Benign Paroxysmal Positional Vertigo

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Benign Paroxysmal Positional Vertigo

• Dr Ahmad Alamadi MB chB, FRCS
• Consultant Otologist and ENT Surgeon
• Al Baraha Hospital

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BPPV

• Commonest vestibular disorder
• Incident 20 100000
• Coexist with other vestibular disorders

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Pathophysiology

• Floating particles originating from the otoliths
  in the utricle.

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Pathophysiology

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

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Etiology

• Spontaneous
• Viral
• Traumatic
• Menieres disease
• Post surgery
• Migraine?

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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

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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

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Management

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

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Surgical Management

• Posterior canal occlusion
• Singular neurectomy