BPPV

Question 1

Define BPPV.

Answer 1

Benign paroxysmal positional vertigo –> episodic vertigo triggered by certain changes in the position of the head

Question 2

What are the different types of BPPV and which is most common?

Answer 2

• Posterior semicircular canal BPPV - most common
• Lateral semicircular canal BPPV
• Anterior semicircular canal BPPV

Question 3

What are the clinical features of BPPV?

Answer 3

• Episodic vertigo (sudden and recurrent)
• Episodes last <1 min
• Associated features include nystagmus, falls + injury, N+V

*Does not usually cause hearing loss or tinnitus

Question 4

What test is used to confirm BPPV?

Answer 4

Dix-Hallpike manoeuvre

Question 5

How is the Dix-Hallpike manoeuvre performed?

Answer 5

1. Ask patient to sit upright on the examination bed and keep eyes open during procedure
2. Rotate head by 45 degrees towards the affected side
3. Keeping the neck rotated, quickly lay the patient in the supine position with head off the bed at an angle of ~20 degrees
4. Hold this for 20-30 seconds
   - assess for nystagmus
   - ask if patient is experiencing vertigo
   - wait for resolution of nystagmus and vertigo
5. Slowly reposition to the upright position with neck in neutral position
   - observe for nystagmus

Question 6

What are the characteristic findings that indicate a positive Dix-Hallpike test?

Answer 6

• Positional vertigo and nystagmus triggered during the manoeuvre
• With posterior canal BPPV there will be upbeat nystagmus with ipsiversive torsional nystagmus

Question 7

What can be done to manage BPPV?

Answer 7

• Epley manoeuvre
• Watch and wait (usually resolves spontaneously)
• Vestibular rehabilitation therapy (refractory BPPV)
• Betahistine (not very effective)