Vertigo caused by the presence of otoliths in the semi-circular canal instead of the utricle; most common cause of vertigo on looking up

Aetiology

• Arises due to a detachment of otoliths from the utricle of the inner ear, can be caused by:
  • Head trauma
  • Ear surgery
  • Idiopathic

Pathophysiology

• Once in the canal, movement of the patient’s head will result movement of the otoliths, causing an abnormal movement of endolymph which results in vertigo

Clinical features

Vertigo on:

• Looking up
• Turning in bed - often worse to one side
• First lying down in bed at night
• Getting out of bed in the morning
• Bending forward
• Rising from bending
• Moving head quickly - often only in one direction
• Attacks will last seconds

Other symptoms

• Nausea and vomiting

Investigations

• The diagnostic examination for BPPV is the Dix-Hallpike manoeuvre, with a positive test invoking the symptoms and geotropic, torsional nystagmus will be present

Management