Benign positional vertigo (Benign Paroxysmal Positional vertigo -BPPV) is a disease characterized by dizziness and flashing eyes (nystagmus) that occur with certain head positions, and can usually resolve spontaneously over time.
The disease can resolve spontaneously over time. The reason is that the small calcium crystals (canaliths) in the inner ear, which enable us to perceive gravity, break off from the area where they normally stay attached, become free in the inner ear fluid, and enter the balance canals opened here, causing typical complaints after some head movements (canalithiasis). Although the shape and direction of the detected eye flashes vary depending on the balance canal where the problem occurs, the posterior balance canal is generally involved, and involvement of the horizontal and upper/anterior canals is extremely rare.
In patients in whom this pathology was detected before the mechanism of BPPV was clarified. Various treatment methods have been used. It has also been stated that since there is no effective drug treatment with proven benefits, avoiding head movements that trigger attacks is the most effective treatment method. There are also various surgical techniques defined to be applied in BPPV cases that do not respond to other treatment methods and are severe enough to affect the life of the patients.
The disease is self-limiting and canalith repositioning maneuver (CRM) is largely used to remove the canaliths from the balance channels they enter. Since it can be controlled, the first treatment option to be preferred is CRM.
DIAGNOSIS
The diagnosis of BPPV is made according to the following criteria:
The patient's story begins with Feeling of dizziness that occurs with movements and changes in body position,
The fast phase of which occurs after a waiting period of 2-5 seconds when the patient's head is turned to one side and the head is tilted backwards (Dix-Hallpike test). Detection of wheel-turning eye flashes towards the ear (rotatory nystagmus) and the development of dizziness and or nausea in the patient within the same period,
The nystagmus is of short duration (tired nystagmus = usually less than 20 seconds),
Sits p Occurrence of nystagmus in the opposite direction and of shorter duration when returning to the position,
Brain, brainstem, balance nerve and cerebellum pathologies have been ruled out by history, examination and, when necessary, hearing, balance tests and radiological evaluations.
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TREATMENT:
In most of the patients diagnosed with BPPV due to posterior balance canal canalithiasis, the complaints are relieved with canalith repositioning maneuver (KRM = Empley and Hallpike maneuvers).
After CRM, patients are advised not to lie on the side of the ear where the disease is located for 48 hours, to lie on their back or on the opposite side on a high pillow, not to lean forward, not to raise their heads to look up, and to avoid sudden movements. Patients are called for a check-up every 2 to 5 days, CRM is repeated in patients who detect flashing eyes or dizziness with the control Dix-Hallpike test, and patients with no problems are excluded from follow-up to apply in case their complaints recur.
BPPV. Although the exact cause cannot be found in most patients, the main causes that can be identified in some patients are; These are listed as head traumas or concussions, advanced age, circulatory disorders, periods of inactive bed rest and other ear diseases.
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