Benign Paroxysmal Positional Vertigo

1. Benign Paroxysmal Positional Vertigo BPPV

2. Definition Of Vertigo • Vertigo is an illusion of movement of the person itself or the environment • Usually a symptom of an underlying condition • Diagnosis is therefore to identify the underlying condition and not to just treat the symptom

3. Dizziness • Dizziness is a broad term used to describe a variety of symptoms such as vertigo, unsteadiness, light-headedness, and other similar symptoms.

4. Requirements for Balance • Vestibular system • Propriception • Visual system • CNS integration

5. Schematic Diagram of Human Vestibular System

6. Common Vestibular Pathologies • BPPV • Labyrinthitis • Vestibular Neuritis/ Neuronitis • Menieres Disease

7. Labyrinthitis • Infection of the bony labyrinth • Includes the cochlear and vestibule • Severe attack of vertigo lasting days • Nausea and spinning leading to hospitalization for approximately 3 days • Associated unilateral hearing loss and Tinnitus- audiological examination indicated. Sudden Sensorineural hearing loss should therefore be treated as a medical emergency. • Usually viral • Vestibular suppressant and anti-emetics recommended – only during the acute phase • Extended use of vestibular suppressants inhibits recovery • Vestibular rehab exercises should begin immediately after the acute phase

8. Labyrinthitis • Referral to audiologist for audiologicalassessment and Videonystagmography • Usually looking for a unilateral vestibular weakness on caloric test

9. Vestibular Neuritis • Usually viral cause • Sudden onset of vertigo • Accompanied by nausea and vomiting • Lasting several hours- decreasing over 3/5 days – faster with vestibular suppressants • No associated hearing loss • Can be mild to permanent destruction of the nerve pathway.

10. Vestibular Neuritis • Audiogram essential for differential diagnosis • VNG usually indicating unilateral peripheral weakness

11. Menieres Disease • Increase in endolymph fluid and pressure in the labyrinth. • Patient complains of several episodes of severe vertigo and nausea lasting many hours • Hearing loss, Tinnitus, and pressure in the affected ear • Patient can localize the ear • Audiological examination reveals an asymmetrical hearing loss. • Vestibular suppressants and diuretics used

12. Menieres Disease • Audiogram shows distinct hearing loss pattern • Hearing fluctuates • VNG also shows a unilateral peripheral weakness

13. BPPV • Most common of episodic vertigo • 10 % of elderly population • Patient complains that he woke up, bent over, rolled over laid down, or sat up from bed – the room started to spin. • Lasted a few seconds to a minute – associated symptoms lasted a few hours • Mechanical dysfunction not an on going disease process

14. BPPV • Peripheral vestibular disorder – manifesting as sudden, short episodes of vertigo elicited by specific head movements • Can become chronic • Patients report that dizziness lasted hours- but actual vertigo lasted less than a minute. • Most common in posterior canal

15. Pathophysiology • Diagram of vestibule

16. Pathophysiology • The SCCs are C shaped tubes filled with endolymph • They are not gravity dependant • BPPV results from otoconia migrating from the utricle into the SCCs –Posterior mainly • Certain head movements cause the otoconia to move. Because they are heavier than the endolymph – gravity dependant – stimulating the hair cells.

17. Diagnosis • Suggestive history • Physical examination • Dix HallpikeManuerver (DHM) • Vestibular tests VNG

18. Nystagmus • In voluntary eye movement that is most often associated with acute vestibular pathology • Rotational up beating nystagmus • Delayed onset and fatigues

19. Dix Hallpike Maneurver

20. BPPV