BPPV Lab

Question 1

What are the three most common types of BPPV?

Answer 1

Posterior Canalithiasis
Horizontal Canalithiasis
Horizontal Cupulothiasis

Question 2

What are the main examination techniques for the anterior canal?

Answer 2

Dix-Hallpike Test (contralateral)

Question 3

What are the main examination techniques for the horizontal canal?

Answer 3

Supine Roll Test
Bow and Lean

Question 4

What are the main examination techniques for posterior canal?

Answer 4

Dix-hallpike (ipsilateral)
Side-lying test (ipsilateral)

Question 5

What is the gold standard for examining the posterior canal?

Answer 5

Dix-Hallpike

Question 6

What examination findings would indicate a positive Dix-Hallpike Test?

Answer 6

Nytagmus towards the ear involved

Question 7

Why might you do the side-lying test instead of the Dix-Hallpike test?

Answer 7

pt unable to assume long sit/supine position

Spinal precautions, pregnancy, LBP, etc.

Question 8

How would you distinguish between canalithiasis and cupulolithiasis during the Dix-Hallpike and Side-lying Tests?

Answer 8

Canalithiasis: 1-40 sec latency, fatigues
Cupulolithiasis: immediate onset, does not fatigue

Question 9

What examination findings would indicate that the anterior canal was involved?

Answer 9

Down-beating and towards anterior canal being tested.

Question 10

What is the difference between geotropic and ageotropic nystagmus, and what does each indicate?

Answer 10

Geotropic: towards the ground; canalithiasis
Ageotropic: towards the air, cupulolithiasis

Question 11

How do we determine which canal is involved with horizontal BPPV?

Answer 11

Bow and Lean
Syptom Severity

Question 12

What is the purpose of the Bow and Lean test, and what will a positive test indicate?

Answer 12

Can be used to determine side of involvement for horizontal canal.
Cupulolithiasis: bow - away; lean - towards
Canalithiasis: bow - towards; lean - away

Question 13

What repositioning maneuver is there for the posterior canal?

Answer 13

• Modified Epley
• Semont

Question 14

What repositioning maneuver is there for the anterior canal?

Answer 14

Deep Head Hang

Question 15

What repositioning maneuver is there for the horizontal canal?

Answer 15

• BBQ Roll
• Appani/Gufoni
• Casani

Question 16

Why is it important to watch the patient’s nystagmus at each maneuver step

Answer 16

To ensure the crystals have moved to the most inferior portion of the canal.

Question 17

What should you do if nystagmus changes direction when completing a repositioning maneuver?

Answer 17

Finish the manuever then retest.

Question 18

What post-maneuver instructions should you give your patient?

Answer 18

• No vertical head pitch for 24 hours
• Sleep semi reclined for one night
• Avoid sleeping on that side if possible