hi, thank for providing the brief history of your daughter. A thorough neuromuscular assessment is advised. Also first thing is to understand is the positional vertigo. Benign paroxysmal positional vertigo (BPPV) is a disorder arising in the inner ear. Its symptoms are repeated episodes of positional vertigo, that is, of a spinning sensation caused by changes in the position of the head. BPPV is the most common cause of the symptoms of vertigo Symptoms Emesis (vomiting) is common, depending on the strength of the vertigo itself and the causes for this illness. Nausea is often associated. Paroxysmal — Sudden onset of episodes with a short duration: lasts only seconds to minutes. Positional in onset: Can only be induced by a change in position. Pre-syncope (feeling faint) or syncope (fainting) is unusual but possible. Rotatory (torsional) nystagmus, where the top of the eye rotates towards the affected ear in a beating or twitching fashion, which has a latency and can be fatigued (the vertigo should lessen with deliberate repetition of the provoking maneuver). Nystagmus should only last for 30 seconds to one minute. Visual disturbance: It may be difficult to read or see during an attack due to associated nystagmus. Vertigo — Spinning dizziness, which must have a rotational component. Many patients will report a history of vertigo as a result of fast head movements. Many patients are also capable of describing the exact head movements that provoke their vertigo. Purely horizontal nystagmus and symptoms of vertigo lasting more than one minute can also indicate BPPV occurring in the horizontal semicircular canal. Patients do not experience other neurological deficits such as numbness or weakness, and if these symptoms are present, a more serious etiology, such as posterior circulation stroke or ischemia, must be considered. The spinning sensation experienced from BPPV is usually triggered by movement of the head, will have a sudden onset, and can last anywhere from a few seconds to several minutes. The most common movements patients report triggering a spinning sensation are tilting their heads upwards in order to look at something, and rolling over in bed. the causes are - Within the labyrinth of the inner ear lie collections of calcium crystals known as otoconia or otoliths. In patients with BPPV, the otoconia are dislodged from their usual position within the utricle, and migrate over time into one of the semicircular canals (the posterior canal is most commonly affected due to its anatomical position). When the head is reoriented relative to gravity, the gravity-dependent movement of the heavier otoconial debris (colloquially ear rocks ) within the affected semicircular canal causes abnormal (pathological) endolymph fluid displacement and a resultant sensation of vertigo. This more common condition is known as canalithiasis. In rare cases, the crystals themselves can adhere to a semicircular canal cupula, rendering it heavier than the surrounding endolymph. Upon reorientation of the head relative to gravity, the cupula is weighted down by the dense particles, thereby inducing an immediate and sustained excitation of semicircular canal afferent nerves. This condition is termed cupulolithiasis. There is evidence in the dental literature that malleting of an osteotome during closed sinus floor elevation, otherwise known as osteotome sinus elevation or lift, transmits percussive and vibratory forces capable of detaching otoliths from their normal location and thereby leading to the symptoms of BPPV. Treatment Repositioning maneuvers A number of maneuvers have been found to be effective including: the Epley maneuver, the Semont maneuver, and to a lesser degree Brandt-Daroff exercises. Both the Epley and the Semont maneuver are equally effective. Usually a physical therapist may help you learn the exercises and helps to recover from symptoms. Regards Jay Indravadan Patel