CLASSIFICATION, DIAGNOSTIC

CRITERIA AND MANAGEMENT OF

BENIGN PAROXYSMAL POSITIONAL
VERTIGO

PRESENTED BY:
PRISCILLIA HILLARY 11.2017.020
AGNES YUDITHA PUTRININGTYAS 11.2016.088

DEPARTMENT OF OTOLARYNGOLOGY
FACULTY OF MEDICINE KRIDA WACANA CHRISTIAN UNIVERSITY
PERIOD DECEMBER, 25-2017 – JANUARY, 27-2017
MARDI RAHAYU HOSPITAL KUDUS
ABSTRACT

• Benign paroxysmal positional vertigo (BPPV) is the most

common peripheral vertigo and the posterior and/or lateral
semicircular canals are usually affected.
• The pathophysiology of BPPV is canalolithiasis or cupulolithiasis
• The observation of positional and/or positioning nystagmus is
essential for the diagnosis of BPPV.
• BPPV is treated with the canalith repositioning procedure
(CRP).
• In this review, we provide the classification, diagnostic criteria,
and examinations for the diagnosis, and specific and non-
specific treatments of BPPV
INTRODUCTION

 BPPV is the most common peripheral

cause of vertigo.
 A direction-changing geotropic or
apogeotropic positional nystagmus
is elicited when the head of the
patient
 Dix and Hallpike also suggested that
BPPV was caused by a lesion of the
otolith organ
 Recently the canalolithiasis theory
has drawn a lot of attention related
to the canalith repositioning
procedure (CRP) for the treatment
of BPPV.
DIAGNOSTIC CRITERIA FOR BPPV

1. Posterior-canal-type of BPPV
(canalolithiasis)

2. Lateral-canal-type of BPPV
(canalolithiasis)

3. Lateral-canal-type of BPPV
(cupulolithiasis)
 1. POSTERIOR-CANAL-TYPE OF BPPV
(CANALOLITHIASIS)

A. Symptoms
• The intensity of the vertigo
decreases or disappears after
repeated head positioning.

B. Signs
• Torsional nystagmus, in which the
upper pole of the eye rotates
toward, the affected ear and the
contra lateral ear is induced by
the Dix– Hallpike maneuver
2. LATERAL-CANAL-TYPE OF BPPV
(CANALOLITHIASIS)
A. Symptoms
• The intensity of the vertigo
decreases after repeated
head positioning.

B. Signs
• Geotropic positional nystagmus
is induced by the supine roll test
• The nystagmus consists of major
horizontal and minor torsional
components.
 3. LATERAL-CANAL-TYPE OF BPPV
(CUPULOLITHIASIS)
A. Symptoms
• Attacks of rotatory vertigo
or dizziness are induced by
specific head positions.
• The vertigo appears
without latency and lasts
for more than a minute
without any decrease in its
intensity.
B. Signs
• Apogeotropic positional
nystagmus is induced by the
supine roll test.
• The nystagmus consists of
major horizontal and minor
torsional components.
• The nystagmus appears
without latency and lasts for
more than a minute without
any decrease in its intensity.
 EXAMINATIONS FOR THE
DIAGNOSIS OF BPPV

• Positional and/or positioning nystagmus should

be observed with Frenzel’s glasses or glasses
equipped with an infrared CCD camera
 EXAMINATIONS FOR THE DIAGNOSIS OF
BPPV
• The positional nystagmus test for diagnosis of the
lateral canal type of BPPV
is called the supine roll test

• The positioning nystagmus test for the diagnosis of

the posterior-canal-type of BPPV
Is called The Dix–Hallpike test
 EXAMINATIONS FOR THE DIAGNOSIS OF
BPPV

1. The positional
nystagmus test for
is called the supine
diagnosis of the
roll test
lateral canal type of
BPPV

2. The positioning
nystagmus test for
Is called The Dix–
the diagnosis of the
Hallpike test
posterior-canal-type
of BPPV
 CHARACTERISTICS OF NYSTAGMUS
ASSOCIATED WITH BPPV
1. Positioning nystagmus of the posterior-canal-type of BPPV
torsional nystagmus, The nystagmus often contains an
additional vertical (upward) component

2. Positional nystagmus in the lateral-canal-type of BPPV

major horizontal nystagmus, and minor torsional
components.

3. Positional and/or positioning nystagmus in patients with

probable and atypical BPPV
• Probable BPPV they show neither observable nystagmus
nor vertigo with any positional or positioning maneuver
• Atypical BPPV nystagmus that does not meet criteria B of
the posterior-canal-type of BPPV and point B of the lateral-
canal-type BPPV.
 TREATMENT FOR BPPV
A. The canalith repositioning procedure (CRP) and non-
specific exercise
1) The Epley maneuver for the treatment of the posterior-
canal-type of BPPV.
2) Other CRPs
3) Non-specific exercises
B. Medications
• Anti-vertiginous
• Anti-anxiety
• Anti-emetic drugs may be used for the
treatment of BPPV.
 CONCLUSIONS

• In this review, we have provided the classification,

diagnostic criteria, the examinations for diagnosis,
and specific and non-specific treatments of the
posterior- and lateral-canal-type of BPPV in
accordance with the Japanese practical guidelines
on BPPV published by the Japan Society for
Equilibrium Research