Benign paroxysmal positional vertigo: Difference between revisions

Revision as of 03:25, 4 October 2011

Otoconia are dislodged from utricle and migrate into one of the semicircular canals

Epley maneuver
- Dix-Hallpike maneuver plus additional maneuvers to replace the migrated otolith

Authors:

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+==Background==
+*Otoconia are dislodged from utricle and migrate into one of the semicircular canals
 ==Diagnosis==
+*Dix-Hallpike Maneuver (50-80% Sn)
+**Contraindications:
--first decide which ear affected- do Dix Hallpike test w head rotated to R and neck hyperextended and head hanging off bed- if get R sided nystagmus then R ear affected
+***Carotid bruits
+***Cerebrovascular disease
-- once decide which ear affected- do bedside manuever on that ear
+***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 lasting <30s
+***If pt has positive test with head turned to right then right ear is affected
 ==Treatment ==
+*Epley maneuver
+**Dix-Hallpike maneuver plus additional maneuvers to replace the migrated otolith
-L Ear Affected
-- place pt recumbant w head turned to left, head hanging off of bed and chin pointing up and wait for sxs to stop
-- then rotate head and body until R ear down
-- then rotate further until face down
-- vertex of head kept down throughout rotation
-- keep face down for 15 sec
-- bring pt back to seated position with head turned to R
-- now keep chin down
 [[File:Epley Maneuver.png]]
 ==Sources==
+*UpToDate
 [[Category:Neuro]]