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In the vertical canals, ampullofugal deflection produces an excitatory response. In the head-hanging position, the canalith mass would move away from the cupula to induce ampullofugal cupular deflection. The time taken for this to occur plus the original inertia of the particles explains the latency seen during the Dix–Hallpike manoeuvre, which is described later. The drag thus created must overcome the resistance of the endolymph in the semicircular canal and the elasticity of the cupular barrier in order to deflect the cupula. The canalith mass moves to a more dependent position when the orientation of the semicircular canal is modified in the gravitational plane. 9, 10 Particles must accumulate to a “critical mass” in the dependent portion of the posterior semicircular canal. The mechanism by which canalithiasis causes nystagmus in the posterior semicircular canal was described by Epley. In this paper, we review the normal vestibular physiology, discuss the pathophysiology and causes of BPPV, and then go on to discuss diagnoses, office-based management and, finally, surgical management. Since this initial description was written, there have been major advances in the understanding of this common condition. If, immediately after the cessation of these symptoms, the head was again turned to the right, no attack occurred, and in order to evoke a new attack in this way, the patient had to lie for some time on her back or on her left side. The attack lasted about thirty seconds and was accompanied by violent vertigo and nausea. When she did this, there appeared a strong rotatory nystagmus to the right. ![]() The attacks only appeared when she lay on her right side. Bárány 2 first described the condition in 1921: 1 It is a condition that is usually easily diagnosed and, even more importantly, most cases are readily treatable with a simple office-based procedure. In 1 large dizziness clinic, BPPV was the cause of vertigo in about 17% of patients. Of all the inner ear disorders that can cause dizziness or vertigo, benign paroxysmal positional vertigo (BPPV) is by far the most common.
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