Vertigo — BPPV

Our Approach In managing Vertigo (BPPV)

Restoring balance begins with the right diagnosis.

Vertigo is a symptom, not a diagnosis. Our team distinguishes between inner ear causes, neurological triggers, and systemic contributors — because the treatment for BPPV is very different from that for Meniere's disease, vestibular neuritis, or central vertigo.

1. Detailed Vestibular & Neurological Assessment

Every vertigo patient undergoes a systematic evaluation:

• Thorough history of onset, duration, triggers, and associated symptoms
• Dix-Hallpike test and Roll Test to confirm BPPV and identify the affected canal
• Videonystagmography (VNG) to objectively assess vestibular function
• Pure tone audiometry to identify any concurrent hearing component
• MRI brain and cerebellum to exclude central (neurological) causes when indicated

2. Diagnosing the Type of Vertigo

Accurate classification is essential:

• BPPV — displaced otoconia (calcium crystals) in the semicircular canals; positional onset
• Vestibular neuritis — sudden onset, no hearing loss, typically post-viral
• Meniere's disease — recurrent episodes with tinnitus and fluctuating hearing loss
• Central vertigo — associated with headache, diplopia, or neurological signs; requires MRI

3. Canalith Repositioning Manoeuvres

The primary treatment for benign paroxysmal positional vertigo treatment Mumbai:

• Epley manoeuvre — most effective for posterior canal BPPV; resolves in 1–3 sessions in 85–90% of patients
• Semont manoeuvre as an alternative for the same canal type
• Barbecue (log) roll manoeuvre for horizontal canal BPPV
• Gufoni manoeuvre for cupulolithiasis variant
  Manoeuvres are performed in-clinic and most patients experience significant improvement within 24–48 hours.

4. Vestibular Rehabilitation Therapy (VRT)

For patients with persistent dizziness and balance disorder following BPPV or vestibular neuritis:

• Structured exercise programme to promote central compensation
• Gaze stabilisation exercises and habituation training
• Balance training on stable and unstable surfaces
• Home programme designed by our vestibular physiotherapist for daily practice

5. Medical Management

While medication does not cure BPPV, it supports recovery in select cases:

• Vestibular suppressants (cinnarizine, betahistine) for acute symptom management
• Anti-emetics for nausea associated with severe vertigo episodes
• Migraine management if vestibular migraine is a co-existing diagnosis
• Vitamin D and calcium supplementation  low levels are associated with recurrent BPPV

6. Meniere's Disease & Chronic Vestibular Conditions

When recurrent vertigo is linked to Meniere's disease or another chronic inner ear condition:

• Low-sodium diet and diuretic therapy to manage endolymphatic pressure
• Intratympanic gentamicin or steroids for drug-resistant cases
• Endolymphatic sac surgery or labyrinthectomy in severe, intractable cases
• Cochlear implantation for patients with associated profound hearing loss

7. Fall Prevention & Safety Counselling

Vertigo poses a real fall risk, particularly in older patients:

• Home safety assessment and modification guidance
• Balance retraining and walking aid prescription where appropriate
• Driving safety discussion  patients should not drive during active vertigo
• Inner ear vertigo self-management handout provided to every patient at discharge