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![POSTERIOR CANAL BPPVPOSTERIOR CANAL BPPV
Most common– posterior canal is most gravity
dependant in upright and supine position
Once debris enter the post. canal ,the cupula at the
shorter most dependant arm trap the debris.
Debris can exit only through the longer arm through the
crus commune [non-ampullary]](https://image.slidesharecdn.com/bppvandparticlerepositioningmaneuvers-150212072357-conversion-gate02/85/Bppv-and-particle-repositioning-maneuvers-6-320.jpg)
Uploaded byDr. Anita Bhandari
Bppv and particle repositioning maneuvers
This document discusses benign paroxysmal positional vertigo (BPPV), including its causes, types, diagnostic tests, and treatment maneuvers. It provides details on: - Posterior canal BPPV is the most common type, accounting for 81-89% of cases. The Dix-Hallpike test is used for diagnosis. Treatment includes particle repositioning maneuvers like Epley's maneuver. - Horizontal canal BPPV, which accounts for 8-17% of cases, is diagnosed using tests like the supine roll test. Treatments include maneuvers like the Lempert maneuver. - Anterior canal BPPV is rare but can result from treatments for other forms
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Bppv and particle repositioning maneuvers
- 1. BPPV AND PARTICLEREPOSITIONING MANEUVERS DR.ANITA BHANDARI CONSULTANT NEUROTOLOGIST VERTIGO AND EAR CLINIC JAIPUR
- 2. The ampulla containsthe cupula – a gelatinous mass with the same density as the endolymph. Cupula forms an impermeable barrier across the lumen of the ampulla. Hence the particles in scc may only exit via the end with no ampulla.
- 3. SECONDARY CAUSES OFBPPVSECONDARY CAUSES OF BPPV Head injury Prolonged bed rest Vestibular neuritis Meniere’s disease – hydropically induced damage to macula of utricle Migraine Ear surgery
- 5. BPPV by canaltypeBPPV by canal type Posterior Horizontal Anterior Estimated frequency 81-89% 8-17% 1-3% Provocative maneuver Dix Hallpike Supine Roll Test (Pagnini-McClure) Dix Hallpike Nystagmus Upbeat, torsional Horizontal Direction Changing Downbeat, torsional
- 6. POSTERIOR CANAL BPPVPOSTERIORCANAL BPPV Most common– posterior canal is most gravity dependant in upright and supine position Once debris enter the post. canal ,the cupula at the shorter most dependant arm trap the debris. Debris can exit only through the longer arm through the crus commune [non-ampullary]
- 10. CAUSE OF LIMITEDCAUSEOF LIMITED DURATIONDURATION
- 11. CAUSE OF FATIGUABILITYCAUSEOF FATIGUABILITY
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- 19. SEMONTSEMONT’S MANEUVER’S MANEUVER Liberatorymaneuver for pBPPV and cupulolithiasis Used to overcome otoconia jam after Epley’s maneuver
- 20. BRANDT – DAROFFEXERCISESBRANDT – DAROFF EXERCISES Used as a home program Indications o Posterior canal cupulolithiasis o Persistant posterior canal canalithiasis Mechanism o Dislodge debris attached to cupula o Habituation through central compensation
- 21. BRANDT – DAROFFEXERCISESBRANDT – DAROFF EXERCISES
- 22. BRANDT – DAROFFEXERCISESBRANDT – DAROFF EXERCISES Things to remember o The exercises may dislodge more otoconia from the utricle causing an increase in symptoms. o May cause multiple canal involvement. o Important to hold for 30 seconds in each position.
- 23. HORIZONTAL SCC BPPVHORIZONTALSCC BPPV Pagnini-McClure maneuvre Geotropic nystagmus – debris are away from ampulla , side showing stronger nystagmus is the side involved Apogeotropic nystagmus – indicates cupulolithiasis
- 24. LOWER INCIDENCE OFLOWERINCIDENCE OF HORIZONTAL CANAL BPPVHORIZONTAL CANAL BPPV
- 26. SEQUENCE OF EVENTSINSEQUENCE OF EVENTS IN hBPPVhBPPV
- 28. McCLURE PAGNINI MANEUVERMcCLUREPAGNINI MANEUVER SUPINE ROLL TESTSUPINE ROLL TEST
- 29. SUPINE ROLL TESTSUPINEROLL TEST
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- 31. LEMPERTLEMPERT’S BARBECUE ROLL’SBARBECUE ROLL
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- 33. VANUCCHI MANEUVERVANUCCHI MANEUVER Forcedprolonged positioning Sleep in lateral position with healthy ear down for 12 hours.
- 34. CUPULOLITHIASISCUPULOLITHIASIS Coined by Schuknetch Rare, more common in horizontal canal Caused by otoliths attached to cupula of scc When cupula is horizontal no vertigo When non-horizontal constant input persistant dizziness Nystagmus : persistant non-fatiguable as long as patient is in the same position
- 36. SEQUENCE OF EVENTSINSEQUENCE OF EVENTS IN CUPULOLITHASISCUPULOLITHASIS
- 38. ANTERIOR CANAL BPPVANTERIORCANAL BPPV Anterior canal BPPV is usually transitory and most often the result of “canal switch” that occurs in the course of treatment more common forms of BPPV
- 39. SUBJECTIVE BPPVSUBJECTIVE BPPV Nonystagmus is detected but patient feels dizzy on provocative tests PRP beneficial Reasons o Subtle nystagmus o Fatigued nystagmus o Inadequate neural signal to stimulate the VOR
- 40. CONTRAINDICATIONS OFCONTRAINDICATIONS OF PARTICLEREPOSITIONINGPARTICLE REPOSITIONING Cervical spine problems Uncontrolled hypertension Retinal detachment
- 41. OTHER CAUSES OFOTHERCAUSES OF POSITIONAL NYSTAGMUSPOSITIONAL NYSTAGMUS Direction changing nystagmus – central Down beating positional nystagmus – nodulus Down beating nystagmus on Dix-Hallpike – anterior canal BPPV . Treated by Epley’s maneuvre
- 42. SURGERYSURGERY Very limited role oPosterior canal occlusion o Singular neurectomy
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