Benign Paroxysmal Positional Vertigo

Question 1

What is benign paroxysmal positional vertigo (BBPV)?

Answer 1

It is defined as an inner ear disorder characterised by canalolithiasis, which is displacement of free-floating otoconia particles from the macula that then become trapped in the semi-circular canals

Question 2

What semi-circular canal is most commonly affected by benign paroxysmal positional vertigo?

Answer 2

Posterior Canal

Question 3

What is the pathophysiology of benign paroxsymal positional vertigo?

Answer 3

The detached otoconial debris in addition to the endolymph continue to stimulate hair cells after movements have ceased

This leads to vertigo and nystagmus when the head moves in the plane of the affected semi-circular canal

Question 4

What are the seven risk factors associated with benign paroxysmal positional vertigo?

Answer 4

Older Age, 40 – 60 Years Old

Female Gender

Meniere’s Disease

Vestibular Neuronitis

Viral Labyrinthitis

Migraines

Head Injury

Question 5

What are the four clinical features associated with benign paroxysmal positional vertigo?

Answer 5

Paroxysmal Vertigo > Head Movements

Nausea & Vomiting

Light Headedness

Rotatory Nystagmus

Question 6

What is the most common cause of vertigo?

Answer 6

Benign paroxysmal positional vertigo

Question 7

Which two head movements are associated with benign paroxysmal positional vertigo?

Answer 7

Turning over in bed

Looking upwards

Question 8

How long do the clinical features of benign paroxysmal positional vertigo persist?

Answer 8

10 - 20 seconds

Question 9

What is the gold standard investigation used to diagnose benign paroxysmal positional vertigo?

Answer 9

Dix-Hallpike Manoeuvre

Question 10

How is the Dix-Hallpike manoeuvre conducted?

Answer 10

It involves positioning the patient sitting upright on the examination couch and turning their head 45 degrees – to the side which appears to trigger the clinical features

The examiner then moves the patient from their sitting position to a supine position in one brisk smooth motion, asking the patient to keep their eyes open through this process

The patients’ eyes are then inspected for nystagmus for a period of at least 30 seconds

Question 11

What is a positive Dix-Hallpike manouevre?

Answer 11

The manouevre results in the onset of vertigo and rotatory nystagmus

Question 12

Benign paroxysmal positinal vertigo is a self-limiting condition. How long following onset does it usually resolve?

Answer 12

Within 6 months

Question 13

What is the conservative management option of benign paroxysmal positional vertigo?

Answer 13

It involves advising individuals to avoid positions that provoke clinical features

Question 14

When are repositioning technqiues used to manage benign paroxysmal positional vertigo?

Answer 14

It is used to manage persistent posterior canal benign paroxysmal positional vertigo

Question 15

What are the two positioning techniques used to manage benign paroxysmal positional vertigo?

Answer 15

Epley Manoeuvre

Brandt-Daroff Exercises

Question 16

What is the Epley manouevre?

Answer 16

It is a repositioning technique, which aims to reposition the displaced otoconial particles back into the utricle from the posterior canal

Question 17

What are Brandt-Daroff exercises?

Answer 17

It is a form of vestibular rehabilitation, which individuals can conduct themselves at home

They aim to reposition the displaced otoconial particles back into the utricle from the posterior canal

Question 18

What is a pharmacological management option of benign paroxysmal positional vertigo?

Answer 18

Vestibular Sedatives

Question 19

When are vestibular sedatives used to manage benign paroxysmal positional vertigo?

Answer 19

They are used to manage persistent posterior canal benign paroxysmal positional vertigo

However, the literature suggests that these medications have little effect on symptomatic control

Question 20

Name two vestibular sedatives used to manage benign paroxysmal positional vertigo

Answer 20

Betahistine

Cinnarizine