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Dizziness/Vertigo/Benign Paroxysmal Positional Vertigo (BPPV)
Published in Charles Theisler, Adjuvant Medical Care, 2023
Benign positional paroxysmal vertigo (BPPV) is the most common type of vertigo and is seven times more likely in individuals over the age of 60.2 Benign paroxysmal positional vertigo (BPPV) is characterized by recurrent episodes of vertigo lasting for seconds. The episodes are precipitated by changes in head position, especially neck extension, bending down, lying supine with the affected ear down, rising from bed, and rolling over in bed to the affected side. Symptoms can be reproduced by performing the Dix-Hallpike test. BPPV has a favorable prognosis, with nearly 25% of patients experiencing spontaneous resolution by one month and up to 50% at three months.1
Cranial Neuropathies I, V, and VII–XII
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Evaluation of the vestibular system may include: Neuro-otological evaluation: This frequently includes assessment for the presence of nystagmus. This can be done with Frenzel's goggles which are essential to eliminate ocular fixation that can hinder nystagmus. In peripheral vertigo, the nystagmus characteristically has horizontal and torsional components and may be present in primary gaze. Peripheral vertigo is not direction-changing and becomes more pronounced in the direction of the fast phase of the nystagmus. In central vertigo, the nystagmus can be direction-changing and may exhibit a vertical component.Electronystagmography/videonystagmography (ENG/VNG) to characterize the nystagmus.Provocative testing to induce vertigo and nystagmus: Dix–Hallpike test.HINTS testing is helpful in a patient with acute vertigo to differentiate a vestibulopathy from a central lesion such as a stroke.38
Examination Stations
Published in Joseph Manjaly, Peter Kullar, Alison Carter, Richard Fox, ENT OSCEs: A Guide to Passing the DO-HNS and MRCS (ENT) OSCE, 2019
Joseph Manjaly, Peter Kullar, Alison Carter, Richard Fox
Dix–Hallpike testTest for benign paroxysmal positional vertigo (BPPV).Check for neck pain and offer to check for carotid bruits.Remember this test would be contraindicated in anyone with atlanto-axial instability, such as a patient with rheumatoid arthritis.Explain to the patient that you would like to test for the position of the crystals within the balance organ, their ear.Explain that this test may make him or her dizzy, but it shouldn’t last for long.Position the patient sitting on the couch, legs extended. Rotate head 45 degrees to the test side. Lower the patient supporting the occiput, and extend the neck 20 degrees and hold in this position for 45 seconds observing the eyes for rotational nystagmus (Figure 2.40).
Assessment of the utricular function in posterior canal benign paroxysmal positional vertigo patients before and after canalith repositioning maneuvre and its relation to residual dizziness
Published in Hearing, Balance and Communication, 2019
Abeir Osman Dabbous, Amira Maged El-Shennawy, Mariam Magdy Medhat, Mona Tarek Kandil
In this study, Dix–Hallpike test was negative after CRM not revealing either vertigo or nystagmus. But some patients reported imbalance without positional vertigo i.e. RD not related to the positioning test. The RD group included 10 patients and the non-RD group included 20 patients. In our study, comparison between RD and non-RD group showed that the IAAD% was larger in RD group than non-RD group before and after CRM (Tables 11 and 12) which showed that persistent VEMP abnormality is related to incomplete improvement of symptoms and that those with greater VEMP abnormality tend to develop RD. Comparing the before and after CRM results, although the oVEMP amplitude significantly increased (improved) after CRM in both groups, the IAAD% significantly decreased (improved) in the non-RD group only.
Otolith dysfunction in recurrent benign paroxysmal positional vertigo after mild traumatic brain injury
Published in Acta Oto-Laryngologica, 2019
Gang Chen, Xuening Zhao, Gang Yu, Huirong Jian, Yun Li, Guangming Xu
We reviewed retrospectively 42 patients with BPPV after mTBI who referred to the Specialist Clinic of Vertigo, Shandong Provincial Hospital Affiliated to Shandong University, between January 2015 and December 2016. The diagnosis of BPPV was based on the history of episodic positional vertigo and the charactered nystagmus induced by the Dix-Hallpike test or Roll test. Patients with BPPV after mTBI were those in whom BPPV occurred within 15 d after well-documented TBI, and the TBI was considered mild according to Binder [5]. We defined recurrence of BPPV as that BPPV recurred more than one month after successful reposition. We excluded patients who had other vestibular disorders, and those who were >60 years old. All procedures were in accordance with the Declaration of Helsinki and informed consent was obtained from all patients.
Evaluation of cervical vestibular evoked myogenic potential measures using different stimulus types in patients with posterior canal benign paroxysmal positional vertigo
Published in Acta Oto-Laryngologica, 2020
Akif Gunes, Elif Karali, Ahmet Ural, Fatih Ruzgar
All patients priorly underwent a thorough ear, nose and throat (ENT)examination. All patients underwent fistula test, pure- tone audiometry, speech audiometry tests, tympanogram, stapes reflex test, routine hemogram and biochemistry tests. The hearing thresholds of the participants were examined at 250, 500, 1000, 2000, 4000 and 8000 Hz frequencies. Dix-Hallpike test was applied to patients with suspected peripheral and positional vertigo. Patients with dizziness and horizontal-rotatory nystagmus in Dix-Hallpike test and complete direction determination were evaluated as having unilateral posterior canal BPPV and included in the study. In the control group, 21 healthy volunteers were evaluated.