Benign Paroxysmal Positional Vertigo BPPV

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

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

Requirements for Balance Vestibular system Propriception Visual system CNS integration

Schematic Diagram of Human Vestibular System

Common Vestibular Pathologies BPPV Labyrinthitis Vestibular Neuritis/ Neuronitis Menieres Disease

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

Labyrinthitis Referral to audiologist for audiological assessment and Videonystagmography Usually looking for a unilateral vestibular weakness on caloric test

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.

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

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

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

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

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

Pathophysiology Diagram of vestibule

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.

Diagnosis Suggestive history Physical examination Dix Hallpike Manuerver (DHM) Vestibular tests VNG

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

Dix Hallpike Maneurver

BPPV