QuestionSBA
QuestionChoice
NICE guidelines suggest that ENT referral is only warranted if the signs of symptoms are atypical or do not resolve in 4 weeks, or there have been at least 3 periods during which the patient has experienced episodes of vertigo
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c
Refer to ENT
QuestionChoice
This is correct. This patient has benign paroxysmal positional vertigo (BPPV), as confirmed by the Dix-Hallpike manoeuvre. The patient can be taught Brandt-Daroff exercises to do at home. The patient should be advised to return after 4 weeks if her dizzy spells have not resolved
31828
a
Brandt-Daroff exercises
QuestionChoice
Symptomatic drug treatment is of limited value in managing BPPV
31829
b
Betahistine
QuestionChoice
This is an anti-emetic to reduce vomiting.
31832
e
Ondansetron
QuestionChoice
Drug treatment is of limited value in the management of BPPV. Prochlorperazine may sometimes be used in viral labyrinthitis to manage dizziness
31831
d
Prochlorperazine
QuestionComment
Difference between Epley manoeuvre and "Brandt-Daroff exercises" ?
11127
QuestionComment
"There are alternative manoeuvres that can be used to treat BPPV, such as an Epley manoeuvre. Your specialist may perform an Epley manoeuvre with you in clinic and then recommend Brandt-Daroff exercises for you to use at home as these are easier to perform unsupervised."

From a patient leaflet about the two... had never heard of it either! 
12189
User
subscriber
Chronic Hypertension
User
subscriber
Abscess Otitis
QuestionComment
Really...

43059
User
subscriber
Kinase Hallux
Concept
Chapter
# Summary

Benign Paroxysmal Positional Vertigo (BPPV) is a condition characterised by sudden episodes of vertigo, typically following head movement. It is the most common cause of vertigo, particularly in the elderly due to calcium deposition within the semicircular canals. The key signs and symptoms include sudden attacks of rotational vertigo lasting for 30 seconds to 1 minute, triggered by changing head positions. There are no associated auditory symptoms. Diagnosis is made using the Dix-Hallpike manoeuvre, and management primarily involves the Epley manoeuvre. 

# Definition

Benign Paroxysmal Positional Vertigo (BPPV) is a medical condition characterised by sudden, episodic attacks of vertigo induced by changes in head position. This condition is due to detachment of otoliths in the inner ear, which results in hair cell stimulation and subsequent vertigo symptoms.

# Epidemiology

BPPV is the leading cause of vertigo and is especially prevalent within the elderly population. This increased prevalence is largely attributed to the accumulation of calcium deposits, known as cholelithiasis, within the semicircular canals of the inner ear.

# Aetiology

BPPV arises due to a detachment of otoliths from the utricle of the inner ear. These detached particles can migrate into the semicircular canals, where they stimulate hair cells and lead to symptoms of vertigo.

# Signs and Symptoms

Key clinical features of BPPV include:

- Vertigo attacks provoked by specific head movements, such as turning the head to one side while in bed or looking upwards
- Episodes of rotational vertigo lasting between 30 seconds to 1 minute
- Absence of auditory symptoms
- Recurrent episodes, often resolving naturally over weeks to months

# Differential Diagnosis

Differential diagnoses for BPPV include other conditions that can cause vertigo such as Meniere's disease, vestibular neuritis, and labyrinthitis. Key signs and symptoms for these conditions include:

- Meniere's disease: episodic vertigo, tinnitus, hearing loss, and a sensation of fullness in the ear
- Vestibular neuritis: sudden onset of severe vertigo, nausea, and imbalance lasting for several days
- Labyrinthitis: vertigo, hearing loss, and tinnitus

# Investigations

The primary diagnostic test for BPPV is the Dix-Hallpike manoeuvre. This test involves a series of specific head movements that provoke the characteristic vertigo and nystagmus associated with BPPV.

[Click here for more information](https://www.thebsa.org.uk/wp-content/uploads/2014/04/HM.pdf)

# Management

The mainstay of BPPV management is the Epley manoeuvre. This therapeutic manoeuvre aims to move the detached otoliths out of the semicircular canal and back to the utricle where they originate.

[Click here for more information](https://www.racgp.org.au/download/Documents/AFP/2013/January/February/201301handi.pdf)

# References

[Click here for NICE CKS on benign paroxysmal positional vertigo](https://cks.nice.org.uk/topics/benign-paroxysmal-positional-vertigo/)
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Benign paroxysmal positional vertigo (BPPV)
Topic
24
Ear, Nose & Throat
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Brandt-Daroff exercises involve a series of head and body movements performed at home to help reposition the otoliths in the inner ear, reducing the frequency and severity of vertigo episodes in benign paroxysmal positional vertigo (BPPV).
An 88 year old woman presents to her GP with recurrent episodes of dizziness and vertigo which she says is often brought on when rolling over in bed. The GP performs the Dix-Hallpike manoeuvre which is positive. She is keen for something to manage her symptoms.

What is the next best step in managing this patient's dizziness?
a