Presentasi Jurnal : Strategies

to Prevent Recurrence of
Benign Paroxxysmal Positional

A.Christanto
6 Juli 2005
Substansi Jurnal
Mechanism of canalolithiasis and
treatment of BPPV of the horizontal
semicircular canal, when the left ear is
affected (the involved left horizontal
canal is colored black).
Patient in supine position with debris in the
posterior part of the left horizontal canal.
When rotating the head towards the affected side, particles
move towards the ampulla, producing an utriculopetal flow and
triggering intense horizontal nystagmus, beating toward the
ground.
When rotating the head towards the healthy side, particles fall in the opposite
direction, causing an ampullofugal flow and triggering nystagmus beating
again towards the ground, but less intense. Forced prolonged stay in this
position is the key of Vannucchi maneuver, through which dislodged otoconia
enters the utricle.
Perasat Halpike
(test nistagmus posisi)
Perasat Halpike
(test nistagmus posisi)
• Pada setiap posisi nistagmus diperhatikan,
terutama posisi akhir
• Catat masa laten dan intensitasnya
• Kekuatan vertigo, ditanyakan secara
subyektif
• Dilakukan berkali kali  ada tidak kelelahan
• PERIFER : ditemukan masa laten, terdapat
kelelahan, vertigo terasa berat
• SENTRAL : tidak ada masa laten, tidak ada
kelelahan, vertigo ringan
Brandt and Daroff
 Brandt and Daroff exercises
• Seated eyes closed
• Tilted laterally to precipitating position
• Lateral occiput resting
• Vertigo subsides
• Sit up for 30 sec
• Opposite head down position 30 sec
• Vertigo opposite (bilateral) maintain until resolves
• Every 3 hrs while awake, until 2 days free
 Brandt and Daroff

• 66 of 67 relief 3-14 days

• Most 7-10 days
• 2 of 66 recurred and responded
• Non-responder had perilymph fistula
Brandt and Daroff
To begin, the patient is seated on the edge
of the bed and the head/neck is rotated 45°
toward the right
– (Figure 1, A). The patient rapidly moves into the left
side lying position, maintaining the head/neck rotation
– (Figure 1, B). The patient then rapidly sits up with the
head slightly flexed forward
– (Figure 1, C). The exercise is repeated toward the
opposite side
– (Figure 1, C, D, A). This constitutes 1 cycle of the
exercise. Each position is maintained for 30 seconds,
the total time being 2 minutes.
Epley Maneuver
 Epley CPR procedure

• Canaliths theory
• Head maneuvers and vibration move
particles
• Target canal determined
• Sum of latency and duration
• Estimate of 90 degree time
• Premedicated
 Epley Maneuver

• Five position cycle

– Repeated until no nystagmus observed
– Induced nystagmus wait until slows
– No nystagmus time based on last observed
– Always complete cycle
– Vibratory source at 700 Hz, and 80 Hz
 Epley Maneuver

• Reclined head hanging 45 degree turn

 Epley Maneuver

• Rotate 45 degrees contralateral

 Epley Maneuver

• Head and body rotated to 135 degrees from

supine
 Epley Maneuver

• Keep head turn and to sitting

• Turn forward chin down 20 degrees
Semont
Semont
TERIMA KASIH

ENT Department
Sardjito Hospital