Benign paroxysmal positional vertigo

Overview

• Definition: A type of peripheral vertigo caused by the displacement of otoconia (tiny calcium particles) into the semicircular canals of the inner ear.
• Most common cause of vertigo.

Etiology

• Often idiopathic.
• Head trauma.
• Inflammation of the inner ear.
• Age-related changes.
• After periods of prolonged bed rest.

Clinical Features

• Recurrent episodes of positional vertigo: Intense, brief episodes triggered by changes in head position.
• Nausea and vomiting may accompany vertigo episodes.
• Nystagmus: A characteristic type of eye movement that occurs with head positioning.

Diagnosis

• Dix-Hallpike test: Patient rapidly moved from a seated position to lying down with the head turned and extended. A positive test shows vertigo and nystagmus.
• Ruling out other causes: Important as other conditions may have similar symptoms.

Management

• Epley manoeuvre: Repositioning technique to move otoconia out of the semicircular canals.
• Brandt-Daroff exercises: A series of movements to help alleviate symptoms.
• Medications: Short-term use of vestibular suppressants like prochlorperazine or antihistamines.
• Balance therapy: Vestibular rehabilitation to help improve symptoms in chronic cases.

Prognosis

• Typically self-limiting with episodes lasting seconds to minutes.
• Can recur in some patients.

Key Points

• BPPV is the most common cause of vertigo and is due to displaced otoconia in the semicircular canals.
• Positional testing (Dix-Hallpike) is diagnostic, and repositioning manoeuvres (Epley) are the mainstay of treatment.
• Recurrences are common and can be managed with repeat manoeuvres or vestibular rehabilitation.

Remember, while BPPV is commonly encountered, it’s crucial to distinguish it from other causes of vertigo, especially central causes which can be indicative of more serious underlying pathology. Always refer to clinical guidelines for a comprehensive approach.