BPPV

Question 1

Define BPPV

Answer 1

Inner ear disorder characterised by episodes of positional vertigo

Question 2

What manoeuvre is used for diagnosis of BPPV?

Answer 2

Dix-Hallpike manoeuvre

Question 3

What manoeuvre can be used in treatment?

Answer 3

Epley manoeuvre

Question 4

What is the estimated lifetime incidence of BPPV?

Answer 4

10%

Question 5

BPPV is characterised by short episodes of positional vertigo typically lasting …

Answer 5

<1minute

Question 6

Contraindications to Dix-hallpike manoeuvre

Answer 6

Neck trauma, spinal fractures, cervical disc prolapse, vertebrobasilar insufficiency, carotid sinus syncope, recent stroke or CABG, and back/spinal pain.

Question 7

Overview of the Dix-Hallpike manoeuvre

Answer 7

Position the patient upright on a couch such that when lying supine their head hangs of the end of the couch.
Ask them to turn their head 45o to one side and to keep their eyes open and look straight ahead during the manoeuvre.
Supporting the head and neck, move the patient swiftly and smoothly from sitting to supine finishing with the head extended 30o below the horizontal plane of the couch.
Observe the eyes for 30 seconds (there is often a latent period) for any nystagmus while continuing to support the head and neck. If nystagmus is present continue to hold the position for up to two minutes (as tolerated) and note the type and duration.
Slowly return the patient to the sitting up position, again supporting the head and neck.
Repeat the test with the head turned 45o to the other side.

Question 8

Peripheral causes of vertigo result from inner ear disorders that affect the vestibular nerve or labyrinth. Conditions include:

Answer 8

Vestibular neuritis (inflammation of the vestibular nerve thought to follow a viral infection, no hearing loss)
Labyrinthitis (inflammation of the labyrinth thought to follow a viral infection, also features hearing loss)
Ménière’s disease
Vestibular ototoxicity
Perilymphatic fistula
Semicircular canal dehiscence syndrome

Question 9

Central causes of vertigo result from pathology affecting the brain, these are less common than peripheral causes. Conditions include:

Answer 9

Migraine
Stroke/TIA
Vestibular schwannoma
MS
Cerebellar tumour

Question 10

Canalith repositioning procedures

Answer 10

Canalith repositioning procedures can be used to treat BPPV. Epley’s manoeuvre is most commonly used, it aims to displace the otoconia from the semicircular canals into the utricle.