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Semester 5 PMNM Exam 8 > BPPV > Flashcards

BPPV Flashcards

1
Q

BPPV - what does it stand for

A

Benign Paroxysmal Positional Vertigo

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2
Q

What is BPPV

A

Recurrent positional vertigo and nystagmus occuring when the head is placed in certain positions

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3
Q

BPPV - evoked by

A

Changes with respect to gravity (such as rolling over in bed or looking up to a shelf)

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4
Q

BPPV - initial occurance usually experienced when

A

upon awakening in the morning and night rather than on first laying down

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5
Q

What is vertigo

A

An illusion of movement, most commonly a sense of spinning

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6
Q

Vertigo and Nystagmus - begin… and will last…

A

Begin after a latency of 3-4 seconds

Will last from 1-40 seconds

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7
Q

Vertigo and Nystagmus - fatigue

A

Will fatigue with repetition

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8
Q

BPPV - how long before it goes away

A

Usually spontaneously disappears after a few weeks

If no tx it may persist for months to eyars

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9
Q

BPPV - reoccurence

A

in 18-50% of patients

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10
Q

Characteristics of patients with BPPV

A 
ADL scores are lower in those with BPPV 
Higher percentage of falls 
More incidence of depression
May have abnormal postural reactions 
Usually learn to avoid whatever position causes their vertigo
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11
Q

Nystagmus

A

Eye jumping

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12
Q

Otoconia

A

Small Ca carbonate crystals derived from utricle

ear debris

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13
Q

Utricle

A

A small sac like structure of the inner ear

Primarily used for postural stability

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14
Q

Cupula

A

Apex of cochlea

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15
Q

Endolymph

A

Fluid in the semicircular canals
Moves freely in response to direction of angular movement
As it moves, it bends hair cells on cupula

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16
Q

Semicircular canals

A

Three canals of the bony labyrinth of the inner ear
Ant, Post, Horizontal
Each respond to movement in own plane
Filled with endolymph
Signals primarily used for gaze stability

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17
Q

Two theories of cause of BPPV

A

Cupulolithiasis theory

Canalithiasis theory

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18
Q

Cupulolithiasis theory

A

Fragments of otoconia break away from the utricle and adhere to the cupula of a semicircular canal
When head is moved into certain positions, the weighted cupula is deflected by the pull of gravity and this leads to vertigo and nystagmus

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19
Q

Problems with the cupulolithiasis theory

A

If it was the weighted down cupula that caused vertigo and nystagmus then it would persist as long as the person was in the provoking position

20
Q

Canalithiasis theory

A

There are fragments of the otoconia freely floating around in one of the SC
When pt changes head position, the pull of gravity causes the otoconia to move within the canal
This mvmnt results in movement of endolymph, which deflects the cupula

21
Q

Canalithiasis theory continued - repeat positioning maneuvers does what

A

would disperse the otoconia thorughout the canal where its movement would still shift the endolymph but be so far dispersed that it does not cause deflection of the cupula

22
Q

Canalithiasis theory - accounts for what

A

the short duration of nystagmus upon position change

23
Q

Semicircular Canal involved with BPPV - most frequent cause of BPPV is what

A

a mechanical disorder in the posterior semicircular canal - upbeating and torsional nystagmus

24
Q

Semicircular canal involved with BPPV - what is rarer

A

Horizontal and anterior semicircular canal impairment are much rarer
Horizontal - horizontal nystagmus
Anterior - down beating and torsional nystagmus

25
Q

How is BPPV Diagnosed

A

A hx of vertigo and a physical exam showing nystagmus during these tests
Hallpike Dix maneuver
EMG

26
Q

Hallpike Dix

A

Pt is moved from sitting with their head rotated 45 degrees to one side, to a supine position of 30 degrees extension with 45 degrees rotation

