Benign paroxysmal positional vertigo: Difference between revisions
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*How to do Epley Manuever: http://www.youtube.com/watch?v=7ZgUx9G0uEs | |||
*Dix-Hallpike and Epley Maneuvers for BPPV, in Claymation: http://www.youtube.com/watch?v=eOuzUi5ckrk | |||
[[Category:ENT]] | [[Category:ENT]] | ||
[[Category:Neuro]] | [[Category:Neuro]] |
Revision as of 05:20, 31 December 2013
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
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:
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
Epley Maneuver
Disposition
- Refer pts w/ persistent symptoms to ENT
See Also
Source
- UpToDate
- How to do Epley Manuever: http://www.youtube.com/watch?v=7ZgUx9G0uEs
- Dix-Hallpike and Epley Maneuvers for BPPV, in Claymation: http://www.youtube.com/watch?v=eOuzUi5ckrk