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ENT
Benign Paroxysmal Positional Vertigo
Built from Haynes-Glasscock-Shambaugh Surgery of the Ear, Seventh Edition
What’s inside
5 sections · 92 slides
Overview and Epidemiology
- Definition of BPPV
- Historical description of BPPV
- Prevalence of vertigo and BPPV
- Incidence and demographic pattern
- Delays in diagnosis and treatment
Pathophysiology
- Normal vestibular sensing
- Return to baseline after head rotation
- Canalithiasis versus cupulolithiasis
- Canalithiasis and cupulolithiasis in the labyrinth
- Origin of the canaliths
- Otoconia retrieved from the posterior canal
- Primary versus secondary BPPV
- Causes of secondary BPPV
- Distribution of BPPV by semicircular canal
- Why the posterior canal predominates
- Ewald's laws in clinical use
- Ewald's laws on vestibular physiology
- Mechanism of nystagmus in posterior canal BPPV
- Slow and fast phases of the evoked nystagmus
- Horizontal canal canalithiasis
- Horizontal canal cupulolithiasis
- Characteristic nystagmus associated with horizontal canal BPPV
Diagnosis
- Characterising the vertigo on history
- Provocative head movements
- Duration and clustering of attacks
- Duration of vertigo across vestibular disorders
- Screening the history for secondary causes
- Red flags for a central lesion
- Differentiating features of BPPV versus central vertigo
- Neurotologic examination before positional testing
- Dix-Hallpike manoeuvre technique
- Positioning for the Dix-Hallpike manoeuvre
- Accuracy of the Dix-Hallpike and the head-hang caveat
- Nystagmus after a positive Dix-Hallpike
- Nystagmus profile in posterior canal BPPV
- Supine head roll for horizontal canal BPPV
- Horizontal canal nystagmus characteristics
- Superior canal BPPV on Dix-Hallpike testing
- Role of ancillary vestibular testing
Nonsurgical Management
- Natural history and prognosis
- Observation and drug treatment
- Semont liberatory manoeuvre
- Sequential positions of the Semont manoeuvre
- Efficacy and practical limits of the Semont manoeuvre
- Epley canalith repositioning procedure
- Particle repositioning manoeuvre
- Particle repositioning manoeuvre: positions A to D
- Particle repositioning manoeuvre: first three steps
- Particle repositioning manoeuvre: final steps
- Labyrinthine particle movement during repositioning
- Reading nystagmus to confirm repositioning
- Post-manoeuvre restrictions and mastoid oscillation
- Follow-up after canal repositioning
- Treatment principles in horizontal canal BPPV
- Barbecue roll manoeuvre
- Gufoni manoeuvre
- Forced prolonged positioning
- Treatment of superior canal BPPV
- Subjective BPPV
- Post-traumatic and bilateral BPPV
- Adverse effects of repositioning manoeuvres
- Approach to repeated treatment failure
Surgery
- Indications for surgical intervention
- Preoperative assessment
- Two surgical options for intractable BPPV
- Singular neurectomy: surgical approach
- Physiological consequence of singular neurectomy
- Outcomes and hearing risk of singular neurectomy
- Rationale for posterior semicircular canal occlusion
- Development and hearing safety of canal occlusion
- Outcomes of posterior canal occlusion
- Posterior canal occlusion: operative steps
- Mastoid exposure of the posterior canal and fenestration
- Plugging materials and technique variations
- Summary: diagnosis
- Summary: treatment
- References
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- References (continued)
- Haynes-Glasscock-Shambaugh Surgery of the Ear, Seventh Edition
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