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 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 • Floating particles originating from the otoliths in the utricle.
Pathophysiology • original theory of cupulolithiasis (i.e. particles attached to cupula)
Etiology • Spontaneous • Viral • Traumatic • Meniere’s disease • Post surgery • Migraine?
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 • 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 • Particle Repositioning Manoeuvre (PRM) • Barrel roll by Eply for lateral canal BPPV • Brandt-Daroff exercises for cupulolithiasis
Surgical Management • Posterior canal occlusion • Singular neurectomy