Hello and welcome to the Zero to Finals podcast. My name is Tom and in this episode I'm going to be

talking to you about benign paroxysmal positional vertigo or BPPV. And you can find written notes on

this topic at zero to finals.com slash BPPV or in the ear, nose and throat

section of the zero to finals surgery book. So let's get straight into it. Benign paroxysmal

positional vertigo or BPPV is a common cause of recurrent episodes of vertigo which are triggered by head movement.

It's a peripheral cause of vertigo, meaning the problem is located in the inner ear

rather than in the brain. It's more common in older adults.

Let's start by talking about the presentation.

A variety of head movements can trigger attacks of vertigo.

A common trigger is turning over in bed.

Symptoms settle after around 20 to 60 seconds and then patients are asymptomatic between attacks.

Often episodes occur over several weeks and then they resolve, but they can reoccur again weeks or months later. BPPV does not cause hearing loss or tinnitus, so if there's

associated hearing loss or tinnitus, think about an alternative cause. Let's talk about the pathophysiology.

BPPV is caused by crystals of calcium carbonate, which are called otoconia,

that become displaced in the semicircular canals.

This occurs most often in the posterior semicircular canal.

They may be displaced by a viral infection, head trauma, aging or without any clear cause.

The crystals or the otoconia disrupt the normal flow of the endolymph through the semicircular

canals, which confuses the vestibular system.

When the person moves their head, the endolymph within the semicircular canals starts to shift,

and this shifting is disrupted by the crystals, which confuses the system and triggers the attack of vertigo.

Therefore, the episodes are triggered by head movement.

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