BPPV

Question 1

BBPV is the most common____ disorder

Answer 1

vestibular

Question 2

BPPV prevalence:

Answer 2

more common in females

typical age: 50s-70s

annual recurrence: 15-20%

Question 3

RISKS of BPPV

Answer 3

• Head trauma
• Prolonged recumbent position * Various inner ear disorders
• Female gender, osteoporosis, Vitamin D deficiency

FACTS:
-risk between sleep position and ear involved
-increased risk with increased number of years playing football
-increased incidence following earthquakes

Question 4

Clinical manifestations of BPPV

Answer 4

• Episodes of vertigo lasting <1 minute
• Intense, room-spinning dizziness, lightheaded, nausea, imabalance
• symptoms precipitated by head movement

Question 5

Pathogenesis of BPPV

Answer 5

• Otoconia become
  dislodged, float into
  SCC
• Otoconia cause
  increased firing of hair
  cells –> rotation sensation of head
• Nystagmus is produced
  in a characteristic
  pattern which indicates
  involved canal
• Posterior canal is most
  commonly involved: 85-
  90% of cases

Question 6

What is the most commonly associated canal in BPPV?

Answer 6

posterior canal

85-90% of cases

Question 7

Canalithiasis:

Answer 7

• Otoconia break off utricle and
  float into SCC
• sensation of rotation brought on by head movement
• vertigo & nystagmus
• latency 5-10 seconds before nystagmus
  -occurs for less than 60 seconds with latency

Assess with: Dix Halpike for posterior and anterior canal, supine roll test for horizontal canal
Treat with: Epley maneuver

Question 8

Cupulolithiasis

Answer 8

• Otoconia break off utricle
  and float into canal –> stick to cupula–> weighs down cupula with head movement
• Nystagmus is longer
  duration (>1 min) (occurs right away)
• more common with horizontal canal BPPV
  -occurs for more than 60 seconds without latency

Assess with: Dix-Halpike, supine roll test for horizontal canal
Treat with: Liberatory (Semont) maneuver

Question 9

What canal is involved with up and right torsion during right head turn during dix-hallpike?

Answer 9

right posterior

Question 10

What canal is involved with down and right torsion?

Answer 10

right anterior canal

Question 11

What canal is involved with up and left torsion?

Answer 11

left posterior canal

Question 12

what canal is involved with down and left torsion?

Answer 12

left anterior canal

Question 13

What treatment would you perform for canalithiasis of the anterior SCC?

Answer 13

deep head hang

Question 14

Horizontal canal BPPV:

Answer 14

-Supine Roll test assesses horizontal canals
-increase in autonomic symptoms
- vertigo and nystagmus with rolling in either direction–> due to excitation of one horizontal canal and inhibition of another horizontal canal –> horizontal nystagmus

NYSTAGMUS FOR HORIZONTAL CANALS:
-geotrophic- toward ground (canalithiasis)
-apogeotrophic - toward ceiling (cupulolithiasis)

Question 15

If patient has stronger right beating geotrophic nystagmus with head turn right compared to left beating geotrophic nystagmus with head turn left what is the dx?

Answer 15

right horizontal canal canalithiasis

Question 16

If the patient has stronger left beating apogeotrophic nystagmus with a head turn to the left compared to right beating apogeotrophic nystagmus with a head turn to the right, the dx is?

Answer 16

right horizontal canal cupulolithiasis

-side with weaker nystagmus has symptoms

Question 17

What is the name of the treatment for horizontal canal canalithiasis?

Answer 17

BBQ roll

Question 18

What is the name of the treatment for horizontal canal cupulolithiasis?

Answer 18

Gufoni

Question 19

Important clinical pearls:

Answer 19

Use goggles/frenzel lenses when available

Clear the c-spine and modify test as needed

Educate the patient!

keep your hands ON the patient –> due to Tumarkin’s otolithic crisis: due to possibel extension response

Question 20

The CPG recommends that clinicians should reassess patients how long after their intitial onset of BPPV symptoms?

Answer 20

1 month