| Chapter
6
Benign Paroxysmal Positional Vertigo (BPPV)
Lornes
Parnes MD
University
of London
London, Ontario, N6A 5A5 Canada
For some, a session
with the bed spins is a terrifying event
that might occur during an alcoholic binge.
Imagine though that while perfectly sober,
each time you lay down, turn over in bed
or look up, you launch into such a spin.
This is the essence of benign paroxysmal
positional vertigo (BPPV). Fortunately,
unlike the alcohol related bed spin, the
BPPV spin (technically known as vertigo)
lasts but for a few seconds and rarely
results in vomiting. Unfortunately, it
can occur with each and every such head
movement for weeks to months (and rarely
years) on end.
Of all of the inner
ear disorders that can cause dizziness/vertigo,
benign paroxysmal positional vertigo (BPPV)
is by far the most common, occurring in
about one in five patients seen in dizziness
clinics. It is a condition that is usually
easily diagnosed and, even more importantly,
readily treated with a simple office-based
procedure. Dr. Robert Barany, the Austrian
neurologist/otologist who won the Nobel
Prize in Physiology/ Medicine in 1914
for his work on the physiology and pathology
of the vestibular (balance) apparatus,
first described the condition in 1921.
He gave the following account from one
of his patients:
“The attacks
only appeared when she lay on her right
side. When she did this, there appeared
a strong rotatory nystagmus to the right.
The attack lasted about thirty seconds
and was accompanied by violent vertigo
and nausea. If, immediately after the
cessation of these symptoms, the head
was again turned to the right, no attack
occurred, and in order to evoke a new
attack in this way, the patient had to
lie for some time on her back or on her
left side.”
Since this initial
description, there have been major advances
in the understanding of this common condition.
In this chapter, I will review the normal
vestibular physiology as it relates to
BPPV, discuss the causes and mechanisms
of BPPV, and then go on to discuss diagnostic
tests, office-based management, and finally,
surgical management.
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