:. The vestibular labyrinth includes three
196:. Symptoms are repeated, brief periods of
40:
31:
2713:
2703:
2636:
2626:
2542:
2501:
2452:
2408:
2359:
2349:
2233:
2021:
2019:
2017:
1808:
1643:
1565:Zieve D, Schwartz S, eds. (August 2011).
1505:
1427:
1368:
1366:
1364:
1362:
1360:
1312:
1259:. Elsevier Health Sciences. p. 170.
1214:
1212:
1210:
1208:
1206:
1204:
1202:
1200:
1198:
1196:
1167:. Elsevier Health Sciences. p. 115.
1091:
1089:
513:. This more common condition is known as
381:Learn how and when to remove this message
2255:
2253:
1535:Bradley's neurology in clinical practice
1087:
1085:
1083:
1081:
1079:
1077:
1075:
1073:
1071:
1069:
695:The roll test can determine whether the
676:characteristic of posterior canal BPPV.
454:something and when rolling over in bed.
2778:
2776:
2692:International Journal of Otolaryngology
1065:
1551:from the original on 21 December 2016.
1340:"Benign Paroxysmal Positional Vertigo"
1291:Hilton MP, Pinder DK (December 2014).
1273:from the original on 8 September 2017.
330:"Benign paroxysmal positional vertigo"
1832:Lempert T, Neuhauser H (March 2009).
1621:
1619:
1482:"Betahistine for symptoms of vertigo"
429:Visual disturbance—due to associated
7:
3292:Benign paroxysmal positional vertigo
2991:Benign paroxysmal positional vertigo
2609:Hegemann SC, Palla A (August 2010).
2028:Otolaryngology–Head and Neck Surgery
1681:10.1001/archotol.1969.00770030767020
1098:Otolaryngology–Head and Neck Surgery
319:adding citations to reliable sources
186:Benign paroxysmal positional vertigo
35:Benign paroxysmal positional vertigo
18:Benign Paroxysmal Positional Vertigo
1402:Kim HJ, Park J, Kim JS (May 2021).
1181:from the original on 15 August 2016
426:(fainting) is unusual, but possible
267:. There is tentative evidence that
2454:10.1212/01.WNL.0000130250.62842.C9
1896:from the original on 16 April 2014
1882:Mayo Clinic Staff (10 July 2012).
25:
1704:Advances in Oto-Rhino-Laryngology
1234:from the original on 27 July 2016
1141:(Press release). 1 November 2008.
883:Lempert maneuver or Roll maneuver
469:or ischemia, must be considered.
2311:"The Deep Head Hanging Maneuver"
2267:. 27 September 2014 – via
2083:10.1097/00129492-200403000-00008
1762:10.1111/j.1600-0501.2010.01998.x
1026:for the treatment of vestibular
998:for the treatment of paroxysmal
945:to the position that causes the
730:Nystagmus lasts for 5–60 seconds
295:
2292:. 20 November 2014 – via
2148:Audiology and Neurotology Extra
1992:Schubert MC (25 January 2019).
1750:Clinical Oral Implants Research
306:needs additional citations for
2494:10.1002/14651858.CD008675.pub2
1498:10.1002/14651858.CD010696.pub2
1374:"Positional vertigo: Overview"
1305:10.1002/14651858.CD003162.pub3
1:
1961:StatPearls [Internet]
1598:The Journal of Otolaryngology
1571:A.D.A.M. Medical Encyclopedia
697:horizontal semicircular canal
3172:Auditory processing disorder
2797:10.3109/00016489.2010.531052
2751:10.1097/mao.0b013e31826352ca
2580:10.1097/MLG.0b013e31814b290d
2040:10.1016/j.otohns.2004.02.046
1110:10.1016/j.otohns.2008.08.022
685:posterior semicircular canal
109:Older age, minor head injury
1567:"Benign positional vertigo"
853:The Epley maneuver employs
528:. This condition is termed
263:, may be used to help with
179:2.4% affected at some point
99:Episodes less than a minute
3376:
3122:Sensorineural hearing loss
2841:10.1007/s00415-019-09309-w
1669:Archives of Otolaryngology
1420:10.1007/s00415-020-10314-7
903:Deep head hanging maneuver
889:lateral (horizontal) canal
846:
171:Resolves in days to months
3115:Superior canal dehiscence
2739:Otology & Neurotology
2071:Otology & Neurotology
1853:10.1007/s00415-009-0149-2
1801:10.5051/jpis.2010.40.2.86
545:osteotome sinus elevation
255:. Medications, including
48:
39:
2401:10.1136/jnnp.2005.085894
2351:10.3389/fmed.2021.654637
1040:Calcium channel blockers
1024:tricyclic antidepressant
874:Half Somersault Maneuver
249:Half Somersault Maneuver
3335:Vestibulo–ocular reflex
3105:Conductive hearing loss
2835:(Supplement 1): 62–64.
