Bppv

Benign Paroxysmal Positional Vertigo (BPPV) is the most common form of vertigo, claiming one third of all vestibular diagnoses in the general human population. Kollen et al1 concluded that consequentially that BPPV is the pathophysiological condition coinciding with approximately 20% of all globally reported cases of disequilibrium. Similar findings by Helminski et al2 determined that in vivo, 2.4% of the general human population will encounter BPPV, mostly occurring between the fifth and seventh decades of life. With such ample occurrences of BPPV along with its often debilitating symptoms of disorientation and nausea, BPPV is often misdiagnosed by patients and health care providers alike. BPPV is characterized by an acute onset of vertigo provoked by cranial contortions in the response to gravity and inertia. Symptoms are short yet elicit an intense vertigo, which may be triggered multiple times daily or remain in remission for up to 1 month. To provoke the onset of vertigo in BPPV, calcium carbonate crystals (otoconia) used to weigh down the sensory membrane of the maculae first become dislodged from the utricle. These otoconia (canaliths) settle within the most gravity-dependent section of the vestibularis labyrinth termed the posterior semicircular canal (PSCC). The tubular PSCC sprouts off the cupulla much like a handle on a coffee mug. With the inertial and gravitational forces during each movement of the head, these “canal rocks” float through the PSCC analogous to a rock in a car tire. Now displaced endolymph within the PSCC transcends fluid pressure onto the cupulla and, in turn, activates the ampullary organ resulting in the perception of vertigo. Due to apparent involvement of extrinsic inertial and gravitational forces during canalithiasis, manual manipulation of said forces during diagnosis and treatment of BPPV display logical coherence. The Dix-Hallpike test (DHT) is the standard mechanism for diagnosis of BPPV. During the DHT, the patient is

References: 1 Kollen L, Beret B, Moller C. Evaluation of treatment in benign paroxysmal positional vertigo (BPPV). CMAJ. 2003;169(7):681-693. Accessed from Medline January 5, 2013. 2 Helminski JO, Zee DS, Janssen I, Hain TC. Effectiveness of particle repositioning maneuvers in the treatment of benign paroxysmal positional vertigo: a systemic review. Phys Ther. 2010;90(5):663-678. Accessed from Medline January 5, 2013.