Benign paroxysmal positional vertigo F063

Current RMA Instruments

Changes from previous Instruments

ICD Coding

• ICD-10-AM Codes: H81.1.

Brief description

Benign paroxysmal positional vertigo (BPPV) is an inner ear disorder characterised by recurrent brief episodes of vertigo, typically lasting less than one minute, that are triggered by specific head movements. Although the vertigo itself is brief, associated symptoms such as nausea, vomiting, dizziness or unsteadiness may persist for longer. 

Confirming the diagnosis

Diagnosing benign paroxysmal positional vertigo involves a clinical presentation of recurrent episodes of brief vertigo provokes by specific head movements. This requires a practitioner's assessment of symptoms together with examination findings consistent with BPPV. 

To confirm the diagnosis, there must be either observation of characteristic positional nystagmus during a provoking manoeuvre (such as the Dix-Hallpike or supine roll test) or evidence of symptoms resolution following an appropriate canal repositioning manoeuvre (such as the Epley repositioning manoeuvre). Imaging is not routinely required but may be undertaken where an alternative central neurological cause is suspected. 

If positional vertigo is attributable to disease or injury of the brain, the diagnosis of BPPV cannot be confirmed. Assessment and management often involve an ENT surgeon or neurologist, although GPs may confirm the diagnosis when supported by consistent clinical findings. 

Additional diagnoses that are covered by SOP

• Benign positional nystagmus
• Benign positional vertigo
• Canalithiasis (vestibular lithiasis)

Conditions that are excluded from SOP

• Positional vertigo caused by disease or injury of the brain (e.g. stroke, brain tumour, multiple sclerosis) *
• Labyrinthitis #
• Meniere disease *
• Vestibular neuritis #

* another SOP applies

# Non-SOP condition

Clinical onset

Clinical onset is the earliest point at which recurrent episodes of vertigo lasting less than one minute, provoked by characteristic head movements, first occurred. Although associated symptoms such as nausea, vomiting, dizziness or unsteadiness may be present before the vertigo itself, these do not determine the onset as they are non-specific symptoms. BPPV most commonly occurs in older adults but may occur at any age.

Clinical worsening

When assessing for possible clinical worsening, it is important to distinguish deterioration from the natural history of BPPV. The condition usually responds well to canal repositioning manoeuvres, although recurrence is common and does not necessarily indicate worsening. Clinical worsening may be evidenced by persistent symptoms despite appropriate repositioning treatment, increasing frequency or severity of episodes or involvement of additional semicircular canals. Assessment by an ENT surgeon or neurologist would be important in assessing if there is true clinical worsening rather than recurrent disease.