There is another diagnostic test called the Roll Test (also called the Pagnini-McClure maneuver) that tests for horizontal BPPV (caused by debris in the horizontal semi-circular canal). Diagnosis depends on the occurrence of vertigo and on noting the torsional and upbeat nystagmus during the Dix-Hallpike maneuver (the gold standard test for BPPV caused by debris in the posterior semi-circular canal). Generally, family practice physicians may not be familiar with the testing and diagnostic processes involved with conditions such as BPPV, so they may refer patients to an otolaryngologist who has been specifically trained in diagnosing and treating vestibular disorders. The theory behind these mechanisms and diseases causing secondary BPPV is that all these modalities in one way or another dislodge or degrade the otoconia leading to aberrant signaling to the brain. Similarly, head trauma appears to also be a cause of BPPV, along with otologic and non-otologic surgery alike. Migraine, vestibular neuritis, and Meniere’s disease have all been shown to have the ability to produce BPPV in patients. However, there are causes of BPPV that are secondary to other diseases or injuries. The source of this inner ear debris is still up to debate.īPPV is a common disease in adults, being more common in seniors and rare among children.īPPV is usually idiopathic, meaning that there is not a known specific cause of the disease. If one ear is sending this incorrect information to the brain while the unaffected ear, eyes, and musculature of the head and neck are sending normal signals, the conflicting information is interpreted as vertigo. The second predominating theory is that there are free-floating particulates in the semi-circular canals themselves and when gravity pulls at that debris during head movement, the force displaces the cupula, thus causing abnormal signaling (canalithiasis). There are two theories as to what causes this irregular signaling: one theory is that endolymphatic debris adheres to a part of the inner ear called the cupula causing it to become highly sensitive to gravity and motion (cupulolithiasis). BPPV is caused by irregular signals being sent from the semi-circular canals in the inner ear causing an illusion of motion. Symptoms can range from mild dizziness to more severely debilitating attacks with nausea, vomiting, and increased risk of falling, all of which disrupt daily activity. BPPV is the most common cause of vertigo. Benign paroxysmal positional vertigo, or BPPV, is a disorder of the inner ear. Positional vertigo is a spinning sensation caused by a change in head position in relation to gravity.
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