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bppv controversies

BJB. Is the standard Dix-Hallpike procedure sufficient to diagnose positional vertigo?. Positional Vertigo from Canal LithiasisMathematical models predict latencies and magnitudes consistent with clinical observationMagnitude = total weight of particlesLatency = time to move from ampulla to apexTrans-cupular pressure is generatedIncreased as particles move through narrowing ductAverage 5sec to transitOne otoconia= 30pL and 2 deg/sec nystagmusRajguru SM Ann Biomed Eng 2004 Jun;32(6):831-9445

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bppv controversies

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    1. BPPV Controversies Ben J. Balough CDR, MC, USNR Department of Otolaryngology Naval Medical Center San Diego

    2. BJB Is the standard Dix-Hallpike procedure sufficient to diagnose positional vertigo? Positional Vertigo from Canal Lithiasis Mathematical models predict latencies and magnitudes consistent with clinical observation Magnitude = total weight of particles Latency = time to move from ampulla to apex Trans-cupular pressure is generated Increased as particles move through narrowing duct Average 5sec to transit One otoconia= 30pL and 2 deg/sec nystagmus Rajguru SM Ann Biomed Eng 2004 Jun;32(6):831-46 Squires J Biomech 2004 Aug;37(8):1137-46

    3. BJB Is the standard Dix-Hallpike procedure sufficient to diagnose positional vertigo? CT and MRI imaging demonstrate that PSSC can vary greatly in relation to sagital plane1 Recent descriptions of alternative diagnostic manuevers for PSSC BPV2 Alternative canals Lateral Canal Anterior Canal 1 Relationship Between 3-D Labyrinth Anatomy and 3-D eye rotations: I Curthoys, Barany meeting: Paris 2004 2 Side lying as an alternative to the Dix-Halpike Test of the Posterior Canal. Cohen HS, Otol & Neurotol 2004;2:130-4

    4. BJB Variations on Epley CRP Should we do anything? CRP more effective than placebo1 Most report improved symptoms, but still +DHT2 Mastoid oscillation No improvement in success or avoiding recurrence3,4 Post-procedure restrictions No additional benefit5 Semont Procedure Also efficacious 1 Chang AK, Schoeman, Hill M, Acad Emerg Med 2004 Sep(11)9:918-924 2 Woodworth, Gillespie, Lambert Laryngoscope 2004 Jul;114(7):1143-6 3 Motamed Laryngoscope 2004 Jul;114(7):1296-8 4 Macias JD Laryngoscope. 2004 Jun;114(6):1011-4 5 Gordon CR, Gadoth N. Acta Neurol Scand 2004 Sep;110(3):166-9

    5. BJB What are the causes of failures of a procedure to adequately treat classical posterior canal BPPV ? Wrong Canal Canal conversion Wrong Diagnosis: Non canal lithiasis positional vertigo Cupular disease Vascular causes CNS tumors

    6. BJB What are the causes of failures of a procedure to adequately treat classical posterior canal BPPV ? Recurrent PSSC BPPV Calcium Supplementation Prophylactic Excersises Brandt-Daroff Surgical Management Singular neurectomy PSSC occlusion Reserve for unique circumstances

    7. BJB What Procedure Do You Utilize to Treat Lateral Canal Positional Vertigo �Log roll� or Lempert Procedure More symptomatic than standard CRP Pre-medicate, have someone assist patient home

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