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BENIGN POSITIONALPAROXYSMAL VERTIGO (BPPV)

OP Kapoor
Ex. Hon. Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.

In private practice we see a lot of patients having giddiness due to vertigo. The patient feels a sensation of rotation (objects going round and round or the patient going round and round).

Rarely, a single attack of vertigo could be due to vestibular neuronitis where the patient has more of imbalance while walking rather than vertigo. More often the aetiology is labyrinthine.

The commonest cause of recurrent vertigo which the GPs diagnose as Meniere’s syndrome can be confirmed by SISI score being > 70% and the audiogram being abnormal. Many other tests like Recruitment and Impedance studies may be abnormal. Unfortunately, there is no permanent cure for this illness.

Since BPPV forms nearly 30% of all the "recurrent vertigo", it is high time that the ENT specialists start doing Hallpike test. The importance of this test is that if this diagnosis is made, the treatment is Epley’s procedure. This is done by an ENT specialist in a single or 2-3 sittings at the bed side. The specialist manoeuvres the neck position so that the otoliths in the semi-circular canals are shifted in such a way that the patient is cured.

By the way, do not diagnose cervical spondylosis or TIA or hypertension as a cause of recurrent vertigo unless the patient is more than 60 years old and has a long standing hypertension or diabetes or is addicted to excess of alcohol or tobacco. In such cases, there is no point asking the patient to spend on MRI Angiograms and X-rays of the spine because even otherwise, these tests will not be normal at this age. These patients can be put on a small dose of Aspirin permanently. Remember that putting a patient on Aspirin permanently without thinking twice is a liability because the patient can bleed from the stomach any time during his life time or can develop anaemia. It is not equivalent to a vitamin pill!

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