Download Benign Paroxysmal Positional Vertigo (BPPV) causes dizziness due

Benign Paroxysmal Positional Vertigo (BPPV)
Cause: debris (calcium carbonate crystals) in the inner part of the ear.
They are a number of reasons why they form but in 50% of cases there is no obvious
cause (idiopathic). There is nothing you can do to prevent it happening.
Features:
 Symptoms: Vertigo, the feeling like you are on a rocking boat, imbalance, and
nausea.
 Symptoms brought on by head movement.
Commonly rolling over or getting up first thing in the morning or looking up.
 Symptoms are worse first thing in the morning and improve over the day only
to be worse again the following morning
 An intermittent pattern is the usual situation. BPPV may be present for a few
weeks, then stop, and then come back again.
The Diagnosis of BPPV:
The diagnosis based on your history, findings on physical examination, and the
results of vestibular and auditory tests. Blood
pressure will be checked lying flat and standing.
The Dix-Hallpike test, also called the "Hallpike" is the
definitive diagnostic test for Benign Paroxysmal
Positional Vertigo (BPPV).
This figure illustrates the Dix-Hallpike test for BPPV. A
person is brought from sitting to a supine position,
with the head turned 45 degrees to one side and
extended about 20 degrees backward. Once supine,
the eyes are typically observed for about 30 seconds.
If no nystagmus ensues, the person is brought back to
sitting. There is a delay of about 30 seconds again,
and then the other side is tested.
When doing the Dix-Hallpike on a flat table, it is often
helpful to place a flat "boat" cushion under the
persons back, to obtain head extension. One of these
is illustrated below (in the mat-table illustration)
If the person has arthritis in their neck, the manoeuvre may be performed in sidelying position. A positive Dix-Hallpike tests consists of a burst of nystagmus (jumping
of the eyes). In classic posterior canal BPPV, the eyes jump upward as well as twist
so that the top part of the eye jumps toward the down side.
The Treatment of BPPV:
There are two exercises that both you and your doctor can perform to help. Both are
very effective, with roughly an 80% cure rate.
The manoeuvres attempt to move the debris out of the sensitive back part of the ear
to a less sensitive location.
The Semont manoeuvre involves a procedure whereby the patient is rapidly moved
from lying on one side to the other.
This is for left ear BPPV
For right ear BPPV, start with the head turned to the right and perform it in the opposite
direction.
1. Start by sitting on a bed with your head turned 45 degrees to the left. Place a pillow behind
you so that on lying back it will be under your shoulders.
2. Lie back quickly with your
shoulders on the pillow, neck
extended and head resting on
the
bed. In this position, the affected
(left) ear is underneath. Wait for
30
seconds.
3. Turn your head 90 degrees to
the
right (without raising it) and wait
again for 30 seconds.
4. Turn your body and head
another 90 degrees to the right
and
wait for another 30 seconds.
5. Sit up on the right side.
Repeat this three times daily
until you are free from positional vertigo for 24 hours.
The Epley manoeuvre involves sequential movement of the head into four positions.
The recurrence rate for BPPV after these manoeuvres is about 5 percent, and in
some instances a second treatment may be necessary.
This is for left ear benign paroxysmal positional vertigo.
For right ear, start with the head turned to the left and perform in opposite direction.
1. Sit upright on a bed with your head turned 45 degrees toward the right ear.
2. Drop quickly to the left side, so that your head touches the bed behind your left ear. Wait
30 seconds.
3. Move head and trunk in a swift movement toward the other side without stopping in the
upright position, so that your head comes to rest on the right side of your forehead. Wait
again for 30 seconds.
4. Sit up again. Repeat this three times
daily until you are free from positional
vertigo for 24 hours.
You may experience bad vertigo, as well as
nausea and vomiting, during the first few
times on these exercises. Ask your doctor if
you need medications or anti-vomiting
drugs.