1998:Physical Rehabilitation
940:Brandt–Daroff exercises
818:Brandt–Daroff exercises
804:Repositioning maneuvers
253:Brandt–Daroff exercises
220:. It can result from a
160:Brandt–Daroff exercises
2785:Acta Oto-Laryngologica
2615:F1000 Medicine Reports
2286:"The Lempert Maneuver"
1994:"Vestibular Disorders"
1104:(5 Suppl 4): S47–S81.
751:Differential diagnosis
129:Differential diagnosis
79:Repeated periods of a
3360:Diseases of inner ear
3139:Nonsyndromic deafness
2686:Hornibrook J (2011).
2338:Frontiers in Medicine
2226:10.5152/iao.2021.9072
986:for the treatment of
972:hyoscine butylbromide
862:its effect somewhat.
591:(required amounts of
543:, otherwise known as
541:sinus floor elevation
3302:Labyrinthine fistula
3227:visual reinforcement
3177:Spatial hearing loss
2829:Journal of Neurology
2544:10.2522/ptj.20090071
2261:"The Epley Maneuver"
1929:10.1212/WNL.37.3.371
1841:Journal of Neurology
1408:Journal of Neurology
633:vestibular labyrinth
567:Sudden head movement
490:otoconia or otoliths
450:semicircular canal.
439:—is often associated
422:—(feeling faint) or
315:improve this article
3066:Excessive response
2705:10.1155/2011/835671
2112:Buchholz D (2002).
1224:"Balance Disorders"
706:health professional
637:semicircular canals
583:barometric pressure
570:Rolling over in bed
498:semicircular canals
146:vestibular migraine
91:Age from 50s to 70s
68:Otorhinolaryngology
2949:External resources
2114:Heal Your Headache
1577:on 26 October 2013
1529:Daroff RB (2012).
1230:. 10 August 2015.
1161:Dickson G (2014).
1008:multiple sclerosis
558:Looking up or down
287:Signs and symptoms
208:BPPV is a type of
81:spinning sensation
3347:
3346:
3343:
3342:
3320:Dix–Hallpike test
3287:Ménière's disease
3237:
3236:
3185:
3184:
3132:Cortical deafness
3000:
2999:
2160:10.1159/000337947
2123:978-0-7611-2566-2
2007:978-0-8036-9464-4
1725:978-3-8055-1338-8
1716:10.1159/000393114
1544:978-1-4557-2807-7
1380:. 30 January 2014
1266:978-0-323-44838-3
1253:Ferri FF (2016).
1174:978-0-323-28717-3
988:Ménière's disease
788:Ménière's disease
782:Other diseases: (
657:Dix–Hallpike test
391:
390:
383:
365:
230:Dix–Hallpike test
218:Ménière's disease
183:
182:
138:Ménière's disease
121:Dix–Hallpike test
115:Diagnostic method
29:Medical condition
16:(Redirected from
3367:
3325:Unterberger test
3279:Balance disorder
3248:
3160:Wolfram syndrome
3095:
3052:
3027:
3020:
3013:
3004:
2865:
2853:
2852:
2823:
2817:
2816:
2780:
2771:
2770:
2745:(7): 1127–1130.
