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Review
. 2018 Nov 5:13:2251-2266.
doi: 10.2147/CIA.S144134. eCollection 2018.

Benign paroxysmal positional vertigo in the elderly: current insights

D G Balatsouras  1 , G Koukoutsis  1 , A Fassolis  1 , A Moukos  1 , A Apris  2
Affiliations
Review

Benign paroxysmal positional vertigo in the elderly: current insights

D G Balatsouras et al. Clin Interv Aging. .

Abstract

Balance disorders, unsteadiness, dizziness and vertigo in the elderly are a significant health problem, needing appropriate treatment. One third of elderly patients with vertigo were diagnosed with benign paroxysmal positional vertigo (BPPV), the most common cause of dizziness in both primary care specialist Neurology and Ear Nose Throat settings. BPPV presents a specific paroxysmal positional nystagmus which can be obtained using the appropriate diagnostic positional test and can be treated effectively using specific therapeutic maneuvers. This review presents current insights into the diagnostic, pathogenetic and therapeutic aspects of BPPV in the elderly. BPPV in older patients does not differ significantly from BPPV in younger patients, with regard to pathogenesis, diagnosis and treatment. However, in older patients, its prevalence is higher and it responds less effectively to treatment, having a tendency for recurrence. Specific issues which should be considered in the elderly are: 1) difficulty in obtaining an accurate history; 2) difficulty in performing the diagnostic and therapeutic maneuvers, which should be executed with slow and gentle movements and extremely cautiously to avoid any vascular or orthopedic complications; and 3) the relation between BPPV and falls.

Keywords: balance; benign paroxysmal positional vertigo; dizziness; elderly; vestibular.

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Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Theories of posterior semicircular canal stimulation in BPPV. Notes: (A) Cupulolithiasis: adherence of debris to the cupula making it gravity sensitive (1. Sensory epithelium. 2. Cupula. 3. Otoconia. 4. Ampulla). (B) Cupulolithiasis: cupula deflection after canal rotation. (C) Canalolithiasis: position of particles before canal rotation. (D) Canalolithiasis: movement of particles and cupula deflection after canal rotation. Abbreviation: BPPV, benign paroxysmal positional vertigo.
Figure 2
Figure 2
The Dix-Hallpike test, for the left (L) ear on the left panel and for the right (R) ear on the right panel. Notes: (A) Initial sitting position. (B) Head turn 45° toward the examined ear. (C) Head hanging 45° below the horizontal, with the examined ear undermost.
Figure 3
Figure 3
The Epley canalith repositioning procedure when the posterior semicircular canal of the left ear is affected. Notes: (A) The patient is sitting with the head turned horizontally 45° to the affected (left) ear. (B) Left head-hanging position. (C) Rightward roll, right head-hanging position. (D) Further rightward roll. (E) Sitting up. The head is held still in all positions for 1–3 minutes.
Figure 4
Figure 4
The Semont maneuver when the posterior semicircular canal of the left ear is affected. Notes: (A) The patient sits with the head turned horizontally 45° to the healthy (right) ear. (B) Moving to left side-lying position (nose up). (C) Moving to the right side-lying position (nose down). Then the patient returns to initial position (D). Again the head is held still in all positions for 1–3 minutes.
See this image and copyright information in PMC

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