Efficacy of particle repositioning manoeuvre in benign paroxysmal positional vertigo.

There is nothing more gratifying for a physician than managing a disorder that is for the most part easily diagnosed, and more important, simply and effectively treated using noninvasive means. Benign paroxysmal positional vertigo (BPPV), the most common affliction of the vestibular labyrinth, is one such disorder. Benign Paroxysmal Positional Vertigo is one of the common causes of vertigo of labyrinthine origin. It is a peripheral labyrinthine disease and seldom a manifestation of a CNS disorder. It is commonly associated with head trauma, inner ear disease such as Meniere’s Disease or vestibular neuronitis. In some cases BPPV is idiopathic. The pathophysiologic finding in BPPV is calcium carbonate (otoconia), deposits on the cupula of the posterior semicircular canal (cupulolithiasis) or free-floating otoconia (canalolithiasis/canalithiasis) within the endolymph. Vestibular nerve and ganglion neuronal degeneration have been reported in patients with BPPV. It is now accepted that BPPV is caused by canalithiasis and cupulolithiasis of any of the three semicircular canals (SCCs), with the posterior canal being most commonly involved. Particle Repositioning Manoeuvres are found to very effective procedures in the management of isolated BPPV affecting a single semicircular canal. Since history and clinical examination are the only tools in the diagnosis of BPPV, a proper evaluation will help in careful localization of the semicircular canal affected. Most commonly occurs in middle aged females. Female male ratio is 1.63 :1. Posterior semicircular canal involvement is most common. Right side is predominant to left. It presents with episodic vertigo, occurs in particular position and lasting for seconds to minutes. Elicitation of history and positional test is adequate to diagnose. Particle repositioning manoeuvre is effective way to treat and give immediate relief to the patients even though it is a self limiting disease. Appropriate particle repositioning manoeuvres when correctly preformed will give the maximum expected benefit to the patients