This document describes a prospective clinical study on 50 patients with benign paroxysmal positional vertigo (BPPV). The study aims to examine the incidence of different BPPV types, efficacy of repositioning maneuvers, and impact on quality of life. Key findings include: 1) Posterior canal BPPV was most common (88%), 2) Epley's maneuver effectively treated posterior canal BPPV in 88% of cases, 3) BPPV significantly impacted quality of life through symptoms like fear of falling and anxiety. The study concludes that canal repositioning maneuvers should be the primary treatment for BPPV to effectively resolve symptoms and reduce psychosocial impacts.

1. DR ANJANA AVINASH MOHITE
ASSOCIATE PROF. IN ENT
DY PATIL MEDICAL COLLEGE KOLHAPUR
,MAHARASHTRA
INDIA

2. Benign paroxysmal positional vertigo (BPPV)
is the most common vestibular organ disorder
that presents an easy, cost- effective and
most successful treatment.

3. But unfortunately, BPPV is found to have a
substantial physical and psychosocial impact on
patients quality of life.
Furthermore leading to a significant medical cost
when diagnosed and treated incorrectly.
Hence the need for this study.

5. Patho-physiology of BPPV
Schuknecht Theory: (Cupulolithiasis)
Schuknecht proposed that calcium
deposits become embedded on the
cupula making the posterior
semicircular canal sensitive to gravity.
Hall & Ruby Theory: (Canalithiasis)
This theory proposed jointly by
Hall & Ruby suggests that the
calcium deposits does not become
adherent to the cupula of posterior
canal but floats freely within the
canal.

6. To study the incidence of different types of BPPV.
To study the efficacy of respective Particle
Repositioning Maneuvers.
To study the impact of BPPV on patients quality of
life.

7. INCLUSION CRITERIA EXCLUSION CRITERIA
 Both males and females.
 Age between 10 to 70 years.
 Presenting with symptoms
and signs of BPPV.
 Patients < 10 and > 70 years.
 Terminally ill and
debilitating patients.
 Central vertigo patients.

8. PROSPECTIVE
CLINICAL
STUDY ON
50 PATIENTS
ON OPD BASIS
Materials and Methods

9. Diagnostic Test:
Dix-Hallpike Test
for
Posterior canal BPPV
Superior canal BPPV
Head Roll Test
for
Horizontal canal BPPV

10. gravitational impact of the test position
moves the otoconia within the SCC
This increases the internal pull on
the endolymphatic fluid of the SCC
In turn producing a more vigorous bending of the
cilia within the ampulla of the SCC
nystagmus
Suggests BPPV
Mechanism of Diagnostic test

11. DIAGNOSTIC TEST :
DIX – HALLPIKE TEST FOR
ANTERIOR & POSTERIOR CANAL LATERAL CANAL.
HEAD ROLL TEST FOR

12. DISTINCTIVE CHARACTER OF NYSTAGMUS IN BPPV.
POSTERIOR
CANAL.
LAT. CANAL SUP. CANAL

14. EPLEY’S MANEUVER
360 YAWS
REVERSE
EPLEY’S

15. •
• Avoid bending over.
• Sleep with head elevated about 45
degree for next couple of days.
• Avoid sudden jerky head
movements.
•Avoid the affected lateral position.

16. Follow up

17. Type of
BPPV
Male Pts Female Pts
Posterior canal 18 26
Lateral canal 2 3
Superior canal 1 0
Total 21 29
52% females
36% males

18. ETIOLOGY NO. %
HEAD INJURY 2 4
VASCULAR
LESIONS
2 4
EAR SURGERY 1 2
VESTIBULAR
NEURONITIS
1 2
IDIOPATHIC 44 88
TOTAL 50 100
Idiopathic -88%

19. SYMPTOMS NUMBER %
VERTIGO 50 100
NAUSEA/
VOMITING
5 10
TINNITUS 3 6
HEARING LOSS 2 4 Vertigo followed by vomiting

20. Efficacy of Repositioning Maneuver
Manoevur No of patients No of patients
improved
Epley’s
360*
Total
Maneuver No. of patients No. of patients
improved
No. of patients
with no
improvement
of symptoms
Epley’s 44 40 4
360*
Yaws
05 05 0

21. Psycho-social impact
FEAR OF FALL - 28
ANXIETY - 09
IRRITABLE - 07
FRUSTRATED - 06
TIREDNESS - 04
POOR CONCENTRATION - 03
TROUBLE SLEEPING - 01

22. *The first description of position induced vetigo is
credited to Adler , later followed by Barany in 1921.
*Charles Hallpike at Queen square Hospital came
out with study of more than 100 positional vertigo
patients.
*Theories of BPPV-Schkunecht, Ruby and Hall.
*Dix Hallpike contributed to diagnose and Epley s
to treat BPPV.

23. Persons between 31-40 yrs were affected the most.This
correlates with studies by Abdulgafer et al and Hesham et
al.
Female patients (52%)outnumbered the males,(36%). The
same was true in studies by Ishikawa and Hesham.
No cause for BPPV was found in 88% of our cases. Studies
by Vicarrio et al report the same.
Positional vertigo in all our cases and nausea /vomiting in
10% of our cases correlates with study by Hesham et al.

24. Fear of fall (96% of pts)followed by anxiety (77%)
were the major psycho-social impacts. The same was
true in a study by Brevern et al.
Majority of our pts had Posterior canal BPPV (88%)
followed by lateral canal (10%). This correlates with
study by Malerulo and Herdman.
Epleys maneuver was done for 88% of our cases
followed by 360 degree Yaws in 10% and Reverse
Epleys in 2%. The same was reported by Magliulo and
Fife et al.

25. CONCLUSION
•-The incidence of Posterior canal BPPV is highest.
•-Majority of cases of BPPV are idiopathic.
•-BPPV has a huge impact on patient`s quality of life.
•
•-The Epley`s maneuver is an effective and efficient
modality of treatment for posterior canal BPPV.
•- 3600 Yaws is an effective way of treatment of lateral
Canal BPPV .
•-Canal repositioning maneuver`s should be the
mainstay of treatment of BPPV.

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27. THANK YOU !