Benign Paroxysmal Positional Vertigo

• Benign paroxysmal positional vertigo (BPPV)

  A common cause of recurrent episodes of vertigo triggered by head movement, a peripheral cause of vertigo located in the inner ear rather than the brain, more common in older adults
• Dix-Hallpike Manoeuvre

  Move the patient's head in a way that moves endolymph through the semicircular canals and triggers vertigo in patients with BPPV, check patient can do the manoeuvre safely, patient sits upright with head turned 45 degrees, rapidly lower patient backwards until head is hanging off end of couch extended 20-30 degrees, hold head still, watch eyes for 30-60 seconds for nystagmus, repeat with head turned other way, in BPPV the manoeuvre will trigger rotational nystagmus and vertigo symptoms
• Epley Manoeuvre

  Move the crystals in the semicircular canal into a position that does not disrupt endolymph flow, follow Dix-Hallpike steps, rotate patient's head 90 degrees past central position, have patient roll onto side so head rotates further 90 degrees, have patient sit up sideways, position head in central position with neck flexed 45 degrees, support head in each position for 30 seconds
• Brandt-Daroff Exercises

  Exercises performed by the patient at home to improve BPPV symptoms, involve sitting on end of bed and lying sideways from one side to the other while rotating head slightly to face ceiling, repeated several times a day until symptoms improve