2734:
2728:
2727:
2717:
2707:
2683:
2677:
2676:
2674:
2672:
2657:
2651:
2650:
2640:
2630:
2606:
2600:
2599:
2568:The Laryngoscope
2563:
2557:
2556:
2546:
2531:Physical Therapy
2522:
2516:
2515:
2505:
2473:
2467:
2466:
2456:
2432:
2423:
2422:
2412:
2380:
2374:
2373:
2363:
2353:
2329:
2323:
2322:
2307:
2298:
2297:
2282:
2273:
2272:
2257:
2248:
2247:
2237:
2205:
2199:
2198:
2196:
2194:
2178:
2172:
2171:
2143:
2128:
2127:
2109:
2103:
2102:
2066:
2060:
2059:
2023:
2012:
2011:
1989:
1974:
1973:
1955:
1949:
1948:
1912:
1906:
1905:
1903:
1901:
1879:
1873:
1872:
1838:
1829:
1823:
1822:
1812:
1780:
1774:
1773:
1744:
1738:
1737:
1699:
1693:
1692:
1664:
1658:
1657:
1647:
1623:
1614:
1613:
1593:
1587:
1586:
1584:
1582:
1562:
1553:
1552:
1526:
1520:
1519:
1509:
1477:
1471:
1470:
1468:
1466:
1451:
1442:
1441:
1431:
1414:(5): 1995–2000.
1399:
1390:
1389:
1387:
1385:
1370:
1355:
1354:
1352:
1350:
1336:
1327:
1326:
1316:
1299:(12): CD003162.
1288:
1275:
1274:
1250:
1244:
1243:
1241:
1239:
1220:
1191:
1190:
1188:
1186:
1158:
1145:
1142:
1132:Lay summary in:
1129:
1093:
595:may vary widely)
573:Tilting the head
386:
379:
375:
372:
366:
364:
323:
299:
291:
210:balance disorder
44:
32:
21:
3375:
3374:
3370:
3369:
3368:
3366:
3365:
3364:
3350:
3349:
3348:
3339:
3308:
3267:
3233:
3207:Tone decay test
3181:
3143:
3086:
3041:
3031:
3001:
2996:
2995:
2944:
2943:
2876:
2862:
2857:
2856:
2825:
2824:
2820:
2782:
2781:
2774:
2736:
2735:
2731:
2685:
2684:
2680:
2670:
2668:
2659:
2658:
2654:
2608:
2607:
2603:
2565:
2564:
2560:
2524:
2523:
2519:
2488:(4): CD008675.
2475:
2474:
2470:
2434:
2433:
2426:
2382:
2381:
2377:
2331:
2330:
2326:
2309:
2308:
2301:
2284:
2283:
2276:
2259:
2258:
2251:
2207:
2206:
2202:
2192:
2190:
2180:
2179:
2175:
2145:
2144:
2131:
2124:
2111:
2110:
2106:
2068:
2067:
2063:
2025:
2024:
2015:
2008:
1991:
1990:
1977:
1957:
1956:
1952:
1914:
1913:
1909:
1899:
1897:
1881:
1880:
1876:
1836:
1831:
1830:
1826:
1782:
1781:
1777:
1746:
1745:
1741:
1726:
1701:
1700:
1696:
1666:
1665:
1661:
1625:
1624:
1617:
1595:
1594:
1590:
1580:
1578:
1564:
1563:
1556:
1545:
1528:
1527:
1523:
1492:(6): CD010696.
1479:
1478:
1474:
1464:
1462:
1453:
1452:
1445:
1401:
1400:
1393:
1383:
1381:
1372:
1371:
1358:
1348:
1346:
1338:
1337:
1330:
1290:
1289:
1278:
1267:
1252:
1251:
1247:
1237:
1235:
1222:
1221:
1194:
1184:
1182:
1175:
1160:
1159:
1148:
1133:
1095:
1094:
1067:
1062:
1053:
1032:4-aminopyridine
966:class, such as
964:anticholinergic
956:
942:
914:
912:Semont maneuver
905:
885:
876:
851:
845:
806:
801:
767:Motion sickness
753:
710:physiotherapist
681:supine position
653:
629:
530:cupulolithiasis
526:afferent nerves
502:posterior canal
478:
387:
376:
370:
367:
324:
322:
312:
300:
289:
240:is not needed.
