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1.Benign Positional Vertigo (BPV)   

1.BENIGN PAROXYSMAL POSITIONAL VERTIGO (BPPV)

BPPV is one of the most common causes of dizziness. This is a good example of paroxysmal dysfunction of the inner ear.

A. POSTERIOR CANAL BPPV

The patient complains of intense rotational vertigo associated with movements of the head with three characteristics:

1. it is only triggered when the position of the head is moved,
2. very violent,
3. it lasts for less than one minute,
4. it can cause nausea and vomiting.

The head positions that trigger vertigo are most often those where the head is extended or when the patient goes to bed at night or goes from lying to sitting in the morning. The vertigo recurs whenever the patient’s head returns to the same position but becomes less intense, reflecting its fatigability. Physician-patient discussion will be immediately helpful but only the clinical examination will confirm diagnosis.

The examination must be performed using VNG and will involve positioning

2. POSITIONAL VERTIGO OF THE HORIZONTAL CANAL

This type of positional vertigo is much rarer. It most often occurs not when the patient lies down or stands up but when they are already lying down and turn over to one side or the other. Clinically, diagnosis is based on several types of argument:

1. it is not triggered by lying on the side as for the posterior canal vertigo, but occurs when patients sit with their head bent forward, placing the horizontal canals in a vertical plane;
2. the nystagmus induced is horizontal and not torsional. In this position, the direction of the rapid phase of nystagmus indicates the affected side;
3. it is rarely fatigable;
4. its onset latency is shorter (less than 5 s) and its duration is longer (20-60 s).

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