Benign Paroxysmal Positional Vertigo (BPPV)

Q1 : incidence?

  • The commonest cause of vertigo
  •  20% of all dizziness.
  •  50% of all dizziness in older people.
  •  Female > Males: 1.6:1 to 2:1

Q2 : PATHOLOGY OF BPPV?

  •  Ear rocks “otoconia”
  •  Displaced from the otolithic membrane in the utricle
  •  Typically settle in the dependent posterior canal and render it sensitive to gravity.
  •  Uncommonly affects lateral canal & rarely affect superior canal.

Q3 : causes of BPPV?

  •  50 % of BPPV is “idiopathic“.
  •  Commonest < 50 yrs is–head injury.
  •  Commonest > 50 yrs is degeneration. (Froeling et al, 1991).
  •  Unusual causes :
  • Viruses : vestibular neuritis
  • Minor strokes: (AICA) syndrome“.
  • Meniere’s disease .
  • Surgery: – ? prolonged period of supine position, – or ear trauma when the surgery is to the inner ear

Q4 : suggesstive symptoms?

  • Symptoms precipitated by a change of position of the head with respect to gravity.
  • Most common movements includes Rolling over in bed
  • Or patients feels dizzy and unsteady when they tip their heads back to look up, sometimes BPPV is called “top shelf vertigo.“
  • Most other conditions that have positional dizziness get worse on standing rather than lying down (e.g. Orthostatic hypotention).
  • An intermittent pattern is common. BPPV may be present for a few weeks, then stop, then come back again.

Q5 : Dix–Hallpike manoeuvre?

Done to diagnose BPPV

The patient is seated and positioned so that the patient’s Head will extend over the top edge of the table when supine. The head is turned 45º toward the ear being tested.

The patient is quickly lowered into the supine position With the head extending about 30º below the horizontal.

The patient’s eyes are observed for nystagmus.

Typical nystagmus of the posterior SCC BPPV:

  • Has a brief latency (1–5 seconds)
  • Limited duration (typically < 30 seconds)
  • & is torsional nystagmus in the plane of the posterior canal (ageotropic).
  • To complete the maneuver, the patient is returned to the seated position, and the eyes are observed for reversal nystagmus, torsional nystagmus in the same plane but opposite direction.

Q6 : OFFICE TREATMENT OF Posterior canal BPPV?

Semont maneuver (=”liberatory” maneuver)

Epley’s maneuver (=the particle repositioning, canalith repositioning procedure, and modified liberatory maneuver.)

Both are very effective, 80% cure rate.

 

Q7 : Semont maneuver?

The patient is rapidly moved from lying on one side to lying on the other.

Q8 : Epley Maneuver?

    1. Turn the head 45° to the side being treated

 

    1. The patient’s head is then rotated toward the opposite side with the neck in full extension in a steady motion by rolling the patient onto the opposite lateral side.

 

    1. The patient’s head is then rotated toward the opposite side with the neck in full extension in a steady motion by rolling the patient onto the opposite lateral side.

 

    1. Continue to roll the patient another 90° until his or her head is diagonally opposite the first Dix–Hallpike position.

 

  1. Patient sit with neck flexed.

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