27
Q

Brandt Daroff Exercises

A 
Also used as a diagnostic test
Pt moves quickly from the seated position to the side lying position 
Pt returns to seated
Pt repeats to opposite side
Return to sitting
Check nystagmus in all positions
28
Q

Frenzel goggles

A

Magnify the patients eyes making nystagmus easier to observe
Also prevent patient from fixating on an object to supress the nystagmus

29
Q

Prior to treating a patient with BPPV a PT should determine

A

What positional changes cause vertigo
Any associated balance problems
Any conditions like neck pain

30
Q

Documentation of vertigo

A

Latency, duration, and intensity should be documented for each position change
Can scale 1 to 5 or 1 to 10

31
Q

Goals for patients with BPPV

A

Replace the otoconia into the vestibule
Reduce the vertigo associated with head motion
Improve balance
Return to daily activities involving head motion
Educate the patient about self treatment strategies

32
Q

Medical tx of BPPV

A

No medication has been proven to to beffective to rid a person of BPPV

33
Q

Surgical tx of BPPV

A

Posterior canal plugging - blocks the post canal function without affecting the other canals
Poses small risk to hearing
Effective in 90%
Only 1% will eventually have this procedure

34
Q

Commonly used interventions for BPPV

A

Epley maneuver/Canalith repositioning tx
Semont/Liberatory maneuver
Brandt Daroff exercises

35
Q

Epley Maneuver

A

Start in sitting and quickly change to supine with head rotated 45 degrees toward symptomatic side with 30 degrees extension
Keep this position for 30-60 seconds based on duration of nystagmus
Quickly rotate head to opposite side and hold 30-60 seconds
Roll to same direction the head is rotated to so that the head is rotated 45 degrees with nose down
Return to sitting with head still tilted down for 1 minute

36
Q

Epley Maneuver Restrictions

A

Remain upright for 1-2 nights

Avoid sleeping on involved side for 5 additional nights

37
Q

EM is based on what theory

A

Canalithiasis theory
93% effective
Perform at weekly intervals until BPPV is gone

38
Q

Semot Maneuver

A

Start in seated position with the head rotated 45 degrees toward the asymptomatic
Quickly lie down to opposite/lesion side shoulder
Remain in this position for 30 seconds/until vertigo stops
Rapidly move 180 degrees to opposite shoulder in ear down position
Remain until vertigo stops
Slowly return pt to seated

39
Q

Semont Maneuver restrictions

A

Recommend having the patient maintain an upright position for 48 hours after - found to be unnecessary
Avoid provoking posiiton for 5 additional nights

40
Q

Semont maneuver - originally based on what theory

A

Cupulolithiasis
90% pts cured after max of 4 sessions
Performed at weekly intervals until BPPV is gone
No more than 5 reps if given as HEP

41
Q

SM - research

A

Efficacy dec each time it was repeated

Pts with long lasting or traumatic BPPV have lower recovery rates

42
Q

SM vs. EM

A

No significant difference between the two maneuvers
Try one maneuver and if the patient still has nystagmus at the 2nd session , try the other maneuver
If both fail then prescribe the Brandt-Daroff exercises

43
Q

Brandt-Daroff Exercises as treatment

A

The patient moves quickly from the seated position into side lying on the affected side
Remains in that position until the vertigo/nystagmus subsides
The patient then returns to the seated position
Wait until vertigo/nystagums subsides
The patient then repeats the maneuver on the opposite side
Return to sitting

44
Q

Brandt-Daroff Exercises as treatment - how many

A

Performed 10 - 20 reps, 3 times a day
Until pt has no vertigo for 2 consecutive days
If pt has severe vertigo, can reduce number of daily reps

45
Q

Considerations for tx of BPPV

A

Elderly may be less tolerant of SM
Pts with long hx of BPPV may have anxiety with provoking positions
Success of BD are dependent on pt compliance
Cervical or back pain might prohibit SM and/or might be aggravated by BD exercises
Epley might be better for patients who are obese

Semester 5 PMNM Exam 8 (8 decks)

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