![]() ![]() After a short latency or pause, rotational or horizontal nystagmus associated with vertigo symptoms confirms the diagnosis. Diagnosis of BPPV involves the Dix-Hallpike manoeuvre to provoke symptoms. The classical presentation of BPPV is recurrent, brief (<1 minute) episodes of vertigo triggered by changes in head position. Canaliths or calcium carbonate crystals are present within the endolymph occasionally, contributing to additional conflicting abnormal cupula deflection, causing vertigo. When the head turns, endolymph movement causes cupula deflection, translated into information on head motion and position via the vestibular nerve. At the base of each canal is the ampulla, which contains the cupula. 4 There are three semicircular canals in each inner ear that are organised at approximately right angles to each other to allow the body to identify three-dimensional angular acceleration. The pathogenesis of BPPV is essentially a disruption in the vestibular system resulting in vertigo. Patients waited an average of 93 weeks until review and treatment. 2 Another study into a tertiary centre clinic identified 85% of patients with BPPV had classic symptoms and findings. 1 For those referred for vestibular assessments and confirmed BPPV, an estimated 10% had the Dix-Hallpike manoeuvre performed beforehand. A retrospective study found only 10% of dizzy patients seen at a medical centre were assessed for BPPV using diagnostic manoeuvres. ![]() Unfortunately, assessment for BPPV is usually done poorly. This can be identified clinically without the need for investigations and, more importantly, it can be easily treated in primary care. When patients present with vertigo, a diagnosis that should not be missed is benign paroxysmal positional vertigo (BPPV). ![]()
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