Clinicians should diagnose posterior semicircular canal BPPV when vertigo associated with torsional, up beating nystagmus is provoked by the Dix-Hall pike maneuver, performed by bringing the patient from an upright to supine position with the head turned 45° to one side and neck extended 20° with the affected ear down. The maneuver should be repeated with the opposite ear down if the initial maneuver is negative. (Strong recommendation)

If the patient has a history compatible with BPPV and the Dix-Hallpike test exhibits horizontal or no nystagmus, the clinician should perform, or refer to a clinician who can perform, a supine roll test to assess for lateral semicircular canal BPPV. (Strong recommendation)

Clinicians should differentiate, or refer to a clinician who can differentiate, BPPV from other causes of imbalance, dizziness, and vertigo. (Strong recommendation)

Clinicians should assess patients with BPPV for factors that modify management, by the recommended repositioning maneuvers, including impaired mobility or balance, central nervous system disorders, a lack of home support, and/or increased risk for falling. (Strong recommendation)

Clinicians should not obtain radiographic imaging in a patient who meets diagnostic criteria for BPPV. (Strong recommendation against)

Clinicians should not order laboratory vestibular testing in a patient who meets diagnostic criteria for BPPV in the absence of additional vestibular signs and/or symptoms inconsistent with BPPV that warrant testing. Vestibular testing may be ordered in case of recurrence, persistence of complaint after repositioning manoeuvre or in the presence of atypical nystagmus (Conditional recommendation against)

Clinicians should treat, or refer to a clinician who can treat, patients with posterior canal BPPV with a canalith repositioning procedure. Epley’s or Semont’s are equivocally effective for posterior canal BPPV. Semont’s is recommended in cupulolithiasis than Epley’s. (Strong recommendation)

The barbecue roll manoeuvre or Gufoni manoeuvre appear moderately effective for the geotropic form of lateral semi-circular canal BPPV. (Conditional recommendation)

Clinicians may not routinely recommend post procedural postural restrictions after canalith repositioning procedure for posterior canal BPPV. Post procedural postrural restriction might be recommended in selected cases as in   failure (or repeated failure) of the repositioning maneuvers, recurrent cases, or cases associated with other vestibular pathology as MD or vestibular Migraine. (Conditional recommendation against)

1-2 sessions would resolve the condition in 87-100% of patients. A minority would require a 3ed trial. Otherwise persistent BPPV is suspected. (Strong recommendation)

Clinicians should start with CRP (or modified) even in those patients who are very obese; have severe cervical or lumber discs; or upon patient’s preference. In the latter case patients should be instructed to avoid activities that may increase the risk of falls until symptoms resolve. (Strong recommendation)

Clinicians may offer observation with follow up only if there is difficulty in performing successful manoeuvre after trials in some patients as : very obese; severe cervical or lumber discs; or upon patient’s preference not to repeat the manoeuvre. (Strong recommendation)

VR should be considered an option in the treatment of BPPV rather than a recommended first-line treatment modality. Home based Brandt-Daroff exercises is indicated in patients with persistent dizziness or imbalance after successful CRP or patients who refuse CRP.A more comprehensive customized VR program is indicated in patients with other vestibular pathology or with comorbid impairments that require balance rehabilitation specially in elderly. (Strong recommendation)

Clinicians should not treat BPPV with vestibular suppressant medications such as antihistamines and/ or benzodiazepines. Exceptions: Prior to CRP in patients with severe nausea and/or vomiting, or patients previously manifested severe nausea and/or vomiting during testing. (Strong recommendation against)

Clinicians should reassess patients within an initial period of observation following the canalith repositioning procedure (40 minutes up to one week) to document resolution, need for repetition of CRP session or persistence of symptoms. (Strong recommendation)

Clinicians should evaluate, or refer to a clinician who can evaluate, patients with persistent symptoms for unresolved BPPV and/or underlying peripheral vestibular or central nervous system disorders. (Strong recommendation)

Clinicians should educate patients regarding the impact of BPPV on their safety, the potential for disease recurrence, and the importance of follow-up. (Strong recommendation)