Benign Paroxysmal Positional Vertigo (BPPV)
Definition: A peripheral vestibular disorder characterized by short episodes of vertigo induced when the head is placed in a certain critical position.
Key Characteristics
- Symptoms: Vertigo in specific head positions.
- Negative Findings: NO hearing loss; NO other neurologic symptoms.
- Aetiology: Disorder of the Posterior Semicircular Canal.
- Often idiopathic.
- History of head trauma or ear infection is common.
Pathophysiology: "Canalithiasis"
The accepted theory involves Otoconial Debris (Calcium Carbonate crystals).
1. Degeneration of Utricle Macula
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2. Otoconia release into Endolymph
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3. Debris floats freely in the endolymph
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4. Settles on Cupula of posterior semicircular canal in critical head position
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5. Cupula Displacement = VERTIGO
The Fatigue Phenomenon:
If the patient assumes the same position repeatedly, the otoconia disperse, and vertigo stops (fatigues). After a period of rest, they re-aggregate, and vertigo can be induced again.
If the patient assumes the same position repeatedly, the otoconia disperse, and vertigo stops (fatigues). After a period of rest, they re-aggregate, and vertigo can be induced again.
Diagnosis
Established by typical history and clinical testing.
- Positional Testing: Differentiates peripheral BPPV from central positional vertigo.
- Dix-Hallpike Manoeuvre: The gold standard test. Induces vertigo and nystagmus if BPPV is present.
Treatment: Epley's Manoeuvre
Principle: Repositioning the otoconial debris from the posterior semicircular canal back into the Utricle (where it won't cause symptoms).
Setup:
- Patient sits on table (head will hang over edge).
- Face turned 45° to the affected side.
- Doctor stands behind; Assistant at side.
The 5 Positions (Steps)
| Position | Action | Notes |
|---|---|---|
| 1. Head Hanging | Lay patient down rapidly with head hanging back (Dix-Hallpike). | Wait for vertigo/nystagmus to subside. |
| 2. Head Turn | Turn head so affected ear faces UP (90° rotation). | Pause until nystagmus slows/stops. |
| 3. Body Roll | Rotate whole body & head away from affected ear to lateral recumbent (Face down 90°). | Pause. |
| 4. Sitting Up | Bring to sitting position; head still turned to unaffected side (45°). | Pause. |
| 5. Forward | Turn head forward; chin down 20°. | End of procedure. |
Epley’s manoeuvre
Success Rate: 80% cured by a single manoeuvre.
Tip: A bone vibrator on the mastoid helps loosen debris during the procedure.
Post-Op: Patient must maintain upright posture for 48 hours.
Tip: A bone vibrator on the mastoid helps loosen debris during the procedure.
Post-Op: Patient must maintain upright posture for 48 hours.
📚 Source: ENT Dhingra | Chapter 7
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