BPPV

1. B…..P….P….V….

2.  BPPV is a clinical syndrome characterized by brief
recurrent episodes of vertigo triggered by changes in
head position with respect to gravity.
 BPPV is the most common cause of recurrent vertigo,
with a lifetime prevalence of 2.4%.
 The duration, frequency, and intensity of symptoms of
BPPV vary, and spontaneous recovery occurs
frequently.

3.  30% of peripheral vestibular disease
 Twice ménière's
 Mean age fifth decades
 Increases with age.
 Women:men 1.6:1

4.  Primary or idiopathic (50%–70%)
 Secondary (30%–50%)
▪ Viral labyrinthitis (15%)
▪Head trauma (10%)
▪ Ménière’s disease (5%)
▪ Migraines (< 5%)
▪ Inner ear surgery (< 1%)

5.  Schuknecht 1969 (Cupulolithiasis)
loose otoconia from the utricle
PSCC
 McClure -1979
Canalithiasis mechanism

6. Pathophysiology
Degenerative debris from utricle (otoconia)
Canalithiasis Theory -Floating freely in the
endolymph
Cupulolithiasis Theory- Adhering to the cupula

7.  Classic post SCC – geotropic rotatory nystagmus
 Horizontal SCC – purely horizontal nystagmus
 Non-fatiguing nystagmus – cupulolithiasis >
canalithiasis

8.  Classic BPPV – post SCC.
 Geotropic NG with affected ear down ▪Rotatory , fast
phase toward the undermost ear
▪ Latency – few seconds
▪Duration – limited < 20 seconds
▪Reversal upon return upright position ▪Response
decline upon repetitive provocation

9. Lat SCC - BPPV
 Most common atypical BPPV
 3-9% of cases
 Consequence of Epley maneuver
 Horizontal purely nystagmus
 Cupulolithiasis rather than canalithiasis

10. Sup SCC - BPPV
 Rare – 2%
 Down-beating /torsional NG for the opposite ear on
Dix-Hallpike maneuver

11. Why posterior SCC common?

41. THANK YOU…….