Benign paroxysmall positional vertigo (BPPV)

Question 1

Benign paroxysmal positional vertigo (BPPV) is a common disorder of the inner ear with symptoms including dizziness, vertigo, unsteadiness and nausea. What is the incidence of BPPV?

1 - 6400 cases per 100,000
2 - 640 cases per 100,000
3 - 64 cases per 100,000
4 - 6.4 cases per 100,000

Answer 1

3 - 64 cases per 100,000

paroxysmal = sudden increase of symptoms (as of a disease) that occurs, quiets down, and occurs again and again

Question 2

Benign paroxysmal positional vertigo (BPPV) is a common disorder of the inner ear with symptoms including dizziness, vertigo, unsteadiness and nausea. What age does the incidence of BPPV peak?

1 - 10-20
2 - 25-35
3 - 40-55
4 - 60-70

Answer 2

4 - 60-70

Average age of onset is typically 55

Question 3

Benign paroxysmal positional vertigo (BPPV) is a common disorder of the inner ear with symptoms including dizziness, vertigo, unsteadiness and nausea. Is this more common in men or women?

Answer 3

• women

3:1 ratio

Question 4

Benign paroxysmal positional vertigo (BPPV) is a common disorder of the inner ear with symptoms including dizziness, vertigo, unsteadiness and nausea. Does a change in head position make symptoms worse, or does it have no effect on BPPV symptons?

Answer 4

• change in head position makes symptoms worse

paroxysmal = sudden increase of symptoms (as of a disease) that occurs, quiets down, and occurs again and again

Question 5

Which of the following is NOT typically a risk factor for developing benign paroxysmall positional vertigo (BPPV)?

1 - history of inner ear pathology
2 - head trauma
3 - male gender
4 - advancing age

Answer 5

3 - male gender

More common in females

Question 6

Which of the following is NOT true about benign paroxysmall positional vertigo (BPPV)?

1 - all ages can be affected, but elderly most
2 - believed to be debris from otoliths and become lodged in utricular maculae and trapped in semi-circular canals
3 - brief paroxysms of vertigo and nausea/vomiting can be induced by head movements
4 - vertigo settles with continued movement
5 - nystagmus accompanies vertigo

Answer 6

4 - vertigo settles with continued movement
- incorrect

• vertigo settles with complete stillness
• paroxysmal = sudden increase of symptoms (as of a disease) that occurs, quiets down, and occurs again and again

Question 7

Benign paroxysmal positional vertigo (BPPV) is a common disorder of the inner ear with symptoms including dizziness, vertigo, unsteadiness and nausea. How long do bouts of symptoms typically last?

1 - constant
2 - 30-50 mins
3 - 5-10 mins
4 - 10-20 seconds

Answer 7

4 - 10-20 seconds

paroxysmal = sudden increase of symptoms (as of a disease) that occurs, quiets down, and occurs again and again

Question 8

Does benign paroxysmal positional vertigo (BPPV) always cause nausea?

Answer 8

• no

Can happen but not in everyone

Question 9

Is benign paroxysmal positional vertigo (BPPV) typically associated with any other otological symptoms?

Answer 9

• no

Question 10

Although the exact cause of Benign paroxysmall positional vertigo (BPPV) is unknown, what is the most commonly citied cause?

1 - increases viscosity of perilymph
2 - reduced levels of endolymph
3 - dislodged otoconia (crystals) in the saccule/utricle into the semi-circular canals
4 - demyelination of the vestibular nerve

Answer 10

3 - dislodged otoconia (crystals) in the saccule/utricle and then into the semi-circular canals

Most commonly affects the posterior semi-circular canals

Question 11

There are different types of Benign paroxysmall positional vertigo (BPPV), but which is by far the most common?

1 - posterior semicircular canal BPPV
2 - lateral semicircular canal BPPV
3 - superior semicircular canal BPPV
4 - all equally likely

Answer 11

1 - posterior semicircular canal BPPV

Accounts for 80-85% of case

Question 12

Benign paroxysmall positional vertigo (BPPV) is the most common cause of paroxysmall vertigo. Which of the following tests is used to diagnose of BPPV?

1 - HINT test
2 - DIX-Hallpike test
3 - Epley manoeuvre
4 - otoscopy

Answer 12

2 - DIX-Hallpike test
- also confirms the side of the dysfunction

paroxysmal = sudden increase of symptoms (as of a disease) that occurs, quiets down, and occurs again and again

Question 13

The DIX-Hallpike test is the most effective way in which to diagnose a patient with Benign paroxysmall positional vertigo (BPPV).

• patient sits on bed
• head is turned 45 degrees
• patient is lay down quickly and head hangs over the edge of the bed
• head remains at 45 degrees, but head must drop to 30 degrees below horizontal line
• observe for nystagmus for >30 seconds
• repeat on the opposite side
• the direction the head is turned is the ear being tested and patient must keep eyes open throughout

Answer 13

Interpretation:

Normal = no nystagmus present
Abnormal = nystagmus when head is lowered over the edge of the bed

Question 14

Benign paroxysmall positional vertigo (BPPV) is the most common cause of paroxysmall vertigo. Which of the following tests can be used to monitor the efficacy of a treatment in BPPV?

1 - HINT test
2 - DIX-Hallpike test
3 - Epley manoeuvre
4 - any of the above

Answer 14

3 - Epley manoeuvre
- essentially a positive DIX-Hallpike test means we need to then do the Epley manoeuvre

Can offer vestibular rehabilitation exercises as well

Question 15

The Epley manoeuvre can be used in an attempt to correct Benign paroxysmall positional vertigo (BPPV) once a positive DIX-Hallpike has been elicited.

• in the final position of the DIX-Hallpike test, the head is then turned to the opposite side
• angle should be the same as used on the opposite side and held for >30 seconds
• patient is asked to turn their body onto the same side
• head is then turned to look down at the ground and held for 30-60 seconds
• patient then sits up while maintaining head position looking at the ground for 30 seconds
• patient must keep eyes open throughout

Question 16

Labyrinthitis and vestibular neuritis is inflammation that is associated with Upper respiratory tract infections that causes vertico. Which of the following are true about Labyrinthitis and vestibular neuritis?

1 - hearing loss and tinnitus are common
2 - symptoms are continuous and last days to weeks
3 - vertigo worsened but not precipitated by head movement
4 - symptoms typically subside spontaneously after a few weeks with no treatment required.
5 - all of the above

Answer 16

5 - all of the above

Question 17

Vestibular rehabilitation can be used in patients with vertigo, including:

• habituation gazing
• gaze stabilisation exercise
• balance training

Are these rehabilitation exercises useful?

Answer 17

• yes
• have been shown to be effective at reducing falls and improving quality of life

Question 18

In patients with vertigo, medications may be considered. Which one of the following medications is most commonly used in a patient with vertigo?

1 - Metoclopramide
2 - Chlorpromazine
3 - Ondansetron
4 - Cyclizine

Answer 18

4 - Cyclizine
- H1 receptor blocker, which is present on the H1 receptors of the vestibular nuclei and the vomiting centre

• Metoclopramide + Chlorpromazine = D2 receptor antagonist
• Ondansetron = 5-HT3 receptor antagonists