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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


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    1. Benign Paroxysmal Positional Vertigo Dr Ahmad Alamadi MB chB, FRCS Consultant Otologist and ENT Surgeon Al Baraha Hospital

    2. BPPV • Commonest vestibular disorder • Incident 20: 100000 • Coexist with other vestibular disorders

    3. Pathophysiology • Floating particles originating from the otoliths in the utricle.

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

    5. Etiology • Spontaneous • Viral • Traumatic • Meniere’s disease • Post surgery • Migraine?

    6. 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

    7. 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

    8. Management • Particle Repositioning Manoeuvre (PRM) • Barrel roll by Eply for lateral canal BPPV • Brandt-Daroff exercises for cupulolithiasis

    9. Surgical Management • Posterior canal occlusion • Singular neurectomy