Benign Positional Paroxysmal Vertigo

Vertigo caused by the presence of otoliths in the semi-circular canal instead of the utricle; most common cause of vertigo on looking up

Aetiology

  • Head trauma
  • Ear surgery
  • Idiopathic

Pathophysiology

  • Once in the canal, movement of the patient’s head will result movement of the otoliths, causing an abnormal movement of endolymph which results in vertigo

Clinical presentation

Vertigo on:

  • Looking up
  • Turning in bed - often worse to one side
  • First lying down in bed at night
  • Getting out of bed in the morning
  • Bending forward
  • Rising from bending
  • Moving head quickly - often only in one direction
  • Attacks will last seconds

Other symptoms

  • Nausea and vomiting

Investigations

  • The diagnostic examination for BPPV is the Dix-Hallpike manoeuvre, with a positive test invoking the symptoms and geotropic, tortional nystagmus will be present

Management

Treatment is with repositioning manoeuvres:
  • Epley manoeuvre
  • Selmont manoeuvre
  • Brandt-Daroff exercises