BPPV

Question 1

What is the pathophysiology of BPPV?

Answer 1

Episodic vertigo

• Provoked by sudden change in head position or when lying down
• Episodes last < 2 minute

Question 2

How does a positive Dix-Hallpike manoeuvre look like?

Answer 2

• Nystagmus and vertigo usually appear with a latency of a few seconds and last less than 30 seconds
• It has a typical trajectory, beating upward and torsionally, with the upper poles of the eyes beating toward the ground
• After it stops and the patient sits up, the nystagmus will recur, but in the opposite direction
• The patient should then have the manoeuvre repeated to the same side; with each repetition, the intensity and duration of nystagmus will diminish

Question 3

How is BPPV managed?

Answer 3

Epley manoeuvre

Recurrent/persistent & refractory to treatment

• Chemical ablation of vestibular system
• Vestibular nerve section
• Posterior SCC plugging

Self-treatment exercises

• Brandt-Daroff exercises (different from Cooksey-Cawthorne exercises, which is a kind of vestibular rehabilitation therapy)
• Modified Epley manoeuvre
• Modified Semont manoeuvre