BPVV

Question 1

what does BPPV stand for?

Answer 1

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

Question 2

what are the symptoms of BPPV?

Answer 2

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

Question 3

what causes BPPV?

Answer 3

displacement of otoconia

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

Question 4

what is the incidence of BPPV?

Answer 4

1 cause of dizziness in patients >60

Most common cause of vertigo!

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

Question 5

what SCC are most impacted by BPPV?

Answer 5

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

Question 6

what is canalithiasis?

Answer 6

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

Question 7

what are the characteristics of canalithiasis?

Answer 7

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

Question 8

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

Answer 8

Left

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

Question 9

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

Answer 9

left torsional and up

Question 10

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

Answer 10

torsional left and down

Question 11

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

Answer 11

right

Question 12

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

Answer 12

torsional right and up

Question 13

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

Answer 13

right torsiona and down

Question 14

With free floating otoconia in the R horizontal canal

which direction would the nystagmus beat?

Answer 14

Right

Question 15

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

Answer 15

down and right torsional nystagmus

Question 16

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

Answer 16

upward and right torsional nystagmus

Question 17

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

Answer 17

left beating

Question 18

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

Answer 18

down and left torsional nystagmus

Question 19

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

Answer 19

upward and left torsional nystagmus

Question 20

what is cupulolithiasis?

Answer 20

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

Question 21

what are the characteristics of cupulolithiasis?

Answer 21

• 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

Question 22

what are common activity triggers for BPPV?

Answer 22

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

Question 23

What are predisposing factors of BPPV?

Answer 23

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

Question 24

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

Answer 24

TBI and concussion

Question 25

how is BPPV diagnosed and treated?

Answer 25

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

Question 26

How is the prognosis of BPPV?

Answer 26

Fantastic

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