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Bppv and particle repositioning maneuvers

Bppv and particle repositioning maneuvers

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Bppv and particle repositioning maneuvers

  1. 1. BPPV AND PARTICLE REPOSITIONING MANEUVERS DR.ANITA BHANDARI CONSULTANT NEUROTOLOGIST VERTIGO AND EAR CLINIC JAIPUR
  2. 2. The ampulla contains the 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. 3. SECONDARY CAUSES OF BPPVSECONDARY CAUSES OF BPPV Head injury Prolonged bed rest Vestibular neuritis Meniere’s disease – hydropically induced damage to macula of utricle Migraine Ear surgery
  4. 4. BPPV by canal typeBPPV 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
  5. 5. 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]
  6. 6. CAUSE OF LIMITEDCAUSE OF LIMITED DURATIONDURATION
  7. 7. CAUSE OF FATIGUABILITYCAUSE OF FATIGUABILITY
  8. 8. DIX-HALLPIKE TESTDIX-HALLPIKE TEST
  9. 9. EPLEYEPLEY’S MANEUVER’S MANEUVER
  10. 10. EPLEYEPLEY’S MANEUVER’S MANEUVER
  11. 11. EPLEYEPLEY’S MANEUVER’S MANEUVER
  12. 12. SEMONTSEMONT’S MANEUVER’S MANEUVER
  13. 13. SEMONTSEMONT’S MANEUVRE’S MANEUVRE
  14. 14. SEMONTSEMONT’S MANEUVER’S MANEUVER
  15. 15. SEMONTSEMONT’S MANEUVER’S MANEUVER Liberatory maneuver for pBPPV and cupulolithiasis Used to overcome otoconia jam after Epley’s maneuver
  16. 16. BRANDT – DAROFF EXERCISESBRANDT – 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
  17. 17. BRANDT – DAROFF EXERCISESBRANDT – DAROFF EXERCISES
  18. 18. BRANDT – DAROFF EXERCISESBRANDT – 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.
  19. 19. HORIZONTAL SCC BPPVHORIZONTAL SCC BPPV Pagnini-McClure maneuvre Geotropic nystagmus – debris are away from ampulla , side showing stronger nystagmus is the side involved Apogeotropic nystagmus – indicates cupulolithiasis
  20. 20. LOWER INCIDENCE OFLOWER INCIDENCE OF HORIZONTAL CANAL BPPVHORIZONTAL CANAL BPPV
  21. 21. SEQUENCE OF EVENTS INSEQUENCE OF EVENTS IN hBPPVhBPPV
  22. 22. McCLURE PAGNINI MANEUVERMcCLURE PAGNINI MANEUVER SUPINE ROLL TESTSUPINE ROLL TEST
  23. 23. SUPINE ROLL TESTSUPINE ROLL TEST
  24. 24. LEMPERT MANEUVRELEMPERT MANEUVRE
  25. 25. LEMPERTLEMPERT’S BARBECUE ROLL’S BARBECUE ROLL
  26. 26. GUFONI MANEUVERGUFONI MANEUVER
  27. 27. VANUCCHI MANEUVERVANUCCHI MANEUVER Forced prolonged positioning Sleep in lateral position with healthy ear down for 12 hours.
  28. 28. 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
  29. 29. SEQUENCE OF EVENTS INSEQUENCE OF EVENTS IN CUPULOLITHASISCUPULOLITHASIS
  30. 30. ANTERIOR CANAL BPPVANTERIOR CANAL 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
  31. 31. SUBJECTIVE BPPVSUBJECTIVE BPPV No nystagmus 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
  32. 32. CONTRAINDICATIONS OFCONTRAINDICATIONS OF PARTICLE REPOSITIONINGPARTICLE REPOSITIONING Cervical spine problems Uncontrolled hypertension Retinal detachment
  33. 33. OTHER CAUSES OFOTHER CAUSES 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
  34. 34. SURGERYSURGERY Very limited role o Posterior canal occlusion o Singular neurectomy
  35. 35. THANKSTHANKS

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