Benign paroxysmal positional vertigo

Question 1

What is benign paroxysmal positional vertigo?

Answer 1

Vertigo lasting seconds to minutes on changing head position (e.g. sitting to lying down, turning head suddenly).
This condition is due to detachment of otoliths in the inner ear, which results in hair cell stimulation and subsequent vertigo symptoms.

Question 2

What are the risk factors of benign paroxysmal positional vertigo?

Answer 2

• Age
• Gender
• Hypertension
• Hyperuricemia
• Hyperlipidemia
• Diabetes
• Osteoporosis

Question 3

What are the presenting symptoms of benign paroxysmal positional vertigo?

Answer 3

• Dizziness 
• Vertigo 
• Loss of balance or unsteadiness 
• Nausea/vomiting 
• Vertigo attacks provoked by specific head movements, such as turning the head to one side while in bed or looking upwards
• Episodes of rotational vertigo lasting between 30 seconds to 1 minute
• Absence of auditory symptoms
• Recurrent episodes, often resolving naturally over weeks to months

Question 4

What signs of benign paroxysmal positional vertigo can be found on physical examination?

Answer 4

No signs

Question 5

What investigations are used to diagnose/ monitor benign paroxysmal positional vertgio?

Answer 5

1. Dix-Hallpike manoeuvre. (clinical test):
   - The patient is seated and positioned on an examination table such that the patient’s shoulders will come to rest on the top edge of the table when supine, with the head and neck extending over the edge.
   - The patient’s head is turned 45° towards the ear being tested.
   - The head is supported, and then the patient is quickly lowered into the supine position with the head extending about 30° below the horizontal while remaining turned 45° towards the ear being tested.
   -The head is held in this position and the physician checks for nystagmus.

Question 6

How is benign paroxysmal positional vertigo managed?

Answer 6

1. Epley or Semont manoeuvres for posterior canal BPPV; barbeque manoeuvre for horizontal canal BPPV.
   - Epley manoeuvre aims to move the detached otoliths out of the semicircular canal and back to the utricle where they originate.
   - Can be done by a physiotherapist. 

Question 7

What causes benign paroxysmal positional vertigo?

Answer 7

BPPV arises due to a detachment of otoliths from the utricle of the inner ear. These detached particles can migrate into the semicircular canals, where they stimulate hair cells and lead to symptoms of vertigo.

Question 8

Describe the epidemiology of BPPV

Answer 8

BPPV is the leading cause of vertigo and is especially prevalent within the elderly population. This increased prevalence is largely attributed to the accumulation of calcium deposits, known as cholelithiasis, within the semicircular canals of the inner ear.