Benign paroxysmal positional vertigo: Difference between revisions
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*Mean age is mid-50s; women are twice as likely to be affected as men | *Mean age is mid-50s; women are twice as likely to be affected as men | ||
*Mean duration is 2 weeks | *Mean duration is 2 weeks | ||
==Clinical Features== | ==Clinical Features== | ||
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*Symptoms worse in the morning (symptoms fatigue as day goes on) | *Symptoms worse in the morning (symptoms fatigue as day goes on) | ||
*No associated hearing loss or tinnitus | *No associated hearing loss or tinnitus | ||
==DDX== | ==DDX== | ||
See [[Vertigo#DDX|Vertigo]] | See [[Vertigo#DDX|Vertigo]] | ||
==Diagnosis== | ==Diagnosis== | ||
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***Positive test = onset of nystagumus after few seconds of latency and lasting <30s | ***Positive test = onset of nystagumus after few seconds of latency and lasting <30s | ||
***If pt has positive test with head turned to right then right ear is affected | ***If pt has positive test with head turned to right then right ear is affected | ||
==Treatment== | ==Treatment== | ||
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**Scopolamine transdermal patch 0.5mg (behind ear) QID | **Scopolamine transdermal patch 0.5mg (behind ear) QID | ||
**Diphenhydramine (benadryl) 25-50mg IM, IV, or PO q4hr or meclizine 25mg PO QID | **Diphenhydramine (benadryl) 25-50mg IM, IV, or PO q4hr or meclizine 25mg PO QID | ||
===Epley Maneuver=== | ===Epley Maneuver=== | ||
[[File:Epley.jpg]] | [[File:Epley.jpg]] | ||
==Disposition== | ==Disposition== | ||
*Refer pts w/ persistent symptoms to ENT | *Refer pts w/ persistent symptoms to ENT | ||
==See Also== | ==See Also== | ||
*[[Vertigo]] | *[[Vertigo]] | ||
*[[Dizziness]] | *[[Dizziness]] | ||
==Source== | ==Source== | ||
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[[Category:ENT]] | [[Category:ENT]] | ||
[[Category:Neuro]] | [[Category:Neuro]] | ||
Revision as of 14:06, 21 June 2013
Background
- Due to canalolithiasis (migration of otoconia into one of the semicircular canals)
- Mean age is mid-50s; women are twice as likely to be affected as men
- Mean duration is 2 weeks
Clinical Features
- Sudden-onset vertigo and associated nystagmus precipitated by head movements
- Latency period <30s between provocative head position and onset of nystagmus
- Intensity of nystagmus increases to a peak before slowly resolving
- Duration of vertigo and nystagmus ranges from 5–40s
- Repeated head positioning causes vertigo and nystagmus to fatigue and subside
- Nystagmus reverses direction during the head down and head up portions of Dix-Hallpike
- Nausea/vomiting common
- Symptoms worse in the morning (symptoms fatigue as day goes on)
- No associated hearing loss or tinnitus
DDX
See Vertigo
Diagnosis
- Dix-Hallpike Maneuver (50-80% Sn)
- Contraindications:
- Carotid bruits
- Cerebrovascular disease
- Concern for vertebrobasilar insufficiency
- Spinal injury
- Cervical spondylosis
- Procedure
- Step 1 of the Epley maneuver (see below)
- Positive test = onset of nystagumus after few seconds of latency and lasting <30s
- If pt has positive test with head turned to right then right ear is affected
- Contraindications:
Treatment
- Epley maneuver
- Dix-Hallpike maneuver plus additional maneuvers to replace the migrated otolith
- Each step should be done slowly (about 30s)
- May require multiple attempts; pt can perform on own at home
- Meds
- Scopolamine transdermal patch 0.5mg (behind ear) QID
- Diphenhydramine (benadryl) 25-50mg IM, IV, or PO q4hr or meclizine 25mg PO QID
Epley Maneuver
Disposition
- Refer pts w/ persistent symptoms to ENT
See Also
Source
- UpToDate