Vestibular / Vertigo
Benign paroxysmal positional vertigo (BPPV)
- BPPV is the most common cause of vertigo
- it can be diagnosed and treated via the Dix-Hallpike maneuver
- age or trauma can cause otoconia to detach from the utricle, and become lodged in a semicircular canal (usually the posterior canal)
- otoconia then move back and forth in response to changes in body position, creating movement of endolymph in the semicircular canal
- patient experiences vertigo and nystagmus when moving the head in the plane of the affected canal
- patient will prefer to lie with the affected ear up as this minimizes symptoms
- lag period of a few seconds
- patients feel as though they are violently thrown into a rolling spin, toppling toward the side of the affected ear
- symptoms have a very rapid onset, and usually dissipate within 20-30 seconds
- vertigo is also triggered by movement in the opposite direction (typically lesser amplitude, and the direction of the nystagmus is reversed)
- will often resolve on its own, however severe vertigo disrupts virtually every aspect of life, since the patient loses the ability to do anything normally, especially when movement is involved
- the Epley maneuver can return otoconia to the utricle