238:medical imaging
30:
23:
22:
15:
12:
11:
5:
3373:
3371:
3363:
3362:
3352:
3351:
3345:
3344:
3341:
3340:
3338:
3337:
3332:
3330:Romberg's test
3327:
3322:
3316:
3314:
3310:
3309:
3307:
3306:
3305:
3304:
3299:
3294:
3289:
3281:
3275:
3273:
3269:
3268:
3266:
3265:
3260:
3254:
3252:
3245:
3239:
3238:
3235:
3234:
3232:
3231:
3230:
3229:
3224:
3214:
3209:
3204:
3199:
3193:
3191:
3187:
3186:
3183:
3182:
3180:
3179:
3174:
3169:
3168:
3167:
3165:Usher syndrome
3162:
3151:
3149:
3145:
3144:
3142:
3141:
3136:
3135:
3134:
3129:
3119:
3118:
3117:
3112:
3101:
3099:
3092:
3088:
3087:
3085:
3084:
3083:
3082:
3077:
3072:
3064:
3058:
3056:
3049:
3043:
3042:
3032:
3030:
3029:
3022:
3015:
3007:
2998:
2997:
2994:
2993:
2982:
2965:
2953:
2952:
2950:
2946:
2945:
2942:
2941:
2930:
2919:
2908:
2893:
2877:
2872:
2871:
2869:
2868:Classification
2861:
2860:External links
2858:
2855:
2854:
2818:
2791:(3): 228–241.
2772:
2729:
2678:
2652:
2601:
2574:(1): 175–180.
2558:
2537:(5): 663–678.
2517:
2468:
2447:(1): 150–152.
2424:
2395:(8): 980–982.
2375:
2324:
2299:
2274:
2249:
2220:(5): 417–421.
2200:
2173:
2129:
2122:
2104:
2077:(2): 130–134.
2061:
2034:(4): 438–444.
2013:
2006:
1975:
1950:
1923:(3): 371–378.
1907:
1874:
1847:(3): 333–338.
1824:
1775:
1756:(6): 669–672.
1739:
1724:
1694:
1675:(6): 765–778.
1659:
1638:(7): 681–693.
1615:
1604:(2): 151–158.
1588:
1554:
1543:
1521:
1472:
1443:
1391:
1356:
1328:
1276:
1265:
1245:
1192:
1173:
1146:
1144:
1143:
1139:EurekAlert.org
1064:
1063:
1061:
1058:
1052:
1049:
955:
952:
941:
938:
933:
932:
929:
925:
921:
913:
910:
904:
901:
884:
881:
875:
872:
849:Epley maneuver
847:Main article:
844:
843:Epley maneuver
841:
814:Epley maneuver
805:
802:
800:
797:
796:
795:
780:
773:
771:proprioception
752:
749:
744:
743:
740:
737:
734:
731:
728:
652:
649:
628:
625:
602:
601:
596:
586:
575:
574:
571:
568:
565:
559:
539:during closed
477:
474:
447:
446:
440:
434:
427:
417:
410:
404:
401:
389:
388:
303:
301:
294:
288:
285:
257:antihistamines
245:Epley maneuver
181:
180:
177:
173:
172:
169:
163:
162:
156:Epley maneuver
153:
149:
148:
131:
125:
124:
117:
111:
110:
107:
101:
100:
97:
93:
92:
89:
85:
84:
77:
71:
70:
65:
59:
58:
46:
45:
37:
36:
28:
24:
14:
13:
10:
9:
6:
4:
3:
2:
3372:
3361:
3358:
3357:
3355:
3336:
3333:
3331:
3328:
3326:
3323:
3321:
3318:
3317:
3315:
3311:
3303:
3300:
3298:
3297:Labyrinthitis
3295:
3293:
3290:
3288:
3285:
3284:
3282:
3280:
3277:
3276:
3274:
3270:
3264:
3261:
3259:
3256:
3255:
3253:
3249:
3246:
3244:
3240:
3228:
3225:
3223:
3220:
3219:
3218:
3215:
3213:
3210:
3208:
3205:
3203:
3200:
3198:
3195:
3194:
3192:
3188:
3178:
3175:
3173:
3170:
3166:
3163:
3161:
3158:
3157:
3156:
3155:Deafblindness
