BPPV

This is the commonest of peripheral vertigo and is characterised by brief attacks of vertigo without any hearing loss and is precipitated by certain head positions.

It is believed to be due to the displacement of calcium carbonate crystals in the fluid filled canals of the inner ear. Movement of the head cause these crystals to move resulting in triggering the vertigo.

In majority of patients the cause is unknown. Sometimes it may occur following head injury or labyrinthitis.

The vertigo is characteristically provoked by turning over to a particular position in bed, bending down or reaching upwards in a particular direction. The vertigo lasts for seconds but never more than one minute. The patient does not usually complain of deafness or tinnitus.

While the history if quite characteristic, diagnosis is made by the Neuro-Otologist performing the Dix and Hallpike manoeuvre, which will elicit the classical positional nystagmus of BBPV.

A proportion of patients will resolve spontaneously. Majority of patients will be successfully treated using particle-repositioning manoeuvres such as the Epley’s or the Semont manoeuvre.
Only in a small minority where repeated manoeuvres fail to resolve the condition is surgical treatment indicated.

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