Benign paroxysmal positional vertigo (BPPV)

Question 1

what is BPPV?

Answer 1

BPPV is ‘a disorder of the inner ear characterised by repeated episodes of positional vertigo’ (symptoms occur with changes in the position of the head)

also has characteristic positional nystagmus on performing diagnostic manoeuvres, depending on the affected semicircular canal

Question 2

what are the causes?

Answer 2

Canalithiasis.

(loose CaCO3 debris, called Otoconia, in the semi circular canals of the inner ear). When the head moves, the Otoconia move, causing motion of the endolymph which induces the symptoms of vertigo.

Question 3

what are the risk factors for BPPV?

Answer 3

• head injury
• prolonged recumbent position e.g hairdressers
• ear surgery
• following an episode of any inner ear pathology e.g meniere’s
• may also be associated with sleep position. BPPV patients likely to lie on side of affected ear.

Question 4

what are the complications of BPPV?

Answer 4

• Falls (particularly in older people).
• Difficulty performing daily activities.
• Adverse effects on quality of life.
• Increased likelihood of depression.

Question 5

what are the typical symptoms you may ask about?

Answer 5

• if they hold certain positions to prevent symptoms
• length of episodes (usually 1 minute)
• nausea and vomiting
• any hearing loss or tinnitus is not a sign of BPPV

Question 6

what will examination show?

Answer 6

• normal at rest

- certain manoeuvres e.g Dix hallpike manoeuvre can help diagnose where in the semicircular canals are affected.

Question 7

what is vertigo?

Answer 7

Vertigo is a symptom, rather than a condition itself. It’s the sensation that you, or the environment around you, is moving or spinning. This feeling may be barely noticeable, or it may be so severe that you find it difficult to keep your balance and do everyday tasks.

Question 8

what advise can be given to a patient with BPPV?

Answer 8

• avoid driving if you think its risky
• inform employer if it poses a risk to workplace
• discuss risk of falling in the home and any measures to help
• offer information e.g nhs website or patient.info

Question 9

how is BPPV managed?

Answer 9

• watchful waiting to see if symptoms settle without treatment
• offer a particle repositioning manoeuvre e.g Epley manoeuvre, which can be done at first presentation in primary care
• Brandt Daroff exercises can be done at home
• symptomatic drug treatment is not usually helpful
• return in 4 weeks if no improvement