Benign paroxysmal positional vertigo
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
Source(s): Benign Paroxysmal Positional Vertigo (BPPV)
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
Source(s): Benign Paroxysmal Positional Vertigo (BPPV)
DDX
See Vertigo
Source(s): Benign Paroxysmal Positional Vertigo (BPPV)
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:
Source(s): Benign Paroxysmal Positional Vertigo (BPPV)
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
Source(s): Benign Paroxysmal Positional Vertigo (BPPV)
Epley Maneuver
Source(s): Benign Paroxysmal Positional Vertigo (BPPV)
Disposition
- Refer pts w/ persistent symptoms to ENT
Source(s): Benign Paroxysmal Positional Vertigo (BPPV)
See Also
Source(s): Benign Paroxysmal Positional Vertigo (BPPV)
Source
- UpToDate
Source(s): Benign Paroxysmal Positional Vertigo (BPPV)