BPVV Flashcards

1
Q

what does BPPV stand for?

A

Benign Paroxysmal Positional Vertigo

  • Benign = not malignant
  • Paroxysmal = recurrent, sudden intensification of symptoms
  • Positional = placement dependent (of ear)
  • Vertigo = false inner sense of rotational movement
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2
Q

what are the symptoms of BPPV?

A
  1. bursts of dizziness or vertigo
  2. ligthheadedness
  3. imbalance
  4. nausea
  5. variable “triggers” but symptoms are almost always precipitated by a change of position of the head with respect to
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3
Q

what causes BPPV?

A

displacement of otoconia

falls out of utricle and into either neighboring semicircular canals or cupulas

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4
Q

what is the incidence of BPPV?

A

1 cause of dizziness in patients >60

Most common cause of vertigo!

  1. prevelence increases as we get older
  2. women > men
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5
Q

what SCC are most impacted by BPPV?

A
  1. posterior → 76-95%
  2. horizontal → 5-12%
  3. anterior → 1-2%
  • Bilateral BPVV in 15-20% of cases
  • Multi-canal in ~5-10% of cases
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6
Q

what is canalithiasis?

A

free floating otoconia within SCC resulting in abnormal endolymphatic flow with the affected canal

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7
Q

what are the characteristics of canalithiasis?

A
  1. delay in the onset of vertigo of 1-40 seconds after the pt has been placed in the provoking position = latency
  2. nystagmus that appears after period of latency with +vertigo
  3. fluctutation in the intensity of the vertigo and nystagmus, which increases and then decreases while the person is in a provoking position, disappearing within 60 sec
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8
Q

if the R horizontal canal is excited, what is the corresponding slow phase of VOR?

A

Left

(turning head to R, eyes move L to keep centered)

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9
Q

if the R anterior canal is excited, what is the corresponding slow phase for the VOR?

A

left torsional and up

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10
Q

if the R posterior canal is excited, what is the corresponding slow phase of the VOR?

A

torsional left and down

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11
Q

if the L horizontal canal is excited, what is the corresponding slow phase of VOR?

A

right

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12
Q

if the L anterior canal is excited, what is the corresponding slow phase of VOR?

A

torsional right and up

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13
Q

if the L posterior canal is excited, what is the corresponding slow phase of VOR?

A

right torsiona and down

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14
Q

With free floating otoconia in the R horizontal canal

which direction would the nystagmus beat?

A

Right

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15
Q

with free-floating otoconia in the R anterior canal, which direction would the nystagmus beat?

A

down and right torsional nystagmus

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16
Q

with free-floating otoconia in R posterior canal, which direction would the nystagmus beat?

A

upward and right torsional nystagmus

17
Q

with free-floating otoconia in L horizontal canal, what direction will the nystagmus beat?

A

left beating

18
Q

with free-floating otoconia in L anterior canal, what direction will the nystagmus beat?

A

down and left torsional nystagmus

19
Q

with free-floating otoconia in L posterior canal, what direction will the nystagmus beat?

A

upward and left torsional nystagmus

20
Q

what is cupulolithiasis?

A

otoconia adherent to the cupula of the affected SSC. The canal becomes gravity sensitive which is not the normal function of the SSC

21
Q

what are the characteristics of cupulolithiasis?

A
  • immediate onset of vertigo when the patient is moved into the provoking position
  • persistence of the vertigo and nystgamus as long as the head is maintained in the provoking position
22
Q

what are common activity triggers for BPPV?

A
  1. Bed mobility (rolling or supine to sit)
  2. Reaching for object on floor or on top shelf
  3. Washing hair
  4. Working under car
  5. Changing a lightbulb
23
Q

What are predisposing factors of BPPV?

A
  1. Age
  2. Head trauma
  3. Inner ear disease
  4. Genetics
  5. Osteopenia/Osteoporosis
  6. Cardiovascular Disease
  7. Diabetes
  8. Migraine
  9. Vit D Deficiency
  10. Sleeping position/Prolonged immobility
24
Q

what is the most common cause of BPPV for individuals under the age of 50?

A

TBI and concussion

25
Q

how is BPPV diagnosed and treated?

A
  1. Dx → clinical exam
  2. Trx
    • repositional maneuvers
    • post-maneuvers activity restrictions
26
Q

How is the prognosis of BPPV?

A

Fantastic

  • average 1.25 sessions for complete resolution for idiopathic BPPV
  • Multi-canal involvement, bilateral involvement will need longer