BPPV
POSITIONING VERTIGO—-NOT POSITIONAL
BPPV—-BRIEF PAROXYSMS OF POSITION INDUCED GEOTROPHIC VERTICO-TORSIONAL NYSTAGMUS—–PROBABLY DIVIDED INTO SHUETNECKS CUPULOLITHIASIS (OTOLITHS IMPREGNATED IN GELATENOUS MEMBRANE) <1/3 (ONCE THOUGHT TO BE A POST MORTEM ARTIFACT) AND CANALOLITHIASIS >2/3—-DO TO THE FACT THAT IT CAN BE CURED BY POSITIONING MANEUVERS
1ST DESCRIBED BY BARANY IN 1921—-THEN HALLPIKE & DIX IN 1952
PRIMARILY DUE TO OTOCONIA (FROM THE OTOLITHIC ORGANS (UTRICLEAND SACCULE) MIGRATING INTO THE POST SCC (STATOCONIA)—-OFTEN SECONDARY TO TRUAMA OR INFLAMMATION (VESTIBULAR NEURITIS)
RARELY THE HORIZINTAL CANAL AFFECTED—-ROTATORY NYSTAGMUS
POST SCC—-EWALD’S 1ST LAW–EYE MOVEMENT, HEAD MOVEMENT, AND PAST POINTING OCCUR IN THE SAME PLANE AND THE STIMULATED CANAL—-PT EXPERIENCES TUMBLING SENSATION
EWALD’S 2ND LAW—EXCITATION IS MORE EFFECTIVE THAN INHIBITION IN CHANGING LABYRINTHIAN ACTIVITY (KINOCILIUM TOWARDS THE STEREOCILIUM LEADS TO DEPOLARIZATION–FIRING)—-HORIZONTAL CANAL(1) AMPULOPETAL FLOW CAUSES INCREASED RESPONSE, VERTICAL CANALS(2) AMPULOFUGAL FLOW CAUSES INCREASED RESPONSE
POST SCC—STIMULATES IPSI SUP OBLIQUE AND CONTRA INF OBLIQUE
GET A TRANSIENT BURST OF VERTICO-TORSIONAL NYSTAGMUS (PTS EXPERIENCE A TUMBLING SENSATION)
THE SUP POLE OF THE GLOBES BEAT GEOTROPHICALLY—-MORE VERTICAL WHEN LOOKING TOWARD THE UP (WELL) EAR AND MORE TORSIONAL WHEN LOOKING DOWN TO THE SICK EAR—REVERSES TO AGEOTROPHIC NYSTAGMUS WHEN RETURNING TO A SITTING POSITION
PTS TEND TO SLEEP ON THEIR WELL EAR
FALL AWAY FROM THE AFFECTED EAR(TOWARD SLOW PHASE)
PPN (PAROXYSMAL POSITIONING NYSTAGMUS)—-ACCOMPANIED BY VERTIGO!
NYSTAGMUS TOWARD THE AFFECTED EAR
LATENCY—5-15 SECOND (CAN BE UP TO 45 SECONDS)
FATIGUABLE—-ALSO LATENCY INCREASES WITH REPRODUCTION OF THE POSITIONING MANEUVERS
SHORT DURATION (AROUND 15-50 SECONDS)
DIRECTION SPECIFIC—-REVERSIBLE ON RESUMPTION OF UPRIGHT POSITION—NEVER CHANGES
SUPPRESSED BY VISUAL FIXATION
WORSENED BY FRENZELS
REPRODUCIBLE
COMPLETELY NL AUDIO
Dx: Hx ALONE—HALLPIKE-DIX
Rx: IMMEDIATE REPOSITIONING MANEUVERS(EPPLEY/SEMONT)—+/- MASTOID OSCILLATOR
D/C VESTIB SUPPRESSANTS, VESTIB REHAB—CAWTHORNE EXCERCISES
POST SCC PLUGGING PROCEDURE—BONE WAX OR BONE DUST OR FASCIA—DRILL OUT THE MEMBRANOUS CANAL AND THEN SMUSH IT—ALMOST NO CHANCE OF HEARING LOSS, SINGULAR NEURECTOMY——BE SLOW TO OPERATE (>1 YEAR) AS THIS IS ALMOST ALWAYS A SELF LIMITING DISEASE
ETOH INTOXICATION CAN CAUSE A GEOTROPHIC POSITIONAL NYSTAGMUS IN THE FIRST 8 HOURS (ETOH MAKES THE CUPULA BOYANT)—THEN AS METABOLIM PROCEEDS–AFTER 8 HOURS—AN AGEOTROPHIC POSITIONAL NYSTAGMUS
MADE WORSE BY CLOSING THE EYES AND BETTER BY VISUAL SUPPRESSION—-”THE SPINS” OF INTOXICATION