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Spontaneous, positional, and paroxysmal positional nystagmus were studied before and after sectioning the superior division of the vestibular nerve and the anterior vestibular artery in squirrel monkeys. Histopathologic study of the temporal bones confirmed the degeneration of the macula utriculi with release of statoconia, but failed to identify the released utricular statoconia within the vestibular endolymphatic space in any animal. Postoperatively the animals consistently demonstrated direction-fixed spontaneous nystagmus until the end of the experiment (five months). Positional tests and Dix-Hallpike maneuver occasionally changed the intensity of the spontaneous nystagmus, but never elicited paroxysmal positional nystagmus. Possible reasons for not demonstrating paroxysmal positional nystagmus in the squirrel monkey are as follows: a resorption of statoconia; slight morphological alteration of the sensory epithelia of the posterior cristae; interference of the posterior crista function due to partial collapse of the membranous ampulla; the existence of interspecies difference; or possibly a faulty hypothesis regarding the etiologic mechanism of benign paroxysmal positional vertigo.

Five patients with incapacitating benign paroxysmal positional vertigo (BPPV) for one year or longer were managed surgically by transection of the posterior ampullary nerve. An approach to this nerve was devised based upon a careful study of the posterior ampullary nerve in temporal bone dissections and specimens of the inner ear. Using the round window membrane as the principal landmark, the singular canal was exposed in the round window niche via a tympanotomy approach under local anesthesia. Transection of the posterior ampullary nerve promptly and completely relieved the signs and symptoms of BPPV in all five patients. A severe sensorineural hearing loss was produced in one case as a result of traumatic labyrinthitis. Transection of the posterior ampullary nerve in the round window niche is recommended to: 1) relieve severe BPPV of one or more years duration, and 2) add to the completeness of transcanal labyrinthectomy by denervating the inaccessible posterior canal crista.

Ru-Vert®, a combination product, containing in each tablet, 25 mg of pentylenetetrazol, 12.5 mg of pheniramine maleate, and 50 mg of nicotinic acid, was evaluated in the treatment of seventeen patients with benign paroxysmal positional vertigo. The study was double-blind with crossover. Ru-Vert® at a dosage of two tablets t.i.d. was found to reduce significantly the nystagmus and the vertigo induced by Hallpike maneuvers in these patients.

Objective: To determine the effects of Epley's maneuver as a single line treatment of Benign paroxysmalpositional vertigo (BPPV).Material and MethodsrThis study was conducted in New Medical Center hospital Dubai from 1st June2010 to 30th may 2011. A total no of 32 patients were included in this study, with age ranged from 28 to 63years.Results: In our study out of 32 patients 19 (59.3%) were female and 13 (40.7%) were male. 20 patients werepresented with in first 48 hours of symptoms while remaining 12 presented in 1st week. All patients weresubjected to Dix-Hallpike positional testing, and positive cases were treated by canal repositioningmaneuver (Epley's maneuver). 21 (65.62%) patients symptomatically improved in first 24hrs, while 11(34%) patients were subjected to 2nd maneuver after 48 hours. 3 (9.37%) patients were advisedrehabilitation exercises on 3rd follow up later after 2 separate sessions of canal repositioning maneuver. Allpatients were on strict advise for post maneuver restrictions.Conclusion: Repositioning treatments appear to be efficacious, regardless of minor differences amongmaneuvers. Thus minor variations in techniques may not substantially influence the outcome of treatment,and the clinician can be confident in using repositioning treatments with a wide variety of patients.Keywords: Vertigo, Benign paroxysmal positional. Epley's maneuver

The position in children is very different. Vertigo in childhood has received very little attention and in fact often goes unrecognized, as will be discussed. The general view is exemplified by Ford (1960), who refers to the purulent and rare serous forms of labyrinthitis complicating gross infections of the middle ear and mastoid process, to vertigo as a symptom of a number of conditions particularly brain-stem lesions and posterior fossa neoplasms, and to Meniere's disease which he states is "so rare in childhood that it does not require more than a very brief discussion." Confirming this view, the case quoted in illustration by him, as well as being atypical of Meniere's disease, also had a posterior fossa exploration during the course of her investigations. No other form of vertigo is mentioned. Harrison (1962a) has discussed other varieties of vertigo occurring in children. The purpose of this paper is to draw attention to the problem and to describe a particular variety of paroxysmal vertigo occurring in childhood, not previously reported, not uncommon, with characteristic and readily recognizable features, and differing from other forms of paroxysmal vertigo found in adult life. It has both practical and theoretical importance.

Keywords: BPPV, Benign Paroxysmal Positional Vertigo; Dix-Hallpike procedure; Epley maneuverDOI: 10.3126/njenthns.v1i2.4764 Nepalese J ENT Head Neck Surg Vol.1 No.2 (2010) p.28-32