Benign paroxysmal positional vertigo: Difference between revisions

No edit summary
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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==
See [[Vertigo#DDX]]


==Diagnosis==
==Diagnosis==
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***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==
*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
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==Disposition==
==Disposition==
*Refer pts w/ persistent symptoms to an ENT
*Refer pts w/ persistent symptoms to an ENT
==See Also==
*[[Vertigo]]


==Epley Maneuver==
==Epley Maneuver==

Revision as of 21:30, 31 March 2012

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#DDX

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

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

Disposition

  • Refer pts w/ persistent symptoms to an ENT

Epley Maneuver

Epley.jpg

See Also

Source

  • UpToDate