Figure 3.

Potential treatment approaches based on known and proposed mechanisms of BPPV. Large ticks represent the mechanisms supported by clinical evidence; small boxes represent potential benefits based on mechanisms with evidence from animal studies or proposed mechanisms. ¹Explanations and advice from the ENT specialist about what to expect during CRM and the expected trajectory for symptom resolution post-CRM may benefit anxious/stressed patients. ²Only for patients with diagnosed vitamin D insufficiency. ³Conditions that may affect the microcirculations, such as hypertension and dyslipidemia. ⁴Patients with orthostatic hypotension, vascular risk factors associated with microcirculatory effects, and brain atrophy may be at greater risk of BPPV. ^*Betahistine is recommended for use in patients with Ménière’s disease. BPPV, Benign paroxysmal positional vertigo; CRM, Canalith repositioning maneuver; and ENT, Ear, nose, and throat.