Beni gn paroxysmal positional Vertigo (BppV) is characterized by vertigo, lasting for a few seconds and usually managed by head positioning maneuvers. To educate clinicians concerning the state-ofthe art knowledge about its management, the international societies developed guidelines.Aim: the aim of this paper is to discuss, in a practical fashion, the current options available to manage BppV. Method:Study design: non-systematic review. This study reviews two recent guidelines regarding the evaluation and treatment of BppV. The first one was published by the American Academy of Otolaryngology Head and neck surgery (AAO-HnS) and the other by the American Academy of neurology (AAn). The similarities were presented in different tables.Results: Those guidelines presented differences regarding methods. Only the AAO-HnS guidelines recommend the dix-Hallpike test for the diagnosis of BppV. Only canalith repositioning maneuver, Semont maneuver and vestibular rehabilitation had showed some benefit and were recommended as good treatment options. Conclusions:Both guidelines fulfilled all the aspects required for clinicians to diagnosed and manage BppV; only the AAO-HnS's guidelines were more comprehensive and of better quality. Braz J Otorhinolaryngol. 2011;77(2):191-200. ORIgInAL ARTIcLE

Benign paroxysmal positional vertigo (BPPV) is the most common cause of peripheral vestibular vertigo. It is caused by free-floating otoconia moving freely in one of the semicircular canals (canalolithiasis) or by otoliths adhered to the cupula (cupulolithiasis). The posterior canal is the most common canal affected, followed by the lateral canal. Diagnosis of the side affected is critical for successful treatment; therefore, suppressing visual fixation is essential to examination of these patients' eye movement. On the basis of our experience, we have adopted the Zuma maneuver and the modified Zuma maneuver for both apogeotropic and geotropic variants of lateral canal BPPV. Knowledge of the anatomy and pathophysiologic mechanisms of the semicircular canals is essential for correct management of these patients. Hence, using a single maneuver and its modification may facilitate daily neurotological practice.

The apogeotropic variant of horizontal semicircular canal benign paroxysmal positional vertigo (HC-BPPV) is attributed to free floating particles in the anterior arm of the lateral semicircular canal – particles attached to the cupula facing the canal or particles attached to the cupula facing the utricle. Zuma e Maia described a new treatment for both canalithiasis of the anterior arm of the horizontal semicircular canal (HC) and cupulolithiasis of the HC. Seventeen patients with apogeotropic HC-BPPV were enrolled and treated with Zuma’s Maneuver. During the repositioning of the particles to the utricule, we observed the direction of the nystagmus evoked in each step of this maneuver in order to know where the otoliths were probably located. Eight patients were diagnosed with canalithiasis of the anterior arm, six patients with cupulolithiasis with the particles facing the canal and three patients with cupulolithiasis with the particles facing the utricle. Our data suggest that we can assume where the otoliths are probably located by observing the pattern of the nystagmus evoked in each step of the Zuma’s Maneuver in patients with apogeotropic HC-BPPV.

There is a strong association between neurotological symptoms and migraine, and the auditory-vestibular dysfunction-associated migraine is the most common cause of spontaneous episodic vertigo (non-positional). Symptoms may vary broadly among patients, making it a diagnostic challenge to the otorhinolaryngologist. This entity usually presents with positional or spontaneous vertigo spells, lasting for seconds or days, associated with migraine symptoms. A better understanding of the relationship between central vestibular mechanisms and migraine mechanisms, besides the discovery of ionic channel disorders in some cases of migraine, ataxia and vertigo, may lead to a better understanding of migraine pathophysiology associated with audio-vestibular disorder.

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The association between hearing and balance disorders with migraine is known since the times of the ancient Greeks, when Aretaeus from Cappadocia in 131 B.C, made an accurate and detailed description of this occurrence during a migraine episode. We present a broad review of migraine neurotological manifestations, using the most recent publications associated with epidemiology, clinical presentation, pathophysiology, diagnostic methods and treatment for this syndrome. Aim: to describe the clinical entity: "Migraine associated with auditoryvestibular dysfunction" in order to help otorhinolaryngologists and neurologists in the diagnosis and management of such disorder. Final Remarks: There is a strong association between neurotological symptoms and migraine, and the auditory-vestibular dysfunction-associated migraine is the most common cause of spontaneous episodic vertigo (nonpositional). Symptoms may vary broadly among patients, making it a diagnostic challenge to the otorhinolaryngologist. This entity usually presents with positional or spontaneous vertigo spells, lasting for seconds or days, associated with migraine symptoms. A better understanding of the relationship between central vestibular mechanisms and migraine mechanisms, besides the discovery of ionic channel disorders in some cases of migraine, ataxia and vertigo, may lead to a better understanding of migraine pathophysiology associated with audio-vestibular disorder.