Title: POST BPPV SYNDROME
BPPV is the commonest cause of vertigo and about 25% of balance disorder patients who attend a vertigo clinic suffer from BPPV. Fortunately, the disease is easily correctable in most cases by some physical manoeuvres called ‘liberatory manoeuvres’ or Canalolith Repositiong Manoeuvre (CRM) and patients are very soon, if not immediately relieved of symptoms if the manoeuvre is properly done. However, quite a sizable portion (34 to 61%) of these patients are not completely symptom-free even after a very successful manoeuvre. They are of course relieved of the symptom of sudden severe head spinning on change of head posture which is the diagnostic feature of BPPV after the properly done manoeuvre; but, yet complain of a new set of symptoms viz. feeling of persistent dizziness, light headedness and unsteadiness, often a mix of all three even though there is no evidence of any positional vertigo whatsoever. This residual dizziness even after successfully repositiong the dislodged otoconia back into the otolith organs is pretty difficult to treat and causes quite a morbidity to the patient. The exact pathomechanism is not known with certainty but most published studies and clinical experience has shown that patients with high anxiety and depression as well as aged patients (in all of whom anxiety and depression are more prevalent) and patients with emotional issues are the ones who are much more likely to develop Post BPPV Syndrome and have the residual dizziness after a successful CRM. The morbidity and poor QOL induced by the residual dizziness is very high. The disease is self limiting in most cases but many patients do need medical treatment.
In our clinic we follow a protocol by which we identify which patients are more likely to have Post BPPV syndrome or the residual dizziness after a successful CRM and manage them differently. The process primarily consists of counselling and educating the patient prior to and after the repositiong manoeuvers and medicating a very select few. By this process the incidence of residual dizziness after a successful CRM is much lesser in our clinic as compared to reported international publications.