Benign paroxysmal positional vertigo

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**Benign paroxysmal positional vertigo**
*Classifications and external resources*

Exterior of labyrinth.
ICD-10	H 81.1
ICD-9	386.11
OMIM	193007
DiseasesDB	1344
eMedicine	ent/761 emerg/57 neuro/411
MeSH	D014717

Benign paroxysmal positional vertigo (BPPV) or "Benign paroxysmal vertigo" (BPV) is a condition caused by problems in the inner ear.

1 Cause
2 Presentation
3 Diagnosis
4 Treatment
5 See also
6 References
7 External links

[edit] Cause

Within the labyrinth of the inner ear lie collections of calcium crystals known as otoliths. Dislodging of the otoliths from their usual position within the utricle with migration into one of the semicircular canals (most commonly the posterior) will cause abnormal fluid movement within that semicircular canal and a resultant sensation of vertigo.

[edit] Presentation

The primary symptom is the sudden onset of severe vertigo that occurs exclusively with head movement in the direction of the affected ear.

Patients often describe their first experience occurring while turning their head in bed.

The vertigo is brief in duration -- less than 15 seconds by definition.

It is often associated with nausea.

Patients do not experience other neurological deficits such as numbness or weakness, and if these symptoms are present, a more concerning etiology such as posterior circulation stroke, must be considered.

[edit] Diagnosis

The condition is diagnosed by performing the Dix-Hallpike (aka Barany) maneuver which is diagnostic for the condition.

[edit] Treatment

The treatment of choice for this condition is the Epley canalith repositional maneuver which is effective in approximately 80% of patients (the Epley and Semont Maneuvers, employ gravity to move the calcium build-up that is causing the condition).^[1] The particle repositioning maneuver (Epley Maneuver) can be performed during a clinic visit by specially trained otolaryngologists, neurologists, physical therapists, or audiologists. The maneuver is relatively simple but few general health practitioners know how to perform it.

Effective treatment may also be achieved with the use of a device such as "The DizzyFIX". This device enables patients and health practitioners to guide themselves through the particle repositioning maneuver successfully. When using such a device the maneuver can be conducted at home and repeated as often as needed. This device is designed to treat the most common form of BPPV which is characterized by particles in the posterior semi-circular canal. This device is not designed for patients who suffer from particles in the horizontal or superior canal. BPPV in these other canals is less common and has a higher spontaneous resolution rate than posterior canal BPPV. Other devices, such as a head over heels "rotational chair", are also available at some tertiary care centers ^[2]

The Epley maneuver (particle repositioning) does not address the actual presence of the particles (otoconia), rather it changes their location. The maneuver moves these particles from areas in the inner ear which cause symptoms, such as vertigo, and repositions them into areas where they do not cause these problems.

Meclizine is a commonly prescribed medication, but is ineffective for this condition. Other sedative medications help mask the symptoms associated with BPPV but do not effect the disease process or resolution rate. Serc is available in some countries and is commonly prescribed but again it is likely ineffective. Particle repositioning remains the current gold standard treatment for most cases of BPPV.

Surgical treatments, such a semi-circular canal occlusion, do exist for BPPV but carry the same risk as any neurosurgical procedure. Surgery is reserved for severe and persistent cases which fail particle repositioning and medical therapy.

[edit] See also

Vestibular system

[edit] References

^ von Brevern M, Seelig T, Radtke A, et al. (2006). "Short-term efficacy of Epley's maneuver: a double-blind randomised trial". J Neurol Neurosurg Psychiatr 77: 980–82.
^ Furman JM, Cass SP, Briggs BC. (1998). "Treatment of benign positional vertigo using heels-over-head rotation.". Ann Otol Rhinol Laryngol 107:: 1046–53..