Benign paroxysmal positional vertigo
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Benign Paroxysmal Positional Vertigo. Dr Ahmad Alamadi MB chB, FRCS Consultant Otologist and ENT Surgeon Al Baraha Hospital. BPPV. Commonest vestibular disorder Incident 20: 100000 Coexist with other vestibular disorders. Pathophysiology.

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Benign paroxysmal positional vertigo

Benign Paroxysmal Positional Vertigo

Dr Ahmad Alamadi MB chB, FRCS

Consultant Otologist and ENT Surgeon

Al Baraha Hospital


BPPV

  • Commonest vestibular disorder

  • Incident 20: 100000

  • Coexist with other vestibular disorders


Pathophysiology
Pathophysiology

  • Floating particles originating from the otoliths in the utricle.


Pathophysiology1
Pathophysiology

  • original theory of cupulolithiasis (i.e. particles attached to cupula)


Etiology
Etiology

  • Spontaneous

  • Viral

  • Traumatic

  • Meniere’s disease

  • Post surgery

  • Migraine?


History
History

  • Four steps

    • Sharp clear history

    • True rotatory vertigo

    • No neurological history

    • Positional( head up & turn in bed) lasting for seconds only, multiple attacks, no other ear symptoms


Examination
Examination

  • Four Steps

    • Otologic examination normal

    • Neurological examination normal

    • Special vestibular tests normal

    • Diagnostic Dix-Hallpike manoeuvre rotatory geotropic nystagmus on the affected side( can have up to 10 sec delay) in post canal BPPV and horizontal nystagmus in lateral BPPV


Management
Management

  • Particle Repositioning Manoeuvre (PRM)

  • Barrel roll by Eply for lateral canal BPPV

  • Brandt-Daroff exercises for cupulolithiasis


Surgical management
Surgical Management

  • Posterior canal occlusion

  • Singular neurectomy


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