Benign Paroxysmal Positional Vertigo

Occurs on head movement due to disruption of small calcium crystals (canolithiasis) in the inner ear which can stimulate nerve endings causing dizziness

Causes/Factors

• Aging: BPPV is more common in older adults.
• Head Injury: Injuries to the head can cause dislodgment of crystals.
• Inner Ear Disorders: Other inner ear disorders can contribute.
• Vestibular Neuritis: Inflammation of the vestibular nerve.
• Lack of Movement: Extended periods of inactivity or bed rest can increase the risk.

Symptoms

• Vertigo: Brief episodes of intense spinning or dizziness triggered by changes in head position.
• Fatiguable Nystagmus: Involuntary rapid eye movements, usually in response to changes in head position.
• Nausea: Some individuals may experience nausea during episodes.

Diagnostic Tests

Diagnosing BPPV often involves a clinical examination and specific manoeuvres to induce and observe nystagmus:

• Dix-Hallpike Manoeuvre: Patient is sat up with their head at 45$°$ and then quickly lie them down with their head overhanging the couch. Nystagmus after 5-20 seconds is diagnostic
• Roll Test: Another manoeuvre that may be used to diagnose and treat BPPV - similar but moving head side to side

Management

Treatment of BPPV aims to reposition the displaced calcium crystals within the inner ear. This can be done through specific physical manoeuvres, including:

1. Epley Manoeuvre: A series of head and body movements to move the crystals out of the ear canal.
   1. Start by sitting on a bed.
   2. Turn your head 45 degrees to the right.
   3. Quickly lie back, keeping your head turned.
   4. Turn your head 90 degrees to the left, without raising it.
   5. Turn your head and body another 90 degrees to the left, into the bed.
   6. Sit up on the left side.
   7. Repeat on other side
2. Semont Manoeuvre: Another manoeuvre to reposition the crystals.

3. Brandt-Daroff Exercises: Home exercises to habituate the inner ear to position changes (head at 45$°$ and wait 15-30 seconds before sitting up again)

Complications/red Flags

• Recurrence: BPPV may recur in some individuals.
• Injury Risk: Dizziness during episodes can increase the risk of falls.