BPPV: Vestibular Pathology III

Question 1

What are the characteristics of BPPV?

Answer 1

• Dizziness or vertigo
• Lightheadedness
• Imbalance
• Nausea

Question 2

What is the mechanism of injury behind BPPV?

Answer 2

displaced utricular debris (otoconia) fall out of utricle and into either neighboring semicircular canals or cupulas

Question 3

Describe how vertigo symptoms are induced with BPPV.

Answer 3

Precipitated by a change of position relative to gravity

Question 4

What is the most common cause of displaced otoconia?

Answer 4

Age-related degeneration of otoconia

Question 5

Canalithiasis BPPV

Answer 5

Free-floating otoconia within the semicircular canal resulting in abnormal endolymphatic flow with the affected canal.

Question 7

What are the major characteristics of canalithiasis BPPV?

Answer 7

• “Latency” of onset (1-40sec)
• Nystagmus appears after latency with vertigo
• Fluctuation in intensity of the vertigo and nystagmus in provoking position
• Symptoms resolve within 60 seconds

Question 8

What canals are most involved with canalithiasis BPPV?

Answer 8

Posterior + horizontal

Question 9

What are the normal eye movements associated with a healthy VOR?

Answer 9

Eyes move contralateral to head turn and contralateral to vertical head movement.

(Ex: R anterior canal is excited when head turns R and goes down: normal VOR Left torsion and up)

Question 10

What direction will nystagmus take on with each canal if BPPV is present?

Answer 10

Ipsilateral to the canal involved

Question 11

What are the major characteristics of cupulolithiasis BPPV?

Answer 11

• Immediate onset of vertigo in provoking position
• Persistence of symptoms as long as head is maintained in provoking position

Question 12

What types of patient populations do we see the most prevalence of BPPV?

Answer 12

Elderly + Women

Question 13

How common is bilateral and multi-canal BPPV?

Answer 13

• Bilateral: 15-20% (trauma common)
• Multi-canal: ~5-10%

Question 14

What are common activity triggers that a patient with BPPV might describe?

Answer 14

• Bed mobility
• Reaching for object on floor or top shelf
• Washing hair
• Working under car
• Changing a lightbulb

Question 15

What are the predisposing factors of BPPV?

Answer 15

- AGE
**- trauma **(concussions)
- Inner ear disease
- Genetics
- Osteopenia/osteoporosis
- CVD
- DM
- Migraines
- Vit D Deficiency
- Sleeping position/prolonged immobility

Question 16

How is BPPV diagnosed?

Answer 16

Clinical examinaiton of BPPV tests

Question 17

How is BPPV treated?

Answer 17

Repositioning maneuvers + post-maneuver activity restrictions

Question 18

What is the prognosis for BPPV?

Answer 18

Avg 1.25 session for complete resolution