3153:
3152:
3150:
3146:
3140:
3137:
3133:
3130:
3128:
3125:
3124:
3123:
3120:
3116:
3113:
3111:
3108:
3107:
3106:
3103:
3102:
3100:
3096:
3093:
3089:
3081:
3078:
3076:
3073:
3071:
3068:
3067:
3065:
3063:
3060:
3059:
3057:
3053:
3050:
3048:
3044:
3040:
3036:
3033:Disorders of
3028:
3023:
3021:
3016:
3014:
3009:
3008:
3005:
2992:
2988:
2987:
2983:
2981:
2978:
2975:
2971:
2970:
2966:
2964:
2960:
2959:
2955:
2954:
2951:
2947:
2940:
2936:
2935:
2931:
2929:
2925:
2924:
2920:
2918:
2914:
2913:
2909:
2907:
2903:
2902:
2898:
2894:
2892:
2888:
2887:
2883:
2879:
2878:
2875:
2870:
2866:
2859:
2850:
2846:
2842:
2838:
2834:
2830:
2822:
2819:
2814:
2810:
2806:
2802:
2798:
2794:
2790:
2786:
2779:
2777:
2773:
2768:
2764:
2760:
2756:
2752:
2748:
2744:
2740:
2733:
2730:
2725:
2721:
2716:
2711:
2706:
2701:
2697:
2693:
2689:
2682:
2679:
2667:
2663:
2656:
2653:
2648:
2644:
2639:
2634:
2629:
2628:10.3410/M2-60
2624:
2620:
2616:
2612:
2605:
2602:
2597:
2593:
2589:
2585:
2581:
2577:
2573:
2569:
2562:
2559:
2554:
2550:
2545:
2540:
2536:
2532:
2528:
2521:
2518:
2513:
2509:
2504:
2499:
2495:
2491:
2487:
2483:
2479:
2472:
2469:
2464:
2460:
2455:
2450:
2446:
2442:
2438:
2431:
2429:
2425:
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281:Róbert Bárány
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3197:Hearing test
3110:Otosclerosis
3062:Hearing loss
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2315:Fauquier ENT
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2290:Fauquier ENT
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2265:Fauquier ENT
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2191:. Retrieved
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1575:the original
1570:
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1531:"Chapter 37"
1524:
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1463:. Retrieved
1458:
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1382:. Retrieved
1377:
1347:. Retrieved
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371:October 2020
368:
358:
351:
344:
337:
325:
313:Please help
308:verification
305:
278:
274:
242:
207:
189:
185:
184:
105:Risk factors
49:Exterior of
26:
3283:Peripheral
3127:Presbycusis
3080:Phonophobia
3075:Hyperacusis
2958:MedlinePlus
2671:20 November
2193:9 September
1889:Mayo Clinic
1710:: 434–443.
976:betahistine
954:Medications
777:optokinetic
716:, or other
714:audiologist
581:Changes in
563:head injury
480:Within the
420:Pre-syncope
269:betahistine
232:results in
222:head injury
212:along with
88:Usual onset
3217:Audiometry
3212:Weber test
3202:Rinne test
2986:Patient UK
2934:DiseasesDB
2698:: 835671.
2344:: 654637.
