Bppv

BENIGN PAROXYSMAL POSITIONAL VERTIGO(BPPV)

BY- PRAJNA SHETTY

- It is characterised by vertigo when the head is placed in a certain critical position.

- Disease is caused by a disorder of posterior semicircular canal.

Pathophysiology

1. Canalithiasis: is defined as a condition in which otoconial debris are floating freely in the canal portion of the SCCs.

2. Cupulolithiasis : refers to condition where otoconial debris are adhered to the cupula of the crista ampullaris.

Degeneration of macula of the utricle

Release of otoconial debris(crystals of calcium carbonate)

Debris floats freely in the endolymph

Critical head position

Settling of otoconia on cupula of post.SCC

Displacement of cupula

Vertigo

Symptoms: - Severe vertigo in certain head position lasting

less than a minute. - Associated with nausea and vomiting. - Absence of deafness and tinnitus. - no other neurologic symptoms.

Signs: - Nystagmus The Dix-Hallpike maneuver is the standard clinical

test for BPPV .

Hallpike Manoeuvre

Investigations• Hearing test - normal• Caloric test and electronystagmography - may be

normal• Hallpike test (positional test) -Positive -Fatiguable vertigo on assuming same position

repeatedly due to dispersal of otoconia.• Posturography

Treatment• Conservative (a) Reassurance and antivertigo drugs.

(b)Epley’ maneuver

Principle- Repositioning of otoconial debris from post.SCC back into the utricle.

Position- patient sitting on a table such that head extends beyond the edge of the table when supine with face turned 45 degrees to affected side.

Procedure( maneuver)-

Position 1: Make patient to lie down in head hanging position with head turned 45 degree. Wait till vertigo and nystagmus subsides.

Position 2: Now turn head, so that affected ear is up.

Position 3: Then rotate the whole body and head away from affected ear to a recumbent position with face-down.

Position 4: Bring back patient to sitting position with head still turned to unaffected side by 45 degrees.

Position 5: Head turned forward and chin brought down 20 degrees.

Follow-up : Maintain upright posture for 48hours

after maneuver.

• Operative Surgery is usually reserved for those in whom

Canalith repositioning(CRP) fails. - Labyrinthectomy - Posterior canal occlusion - Singular neurectomy - Vestibular nerve section

THANK YOU FOR LISTENING!