Med Aspects 2- BPPV

Peripheral vestibulardisorder (comes from innerear not brainstem); freefloatingparticles in theendolymph of the SCC, 20%of dizziness is related toBPPV, results from damageto the delicate sensory unitsof the inner ear, SCC andotolith organs

Mean age of onset is 54years (11-84 years; 50-70most common)

64% of cases are women. No evidence of ethnicity indiactors.

11-64 per 100,000; lifetimeprevalence of 2.4%;uncommon to havebilateral BPPV

15-50% due to ear traumaor infection

Dizziness, vertigo,accompanying nystagmus(torsional and vertical),lightheadedness,imbalance/disequilibrium,nausea, postural instability;Patient complaints: illusionthat you or environmentare moving, occurs whileroling into lateral positionin bed, occurs from gazingupward/bendingforward/fast neck turn

Vestibular case history, ENGto rule out other vestibularor neurological symptomsand to measure nystagmusto determine type of BPPV,Dix-Hallpike - positive hasburst of nystagmus, can bemade more sensitive withFrenzel goggles

Characteristics: episodic,elicited by rotationalmovement, lower bonedensity scores associatedw/ recurrent BPPV

Canalithiasis: most commonform of BPPV, displacementof otoconia causing them tobe free-cloating in a SCC,later onset (10-40 seconds)and shorter duration ofnystagmus Cupulolithiasis:rare form of BPPV,displacement of otoconiacausing them to attach tothe cupula in a SCC,immediate onset and longerduration of nystagmus willbe seen Variant forms:posterior canal - 90% ofcases, canalithiasis andcupulothiasis are causativefactors, down side ear isaffected during Dix-Hallpike, geotropic rotarynystagmus; Anterior canal -4%, up facing ear provokedduring Dix-Hallpike;Horizontal canal - 6%,provoked when pt. liessupine and head is movedright and left, horizontalgeotropic nystagmusobserved while pt. isvertiginous

NO- so pure tone, speech, tymps, OAEs, and ABR will be normal.

Common causes: otoconiamigrating into SCC, headtrauma, degeneration ofvestibular system, viral,labrynthitis, prolonged bedrest, latrogenic

ENG: detects presence andtiming of nystagmus, calorictest is abnormil in 32-47%of patients; Infrarednystagmography: torionaleye movement can bedetected directly;Posturography: oftenabnormal but doesn'tfollow a predictable pattern

Watchful waiting, vestibulosuppressant medication,canalith reposition,vestibular rehabilitationtherapy, posterior canalplugging, singular nervesection

20

11-64/100, 000. Around 2.4% of population. 50-70 age group- most common in women. Usually a unilateral problem. 15-50% due to ear trauma.