Understanding Benign Paroxysmal Positional Vertigo Francesco Dispenza, Alessandro De Stefano
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fm1Understanding Benign Paroxysmal Positional VERTIGOfm2
fm3Understanding Benign Paroxysmal Positional VERTIGO
Editors Alessandro De Stefano MD PhD Associate Professor Audiology and Speech Disorders Department of ASL of Lecce Lecce, Italy Francesco Dispenza MD PhD Consultant of Otorhinolaryngology UOC Otorinolaringoiatria–Azienda Universitaria Ospedaliera Policlinico ‘P Giaccone’ Palermo, Italy Foreword Adolfo M Bronstein
fm4
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Understanding Benign Paroxysmal Positional Vertigo
First Edition: 2017
9789385999055
Printed at:
fm5Dedication
To my wife Caterina, the greatest love of my life
To my Father and Mother for their life suggestions
Alessandro De Stefano
To my wife Vittoria and my sons Chiara and Carlo for their daily support
To my father Carlo for his teaching
Francesco Dispenzafm6
fm7Contributors fm11Foreword
Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause of vertigo and also the most common peripheral vestibular disorder. Fortunately, the clinical developments of the last three decades have turned this condition into one of the best success stories of medicine in general. Within a few minutes, the vast majority of patients with BPPV can now be treated successfully by a doctor or paramedic in his own consulting room. No other area in medicine has seen so much of progress with so little research funding invested. The revolution in BPPV treatment is an extraordinary example of how good clinical observation and practice can still change patient outcomes.
In this book, Doctors De Stefano and Dispenza have achieved a remarkable gathering of specialists in the field. Any neurologist or ENT specialist interested in the area of vertigo can feel fully confident and backed up. He or she will now be able to proceed with even the more complicated and difficult cases of positional vertigo and be aware of the important differential diagnoses that have to be kept in mind. With so much of progress in this area, a dedicated book on BPPV was long overdue. The editors are to be congratulated on their idea and implementation of this project.
Professor Adolfo M Bronstein MD PhD FANA FRCP
Professor of Clinical Neuro-otology
Imperial College London Consultant Neurologist and Neuro-otologist
Charing Cross Hospital (Imperial College Healthcare NHS Trust) and National Hospital for Neurology and Neurosurgery
University College London Hospitals (UCLH)
London, United Kingdomfm12
fm13Preface
Vertigo is a frequent and frustrating symptom for which patients seek help from an Otolaryngologist and Benign Paroxysmal Positional Vertigo (BPPV) represents the most common cause of peripheral vertigo observed.
Typically, BPPV affects approximately 20–24% of patients suffering from vestibular diseases, but, unfortunately, it is very difficult to find a cause for this entity.
Sometimes, head trauma, vestibular neuritis and other inner ear disorders, such as Meniere's disease, labyrinthitis, herpesvirus infection, mastoid and stapes surgery, and vascular alterations (circulatory failure of anterior vestibular artery) have been associated with BPPV, but more than 50% of all the reported cases are identified as being idiopathic in nature.
Typically, in BPPV, the semicircular canals are inappropriately stimulated by loose otoconia in certain head positions, resulting in brief episodes of vertigo.
The incidence of BPPV progressively increases in the elderly population as reported by BPPV Guidelines of the American Academy of Otolaryngology– Head and Neck Surgery.
The elderly tend to have multiple comorbidities, such as hypertension, diabetes, osteoporosis, osteoarthrosis and many others, which cause major geriatric syndromes, such as falls, dementia, and limitation of mobility.
The comorbidities compromise the autonomy of elderly population, causing a quick worsening of quality of life.
Coincidentally, increasing age is directly proportional to the presence of several neurotological disorders associated with deterioration in equilibrium and hearing function, such as BPPV and other dizziness, sensorineural hearing loss, tinnitus, changes in the body balance, gait disorders, and occasional falls.
In our previously published study, we showed the relationship between recurrent BPPV attack and comorbidities in elderly population.
BPPV is a simple pathology if properly diagnosed by a physician, but it becomes formidable to reduce a patient's quality of life and increased spending for unnecessary medical imaging studies and incorrect assessments, if not recognized in time.
For these reasons, the knowledge of all the clinical signs of BPPV and its related new treatments can be a good opportunity for the work of the physicians, who meet the world of BPPV for the first time or for the expert neurotologists, who love to discover and treat these balance disorders.
Alessandro De Stefano MD PhD
Francesco Dispenza MD PhDfm14