A common cause of recurrent vertigo triggered by head movement.
An inner ear issue (peripheral vertigo) more common in older adults
Aetiology: common after a head injury
BPPV is caused by crystals of calcium carbonate called otoconia that become displaced into the semicircular canals. This occurs most often in the posterior semicircular canal. They may be displaced by a viral infection, head trauma, ageing or without a clear cause.
The semicircular canals contain stereocilia which respond to movement and relay signals via CNVIII, the displacement of the crystals into the semicircular canals disrupt the normal flow of endolymph and the signals and cause the vertigo.
Until the crystals are dissolved or moved out of the canals, the canal may not work properly and chronic disequilibrium and positional vertigo may be present
A variety of head movements can trigger attacks of vertigo. A common trigger is turning over in bed. Symptoms settle after around 20 – 60 seconds, and patients are asymptomatic between attacks. Often episodes occur over several weeks and then resolve but can reoccur weeks or months later.
The attacks can be accompanied by nausea and vomitting
BPPV does not cause hearing loss or tinnitus.
Dix-Hallpike manouevre -
It involves moving the patient’s head in a way that moves endolymph through the semicircular canals and triggers vertigo in patients with BPPV.
In patients with BPPV, the Dix-Hallpike manoeuvre will trigger rotational nystagmus and symptoms of vertigo. The eye will have rotational beats of nystagmus towards the affected ear (clockwise with left ear and anti-clockwise for right ear BPPV).
Epley manoeuvre - The Epley manoeuvre can be used to treat BPPV. The idea is to move the crystals in the semicircular canal into a position that does not disrupt endolymph flow.