ROMANIAN JOURNAL OF NEUROLOGY – VOLUME IX, NO. 4, 2010 189 THE CLINICAL CHARACTERISTICS AND TREATMENT OF BENIGN PAROXYSMAL POSITIONAL VERTIGO IN THE ELDERLY Gabriela Musat ENT Department ”St. Mary“ Hospital, UMF Carol Davila, Bucharest, Romania ABSTRACT Background. Benign paroxysmal positional vertigo (BPPV) is an inner ear disease that affects especially elderly people, being a common cause of dizziness at this age. The condition is diagnosed using the Dix- Hallpike maneuver and treated by the particle repositioning maneuver. Objective. To establish whether there is any difference between BPPV at old ages compared to BPPV in younger people. Method. A comparative study between two groups of patients diagnosed with BPPV; one group with ages 65-85 and another group with ages 35- 65. All patients were assesed by physical examination including the Dix-Hallpike maneuver. We used as a treatment maneuver the particle repositioning maneuver, Epley. Results. No major differences were found between the two age groups concerning the clinical characteristics and the response to treatment. Key words: benign paroxysmal positional vertigo, elderly people, Dix Hallpike test, Epley maneuver CLINICAL STUDY 5 Author for correspondence: Gabriela Musat, “St. Mary“ Clinical Hospital, Ion Mihalache Bvd., No. 37, Bucharest, Romania INTRODUCTION The benign paroxysmal positional vertigo (BPPV) is defined as a disorder of the inner ear characterized by repeated episodes of positional vertigo. The benign paroxysmal positional vertigo accounts for about 20% of all diziness. It seems that BPPV is the most common vestibular disorder. The age of onset of BPPV is considered to be some- where between 50 and 70 years old. Different sta- tistics situate the incidence of BPPV amongst el- derly between 40 to 50% in all dizzinesses of older people. As the life expectancy increases all over the world it is expected that the incidence and the prev- alence of BPPV will also increase. It is thought that the pathophysiology of BPPV is explained by the canalolithiasis, that means oto- lithic debris entering the semicicular canals and causing there inertial changes that account for the nystagmus and the vertigo when the head moves in the plane of the canal. In the great majority of cases the affected canal is the posterior semicircular ca- nal 85-95%. The incidence of the BPPV of the semicircular lateral canal is much less important, only 5-15% of the cases. The diagnostic criteria for the posterior canal BPPV are history and the physical examination. The history of the pacient with BPPV reveals rota- tional sensations when the patient moves the head relative to gravity for example when rolling-over in bed, tilting the head to look upward, bending for- ward. As for the physical examination, the the pos- terior canal BPPV is evidenced by the Dix-Hallpike maneuver. The patient is positioned in clinostatism with the head turned 45 degrees to one side and 20 degrees tilted backwards. In BPPV, after a latency period of about 50-20 seconds, this maneuver trig- gers a nystagmus and a vertigo that increase and resolve in maximum 60 seconds. The nystagmus is a mixt torsional and vertical eye mouvement beating