BPVV Flashcards
what does BPPV stand for?
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
what are the symptoms of BPPV?
- bursts of dizziness or vertigo
- ligthheadedness
- imbalance
- nausea
- variable “triggers” but symptoms are almost always precipitated by a change of position of the head with respect to
what causes BPPV?
displacement of otoconia
falls out of utricle and into either neighboring semicircular canals or cupulas
what is the incidence of BPPV?
1 cause of dizziness in patients >60
Most common cause of vertigo!
- prevelence increases as we get older
- women > men
what SCC are most impacted by BPPV?
- posterior → 76-95%
- horizontal → 5-12%
- anterior → 1-2%
- Bilateral BPVV in 15-20% of cases
- Multi-canal in ~5-10% of cases
what is canalithiasis?
free floating otoconia within SCC resulting in abnormal endolymphatic flow with the affected canal
what are the characteristics of canalithiasis?
- delay in the onset of vertigo of 1-40 seconds after the pt has been placed in the provoking position = latency
- nystagmus that appears after period of latency with +vertigo
- 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
if the R horizontal canal is excited, what is the corresponding slow phase of VOR?
Left
(turning head to R, eyes move L to keep centered)
if the R anterior canal is excited, what is the corresponding slow phase for the VOR?
left torsional and up
if the R posterior canal is excited, what is the corresponding slow phase of the VOR?
torsional left and down
if the L horizontal canal is excited, what is the corresponding slow phase of VOR?
right
if the L anterior canal is excited, what is the corresponding slow phase of VOR?
torsional right and up
if the L posterior canal is excited, what is the corresponding slow phase of VOR?
right torsiona and down
With free floating otoconia in the R horizontal canal
which direction would the nystagmus beat?
Right
with free-floating otoconia in the R anterior canal, which direction would the nystagmus beat?
down and right torsional nystagmus
with free-floating otoconia in R posterior canal, which direction would the nystagmus beat?
upward and right torsional nystagmus
with free-floating otoconia in L horizontal canal, what direction will the nystagmus beat?
left beating
with free-floating otoconia in L anterior canal, what direction will the nystagmus beat?
down and left torsional nystagmus
with free-floating otoconia in L posterior canal, what direction will the nystagmus beat?
upward and left torsional nystagmus
what is cupulolithiasis?
otoconia adherent to the cupula of the affected SSC. The canal becomes gravity sensitive which is not the normal function of the SSC
what are the characteristics of cupulolithiasis?
- 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
what are common activity triggers for BPPV?
- Bed mobility (rolling or supine to sit)
- Reaching for object on floor or on top shelf
- Washing hair
- Working under car
- Changing a lightbulb
What are predisposing factors of BPPV?
- Age
- Head trauma
- Inner ear disease
- Genetics
- Osteopenia/Osteoporosis
- Cardiovascular Disease
- Diabetes
- Migraine
- Vit D Deficiency
- Sleeping position/Prolonged immobility
what is the most common cause of BPPV for individuals under the age of 50?
TBI and concussion
how is BPPV diagnosed and treated?
- Dx → clinical exam
- Trx
- repositional maneuvers
- post-maneuvers activity restrictions
How is the prognosis of BPPV?
Fantastic
- average 1.25 sessions for complete resolution for idiopathic BPPV
- Multi-canal involvement, bilateral involvement will need longer