Benign Paroxysmal
Positional Vertigo
Dr Ahmad Alamadi MB chB, FRCS
Consultant Otologist and ENT Surgeon
Al Baraha Hospital
BPPV
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Commonest vestibular disorder
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Incident 20: 100000
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Coexist with other vestibular disorders
Pathophysiology
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Floating particles originating from the
otoliths in the utricle.
Pathophysiology
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original theory of cupulolithiasis (i.e.
particles attached to cupula)
Etiology
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Spontaneous
Viral
Traumatic
Meniere’s disease
Post surgery
Migraine?
History
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Four steps
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Sharp clear history
True rotatory vertigo
No neurological history
Positional( head up & turn in bed) lasting for
seconds only, multiple attacks, no other ear
symptoms
Examination
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Four Steps
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Otologic examination normal
Neurological examination normal
Special vestibular tests normal
Diagnostic Dix-Hallpike manoeuvre rotatory
geotropic nystagmus on the affected side( can
have up to 10 sec delay) in post canal BPPV and
horizontal nystagmus in lateral BPPV
Management
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Particle Repositioning Manoeuvre (PRM)
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Barrel roll by Eply for lateral canal BPPV
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Brandt-Daroff exercises for
cupulolithiasis
Surgical Management
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Posterior canal occlusion
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Singular neurectomy