BPPV

Question 1

def BPPV

Answer 1

Vertigo lasting seconds to minutes on changing head position (e.g. sitting to lying down, turning head suddenly) due to disruption of debris in the semicircular canal of the ears (canalolithiasis).

Question 2

aetiology BPPv

Answer 2

displacement of otoliths (from degeneration, trauma or post-viral) into canals (usually posterior canal) resulting in canaliths = stimulation of the semicircular canals

idiopathic

head injury

Question 3

RF BPPV

Answer 3

head trauma

vestibular neuritis

labyrinthitis

migraines

inner ear injury

meniere’s disease

Question 4

epi BPPV

Answer 4

The commonest cause of peripheral vertigo.

Question 5

sx of BPPV

Answer 5

Attacks of sudden rotational vertigo lasting >30sec are provoked by head-turning.

• sensation that you, or the world around you, is moving or spinning.
• peripheral vertigo is often severe
• lasts seconds to minutes

Other otological symptoms are rare

specific provoking positions

breif duration of vertigo

episodic vertigo

sever episodes of vertigo

sudden onset

nausea, imbalance and lightheadedness

Question 6

signs of BPPV

Answer 6

absence of associated neuro or otological symptoms

normal neuro exam

normal otological exam

Question 7

ix BPPV

Answer 7

fatiguable nystagma on Hallpike testing = diagnostic

pt keep eyes open and look ahead at all times

Place the patient sitting on the couch in such a way that when they lie back, their head will be over the edge of the couch.

turn their head 45° towards the test ear (this leads to maximal stimulation of the posterior circular canal on lying).

Continue to hold the patient’s head between your hands. Ask them to lie backwards and then quickly lower their head 30° below the level of the couch.

Ask the patient if they feel dizzy and look for nystagmus.

If +ve, there is vertigo and rotary nystagmus towards the undermost ear, after a latent period of 5–10sec. This lasts <30sec and is fatiguable. On sit-ting, there is more vertigo (±nystagmus). If any of these features are absent (no latency, no symptoms, and persisting nystagmus), seek a central cause

Question 8

important -ve for BPPV

Answer 8

no persistent vertigo

no speech, visual, motor or sensory problems

no tinnitus, headache, ataxia, facial numbness, or dysphagia

no vertical nystagmus

Question 9

for all vertigo assess….

Answer 9

• CNs and ears
• cerevellar function and reflexes
• nystagmus
• gait
• Romberg’s test (+ve if balance is worse when eyes are shut - implying defective joint position sense, or vestibular input)
• provocation tests (head thrust test, hallpike)
• If clinical doubt request audiometry ± electro nystagmography; MRI.

Question 10

mx of BPPV

Answer 10

advice
* most recover over several weeks w/o treatment
* get out of bed slowly, avoid looking upwards
* dont drive when have vertigo
* inform work if necessary
* be aware of fall risk

1. watchful waiting
2. Epley manouvre
3. Brandt-Darodd exercises
4. return in 4 wks if sx have not resolved

Question 11

what are the Brandt Daroff exercises

Answer 11

1. sit on edge of bed with eyes closed
2. quickly lie down sideways with eyes closed, with head positioned as if looking to the ceiling - at 45 degrees
3. keep eyes closed sit upright again - stay for 30 seconds
4. repeat on other side
5. repeat 3-4 times until symptom free
6. repeat 3-4 times a day until sx free for 2 consecutive days