Geriatric Syndrome

BPPV: Dix-Hallpike & Epley Maneuver Guide

Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo in older adults and a leading contributor to falls, fear of falling, and activity restriction. It results from displaced otoconia in the semicircular canals — most often the posterior canal — producing brief episodes of spinning triggered by head position changes such as rolling over in bed, looking up, or bending forward. Diagnosis is bedside: the Dix-Hallpike maneuver reproduces upbeat-torsional nystagmus and vertigo within seconds. Treatment is also bedside — the Epley canalith repositioning maneuver resolves symptoms in roughly 80–90% of patients in a single session and can be repeated. This guide walks through patient positioning, what nystagmus to look for, when to repeat the maneuver, when to refer to vestibular therapy or ENT, and how to counsel patients about post-maneuver activity and recurrence risk.

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