BPPV

Question 1

Define BPPV? (Benign paroxysmal positional vertigo)

Answer 1

Vertigo lasting seconds to minuteson changing head position(e.g. sitting to lying down or turning the head suddenly – ask about whether it gets worst when they are rolling around in bed)

Question 2

outline the aetiology of BPPV?

Answer 2

Displacement of otoliths(from degeneration, trauma or post-viral, but most are idiopathic) into the semicircular canals

Otoliths are Calcium carbonate crystals

Question 3

What are the risk factors of BPPV?

Answer 3

Female, increasing age, head trauma, vestibular neuronitis, labryrinthitis, migraines, inner ear surgery and Meniere’s

Question 4

What are the presenting symptoms of BPPV?

Answer 4

• Dizziness
• Vertigo – HAS TO BE SUDDEN ONSET + EPISODIC + usually <30secs (attacks repeatedly over wks – mnths)
• Loss of balance or unsteadiness
• Nausea/vomiting

Question 5

what are the signs of BPPV on physical examination?

Answer 5

• No signs (norm neuro exam and otological exam )

Question 6

what are the appropriate investigations for BPPV?

Answer 6

• Hallpike test– used to diagnose post. canal BPPV; vertigo within 1 – 5 secs, nystagmus(reversible with sitting: L.ear=clockwise torsional nystagmus; R.ear=anti-clockwise)
• Supine lateral head turns – used to diagnose lateral canal BPPV; The clinician places the patient in a supine position and, ideally, flexes the neck 30° from horizontal to bring the lateral canals into the vertical plane of gravity. The head is then rotated to one side, left for a minute, and then rotated to the opposite side. Similar to the Dix-Hallpike manoeuvre, a positive test is noted when the patient experiences vertigo with nystagmus.