1349:19 January
1060:References
1016:topiramate
1012:metoprolol
1000:dysarthria
984:gentamicin
561:Following
412:Torsional
398:Paroxysmal
393:Symptoms:
341:newspapers
3263:nystagmus
3222:pure tone
2980:neuro/411
2969:eMedicine
2441:Neurology
1917:Neurology
1459:Drugs.com
1044:verapamil
1036:nystagmus
968:meclizine
896:clinician
799:Treatment
760:dizziness
718:physician
674:nystagmus
651:Diagnosis
627:Mechanism
537:osteotome
507:endolymph
486:inner ear
482:labyrinth
431:nystagmus
414:nystagmus
261:meclizine
234:nystagmus
194:inner ear
176:Frequency
167:Prognosis
152:Treatment
119:Positive
63:Specialty
55:inner ear
51:labyrinth
3354:Category
3251:Symptoms
3070:Tinnitus
3055:Symptoms
2977:emerg/57
2849:30989371
2813:32591311
2805:21142898
2767:32993812
2759:22892804
2724:21808648
2660:Gold D.
2647:21173877
2596:39015590
2588:18251035
2553:20338918
2512:22513962
2463:15249626
2419:16549410
2370:33996859
2244:34617892
2181:Gold D.
2099:12649245
2091:15021771
2056:28018301
2048:15467614
1970:29261987
1900:16 April
1894:Archived
1869:27402289
1861:19225823
1819:20498765
1770:21054553
1654:14517129
1581:16 April
1549:Archived
1516:27327415
1465:22 March
1438:33231724
1323:25485940
1314:11214163
1271:Archived
1232:Archived
1179:Archived
1126:16175316
1118:18973840
1042:such as
1028:migraine
887:For the
868:DizzyFIX
825:otoconia
810:Canalith
792:migraine
613:migraine
606:diarrhea
463:weakness
459:numbness
443:Vomiting
259:such as
96:Duration
75:Symptoms
3272:Disease
3258:Vertigo
3243:Balance
3091:Disease
3047:Hearing
3039:balance
3035:hearing
2974:ent/761
2928:D014717
2715:3144715
2638:2990630
2503:6885068
2410:2077628
2361:8116577
2319:YouTube
2294:YouTube
2269:YouTube
2235:8975417
2168:8441692
1945:1610861
1937:3822129
1810:2872812
1734:4710517
1689:5353084
1507:7388750
1429:7684151
1384:25 July
1238:25 July
1185:25 July
1051:Surgery
947:vertigo
859:calcium
855:gravity
794:, etc.)
756:Vertigo
689:without
670:vertigo
666:ampulla
641:otolith
511:vertigo
494:utricle
484:of the
424:syncope
407:Vertigo
355:scholar
226:otolith
198:vertigo
53:of the
2963:001420
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2906:386.11
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1030:, and
1004:ataxia
790:, and
599:Stress
522:cupula
467:stroke
437:Nausea
357:
350:
343:
336:
328:
265:nausea
203:Nausea
142:stroke
3313:Tests
3190:Tests
3148:Other
2891:H81.1
2809:S2CID
2763:S2CID
2592:S2CID
2164:S2CID
2095:S2CID
2052:S2CID
1941:S2CID
1865:S2CID
1837:(PDF)
1122:S2CID
928:duct.
924:duct.
593:sleep
500:(the
476:Cause
362:JSTOR
348:books
3098:Loss
3037:and
2939:1344
2923:MeSH
2912:OMIM
2901:9-CM
2845:PMID
2801:PMID
2755:PMID
2720:PMID
2696:2011
2673:2019
2643:PMID
2584:PMID
2549:PMID
2508:PMID
2486:2012
2459:PMID
2415:PMID
2366:PMID
2240:PMID
2195:2019
2118:ISBN
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2002:ISBN
1966:PMID
1933:PMID
1902:2014
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1815:PMID
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1650:PMID
1632:CMAJ
1606:PMID
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1490:2016
1467:2019
1434:PMID
1386:2016
1351:2020
1319:PMID
1261:ISBN
1240:2016
1187:2016
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1114:PMID
1002:and
970:and
962:and
672:and
549:lift
334:news
216:and
190:BPPV
2897:ICD
2882:ICD
2837:doi
2833:266
2793:doi
2789:131
2747:doi
2710:PMC
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