Benign paroxysmal positional vertigo

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Benign paroxysmal positional vertigo Classification and external resources

Exterior of labyrinth.

ICD-10 ICD!"I"

H81.1 386.11 1 3!!"

DiseasesDB 13## e"edicine ent$"61 emerg$%" neuro$#11 "e#$ &!1#"1"

Benign paroxysmal positional vertigo '())*+ or %enign paroxysmal vertigo '()*+ is a con,ition cause, by problems in the inner ear.

Contents
-hi,e.

1 /ause 0 1riggers 3 )resentation # &iagnosis % 1reatment 6 2ee also " 3eferences

8 External lin4s

&edit' Ca(se
5ithin the labyrinth of the inner ear lie collections of calcium crystals 4no6n as otoconia. 7n patients 6ith ())*, the otoconia are ,islo,ge, from their usual position 6ithin the utricle an, they migrate over time into one of the semicircular canals 'the posterior canal is most commonly affecte, ,ue to its anatomical position+. 5hen the hea, is reoriente, relative to gravity, the gravity8,epen,ent movement of the heavier otoconial ,ebris 6ithin the affecte, semicircular canal causes abnormal 'pathological+ flui, en,olymph ,isplacement an, a resultant sensation of vertigo. 1his more common con,ition is 4no6n as canalithiasis. 7n rare cases, the crystals themselves can a,here to a semicircular canal cupula ren,ering it heavier than the surroun,ing en,olymph. 9pon reorientation of the hea, relative to gravity, the cupula is 6eighte, ,o6n by the ,ense particles thereby in,ucing an imme,iate an, maintaine, excitation of semicircular canal afferents afferent nerve. 1his con,ition is terme, c(p(lolithiasis.

&edit' )riggers
May vary from person to person

/hanges in barometric pressure 8 patients often feel symptoms approximately t6o ,ays before rain or sno6 :ac4 of sleep 're;uire, amount of sleep may vary 6i,ely+ *isual exposure to nearby moving ob<ects 'examples 8 cars, sno6+ 1ilting the hea, &ifferences bet6een visual stimuli an, the information receive, from the inner ear about one=s location in space.

&edit' *resentation
1he primary symptom is the su,,en onset of severe vertigo an, nystagmus that occurs exclusively 6ith hea, movement in the ,irection of the affecte, ear. )atients often ,escribe their first experience occurring 6hile turning their hea, in be,. 1he vertigo is brief in ,uration > % secon,s to 3! secon,s.

7t is often associate, 6ith nausea. )atients ,o not experience other neurological ,eficits such as numbness or 6ea4ness, an, if these symptoms are present, a more concerning etiology such as posterior circulation stro4e, must be consi,ere,.

&edit' Diagnosis
1he con,ition is ,iagnose, from patient history 'feeling of vertigo 6ith su,,en changes in positions+? an, by performing the &ix8Hallpi4e maneuver 6hich is ,iagnostic for the con,ition. 1he test involves a reorientation of the hea, to align the posterior canal 'at its entrance to the ampulla+ 6ith the ,irection of gravity. 1his test stimulus is effective in provo4ing the symptoms in sub<ects suffering from archetypal ())*. 1hese symptoms are typically a short live, vertigo, an, observe, nystagmus. 7n some patients, the vertigo can persist for years.

&edit' )reatment
1he treatment of choice for this con,ition is the Epley canalith repositional maneuver 6hich is effective in approximately 8!@ of patients-1.. 1he treatment employs gravity to move the calcium buil,8up that causes the con,ition+.-0. 1he particle repositioning maneuver 'Epley=s maneuver+ can be performe, ,uring a clinic visit by specially traine, otolaryngologists, neurologists, chiropractors, physical therapists, or au,iologists. 1he maneuver is relatively simple but fe6 general health practitioners 4no6 ho6 to perform it. A metho, 4no6n as the 2emont maneuver in 6hich patients themselves are able to achieve canalith repositioning has been sho6n to be effective.-3. &evices such as a hea, over heels Brotational chairB are available at some tertiary care centers -#. Home ,evices, li4e the &iCCyD7E, are also available for the treatment of ())* an, vertigo. -%. 1he Epley maneuver 'particle repositioning+ ,oes not a,,ress the actual presence of the particles 'otoconia+, rather it changes their location. 1he maneuver moves these particles from areas in the inner ear 6hich cause symptoms, such as vertigo, an, repositions them into areas 6here they ,o not cause these problems. FecliCine is a commonly prescribe, me,ication, but is ultimately ineffective for this con,ition, other than mas4ing the ,iCCiness. Gther se,ative me,ications help mas4 the symptoms associate, 6ith ())* but ,o not affect the ,isease process or resolution rate. 2erc is available in some countries an, is commonly prescribe, but again it is li4ely ineffective. )article repositioning remains the current gol, stan,ar, treatment for most cases of ())*.

2urgical treatments, such as a semi8circular canal occlusion, ,o exist for ())* but carry the same ris4 as any neurosurgical proce,ure. 2urgery is reserve, for severe an, persistent cases 6hich fail particle repositioning an, me,ical therapy.