Latest treatment for BPPV is:
Ans. A. Intralabrynthine streptomycin. (Ref. PL Dhingra ENT, 5th /pg.51)BPPV (BENIGN PAROXYSMAL POSITIONAL VERTIGO):It is characterized by vertigo when head is placed in a certain critical position.# Cause:- Disorder of posterior semicircular canal.- Otoconial debris, consisting of calcium carbonate, is released from the degenerating macula of utricle and floats freely in endolymph. When it settles on the cupula of posterior semicircular canal in critical head position; it causes displacement of cupula and vertigo.# H/o: Deafness, Vomiting and Tinnitus.# Positional vertigo is precipitated by a recumbent head position, either to the right or to the left.# BPPV generally abates spontaneously after weeks or months. The vertigo and accompanying nystagmus have a distinct pattern of latency, fatigability, and habituation that differs from the less common central positional vertigo due to lesions in and around the fourth ventricle. Moreover, the pattern of nystagmus in posterior canal BPPV is distinctive.# When supine, with the head turned to the side of the offending ear (bad ear down), the lower eye displays a large- amplitude torsional nystagmus, and the upper eye has a lesser degree of torsion combined with upbeating nystagmus. If the eyes are directed to the upper ear, the vertical nystagmus in the upper eye increases in amplitude. Mild dysequilibrium when upright may also be present.FeaturesBPPVCentralLatency3-40 sNone: immediate vertigo and nystagmusFatigabilityYesNoHabituationYesNoIntensity of vertigoSevereMildReproducibilityVariableGoodTreatment:a) Epley's Maneuverb) Intra-labyrinthine Streptomycin / Gentamycin. (newer Rx)Benign paroxysmal positional vertigo (BPPV) is caused by dislodged otoconia that move with changes in head position. Single applications of the Epley procedure or the Semont maneuver have been reported to relieve symptoms in the majority of patients. Repeated treatment sessions may be necessary before symptoms resolve.Also know:Technique of syringing the ear# Patient seating with ear to be syringed towards examiner.# Patient's head slightly tilted over tray to collect returning fluid.# Pinna is pulled upwards and backwards and a jet of water from ear syringe is directed along posterosuperior wall of meatus which expels wax out.
Intralabrynthine streptomycin
Intralabrynthine steroid
Valsalva maneuver
Modified Epley's manoeuvre
Assessment of Vestibular Function