Benign Positional Paroxysmal Vertigo (BPPV)

Question 1

what is it?

Answer 1

lasts seconds < 1 minute

vertigo - usually rotatory when arising from the ear - other ear symptoms point to ear being the cause

Question 2

possible pathogenesis?

Answer 2

Thought to occur when otoconia (tiny crystals of calcium carbonate) are dislodged from the utricle into the semi-circular canals – normally the posterior canal

Question 3

how does it present?

Answer 3

Positional vertigo is precipitated by head movements usually in a particular direction
Often happens when turning in bed or sitting up
Typically sudden and distressing onset
Last less than 1 min
Phenomenon becomes less severe on repeated movements (fatigue)
No serious underlying cause – sometimes follows vestibular neuronitis, head injury or ear infection
Occurs in 50% of older people
Most common cause of head injury in under 50s

Question 4

how is it diagnosed?

Answer 4

History
Hallpike manoevure – sit up, enough room to lay on the couch, eyes open short latency positive test they will be dizzy and maybe sick

Question 5

how is it managed?

Answer 5

90% cured by the Epley manoeuvre – gentle and specific manipulation and rotation of the head to shift the loose otoliths from the semicircular canals