Benign paroxysmal positional vertigo

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**Benign paroxysmal positional vertigo**
*Classification & 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 otoconia. In patients, the otoconia are dislodged from their usual position within the utricle and they migrate over time into one of the semicircular canals (the posterior canal is most commonly affected due to its anatomical position). When the head is reoriented relative to gravity, the gravity-dependent movement of the heavier otoconial debris within the affected semicircular canal causes abnormal (pathological) fluid endolymph displacement and a resultant sensation of vertigo (medical). This more common condition is known as canalithiasis. In rare cases, the crystals themselves can adhere to a semicircular canal cupula rendering it heavier than the surrounding endolymph. Upon reorientation of the head relative to gravity, the cupula is weighted down by the dense particles thereby inducing an immediate and maintained excitation of semicircular canal afferents afferent nerve. This condition is termed cupulolithiasis.

[edit] Presentation

The primary symptom is the sudden onset of severe vertigo (medical) and nystagmus (see a video of nystagmus related to BPPV) 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 (medical) is brief in duration — 5 seconds to 30 seconds.

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 maneuver which is diagnostic for the condition. The test involves a reorientation of the head to align the posterior canal (at its entrance to the ampulla) with the direction of gravity. This test stimulus is effective in provoking the symptoms in subjects suffering from archetypal PC-BPPV.

[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..