BPPV

Benign paroxysmal positional vertigo results from displacement of otoconia (calcium carbonate crystals) from the utricular macula into one of the semicircular canals, most commonly the posterior canal (canalithiasis). In the less common cupulolithiasis variant, otoconia adhere directly to the cupula, rendering it gravity-sensitive. During head movement, displaced otoconia create abnormal endolymph flow that deflects the cupula, generating a false signal of angular acceleration. This vestibular-visual-proprioceptive mismatch causes vertigo, nystagmus, and postural instability. The nurse performs the Dix-Hallpike diagnostic maneuver, interprets nystagmus patterns to identify the affected canal, executes canalith repositioning procedures, and develops comprehensive fall prevention and vestibular rehabilitation plans.

Risk factors: - Age >50 years with progressive otoconia degeneration - Female sex (2:1 ratio) - Head trauma (post-concussive BPPV) - Prolonged bed rest or post-surgical immobility - Prior inner ear infection (labyrinthitis, vestibular neuritis) - Osteoporosis and vitamin D deficiency - Meniere's disease (secondary BPPV) - Post-stapedectomy or inner ear surgery