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    Benign Paroxysmal Positional Vertigo

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    Miloman2001
    Benign paroxysmal positional vertigo (BPPV) is a common cause of inner ear dizziness brought on by certain head movements. It is caused by calcium carbonate crystals called otoconia becoming dislodged from the utricle and entering one of the semicircular canals. The most effective treatment is repositioning maneuvers like the Epley or Semont maneuvers which work to move the debris back into the utricle. These treatments are effective in resolving symptoms in 67-90% of patients within 6-12 months. If symptoms do not resolve, balance exercises or rarely surgery may be options.

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    Benign Paroxysmal Positional Vertigo

    Uploaded by

    Miloman2001
    214 views38 pages
    Benign paroxysmal positional vertigo (BPPV) is a common cause of inner ear dizziness brought on by certain head movements. It is caused by calcium carbonate crystals called otoconia becoming dislodged from the utricle and entering one of the semicircular canals. The most effective treatment is repositioning maneuvers like the Epley or Semont maneuvers which work to move the debris back into the utricle. These treatments are effective in resolving symptoms in 67-90% of patients within 6-12 months. If symptoms do not resolve, balance exercises or rarely surgery may be options.

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    Benign paroxysmal positional vertigo (BPPV) is a common cause of inner ear dizziness brought on by certain head movements. It is caused by calcium carbonate crystals called otoconia becoming dislodged from the utricle and entering one of the semicircular canals. The most effective treatment is repositioning maneuvers like the Epley or Semont maneuvers which work to move the debris back into the utricle. These treatments are effective in resolving symptoms in 67-90% of patients within 6-12 months. If symptoms do not resolve, balance exercises or rarely surgery may be options.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    214 views38 pages

    Benign Paroxysmal Positional Vertigo

    Uploaded by

    Miloman2001
    Benign paroxysmal positional vertigo (BPPV) is a common cause of inner ear dizziness brought on by certain head movements. It is caused by calcium carbonate crystals called otoconia becoming dislodged from the utricle and entering one of the semicircular canals. The most effective treatment is repositioning maneuvers like the Epley or Semont maneuvers which work to move the debris back into the utricle. These treatments are effective in resolving symptoms in 67-90% of patients within 6-12 months. If symptoms do not resolve, balance exercises or rarely surgery may be options.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
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    of 38

    BPPV

    Benign Paroxysmal Positional Vertigo Chad Caswell

    Vertigo

    Sensation of rotation or movement of you or your surroundings. Dizziness or a spinning sensation. Dizziness, a malfunction of the inner ear that makes the patient feel like everything is whirling around.

    Causes of Vertigo

    Visual malfunction Somatosensory malfunction

    Nerve damage
    Positional (inner ear)

    Anatomy of the Inner Ear

    Anatomy of the Inner Ear

    Etiology

    Cupulolithiasis

    Utricular otoconia Attach to cupula in ampulla Density difference between cupula and endolymph Angular to linear

    Canalithiasis

    Most common cause in posterior canal Movement of freefloating debris in endolymph causes currents that deflect the cupula

    Causes of BPPV

    Diagnosis - History
    Sudden, severe attacks of vertigo Specific head movements 5-30s, but often overestimated Lightheadedness, nausea, imbalance Screen for secondary causes 2.1% familial tendency

    Diagnosis Dix-Hallpike

    Tests for posterior canal BPPV Maneuver Nystagmus Return to seated position 1-3s latency Nystagmus fatigues with repeated testing

    Nystagmus

    Diagnosis Roll Test


    Tests for horizontal canal BPPV Maneuver Ageotropic = Cupulolithiasis Geotropic = Canalithiasis Other criteria is same as for Dix-Hallpike

    Diagnosis Subjective BPPV


    Patient reports vertigo with positioning No nystagmus is seen

    Frenzel Goggles

    Prognosis

    Self-limiting Dizziness, falls, ADLs Usually resolves in 6-12 months Repositioning techniques improve prognosis

    Epley maneuver 67-89% effective Semont maneuver 52-90% effective Prolonged positioning 90% effective

    Surgery for patients with no relief in 12 months

    Medical

    Drugs are only used to treat symptoms since physical treatments are so effective Antihistaminic antiemetics for nausea

    Meclizine

    Antivert Dramamine

    Surgical

    Singular neurectomy

    Cut the posterior ampullary nerve

    Eliminates excitatory signals

    Complications Best surgical option Obstructs membranous labyrinth Particle movement in endolymph is prevented Efficacious and safe in short and long term

    Posterior semicircular canal occlusion


    Posterior semicircular canal occlusion

    Therapeutic Treatment

    Treatment for nausea and vertigo


    Epley maneuver Semont maneuver Prolonged positioning techniques Brandt-Daroff exercises

    Treatment to create habituation

    Treatment for balance dysfunction

    Epley Maneuver

    AKA Particle repositioning maneuver Canalithiasis Series of positions Otoconia moved from posterior canal to utricle Often combined with oscillations and nausea medication

    Semont Maneuver

    Liberatory maneuver Cupulolithiasis Brisk positional changes Frees debris attached to cupula One study states that there is no difference in efficacy between the Semont and Epley maneuvers

    Prolonged Positioning

    Horizontal canal Patient lies on side with unaffected ear downward for 12 hours Sometimes converts BPPV to posterior canal

    Then treated by Epley maneuver

    Brandt-Daroff Exercises

    Used to create habituation

    Figure skaters

    Only used if repositioning techniques arent effective First used as a treatment technique Then used as a daily exercise routine to create habituation 3 sets of 5 reps daily

    Treatment for Balance Dysfunction


    Tai Chi Strengthening Balance retraining Education Safety techniques Balance Master

    References

    Walsh RM, Bath AP, Cullen JR, Rutka JA. Long-term results of posterior semicircular canal occlusion for intractable benign paroxysmal positional vertigo. Clin Otolaryngol Allied Sci. 1999;24(4):316-23. Parnes LS, Agrawal SK, Atlas J. Diagnosis and management of benign paroxysmal positional vertigo (BPPV). CMAJ. 2003;169(7):681-93. Uneri A. Migraine and benign paroxysmal positional vertigo: an outcome study of 476 patients. ENT. 2004;83(12):814-815. Cizzi M, Ayyagari S, Khattar V. The familial incidence of benign paroxysmal positional vertigo. Acta Otolaryngol. 1998;118(6):774-7. Richard W, Bruintjes TD, Oostenbrink P, van Leeuwen RB. Efficacy of the Epley maneuver for posterior canal BPPV: a long-term, controlled study of 81 patients. ENT. 2005;84(1):22-25. Hain TC, Uddin M. Pharmacological treatment of vertigo. CNS Drugs. 2003;17(2):85-100. Helminski JO, Janssen I, Kotaspouikis D, et al. Strategies to prevent recurrence of benign paroxysmal positional vertigo. Arch Otolaryngol Head Neck Surg. 2005;131(4):344-8.

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