BPPV is a common cause of recurrent vertigo triggered by changes in head position. It affects the inner ear and is characterized by brief episodes of vertigo and nystagmus. BPPV most often involves the posterior semicircular canal and results from debris known as otoconia becoming dislodged and entering the canal. Symptoms vary between individuals but usually include vertigo when the head is moved into certain positions that last for seconds before resolving. Spontaneous recovery is common though treatment aims to reposition the debris.

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?

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