Benign paroxysmal positional vertigo: Difference between revisions
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==Treatment== | ==Treatment== | ||
*Epley maneuver | *Epley maneuver: | ||
**Dix-Hallpike maneuver plus additional maneuvers to replace the migrated otolith | **Dix-Hallpike maneuver plus additional maneuvers to replace the migrated otolith | ||
**Each step should be done slowly (about 30s) | **Each step should be done slowly (about 30s) | ||
**May require multiple attempts | **May require multiple attempts, but you can d/c pt home with daily exercises | ||
* | **See link below for YouTube How-To videos | ||
**Scopolamine transdermal patch 0.5mg (behind ear) QID | *Medical management: | ||
** | **Antihistamines | ||
***Diphenhydramine (Benadryl) 25-50mg IM/IV/PO q4hr | |||
***Meclizine (Antivert, Antrizine, Dramamine) 25mg PO QID | |||
***Promethazine (Phenergan, Anergan, Prorex) 12.5-25mg PO/IM/IV q4-6hr | |||
**Anticholinergic | |||
***Scopolamine transdermal patch 0.5mg (behind ear) QID | |||
**Benzodiazepines | |||
***Lorazepam (Ativan), diazepam (Valium) or Klonopin (Clonazepam) | |||
===Epley Maneuver=== | ===Epley Maneuver=== | ||
[[File:Epley.jpg]] | [[File:Epley.jpg]] | ||
Revision as of 05:42, 31 December 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, but you can d/c pt home with daily exercises
- See link below for YouTube How-To videos
- Medical management:
- Antihistamines
- Diphenhydramine (Benadryl) 25-50mg IM/IV/PO q4hr
- Meclizine (Antivert, Antrizine, Dramamine) 25mg PO QID
- Promethazine (Phenergan, Anergan, Prorex) 12.5-25mg PO/IM/IV q4-6hr
- Anticholinergic
- Scopolamine transdermal patch 0.5mg (behind ear) QID
- Benzodiazepines
- Lorazepam (Ativan), diazepam (Valium) or Klonopin (Clonazepam)
- Antihistamines
Epley Maneuver
Disposition
- Refer pts w/ persistent symptoms to ENT
See Also
Source
- UpToDate
- How to do Epley Manuever: http://www.youtube.com/watch?v=7ZgUx9G0uEs
- Dix-Hallpike and Epley Maneuvers for BPPV, in Claymation: http://www.youtube.com/watch?v=eOuzUi5ckrk