Condition- BPPV

Question 1

What is BPPV?

Answer 1

Benign Paroxysmal Positional Vertigo

A peripheral vestibular disorder that manifests as sudden, short-lived episodes of vertigo elicited by specific head movements.

Question 2

What is the difference between primary and secondary BPPV? List some of the causes…

Answer 2

• Primary BPPV: idiopathic so no underlying cause
• Secondary BPPV: underlying conditions

Question 3

Describe the process of canalithiasis and the pathophysiolgy of BPPV

Answer 3

• Displacement of otoliths from the Otolith organs (Saccule and Utricle) to the semi-circular canals = CANALITIHASIS
• Debris resettles since it is denser than the endolymph and may displace the cupula and stimulate the hair cellls causing vertigo

Question 4

Describe the presentig symptoms of someone with BPPV

Answer 4

• Dizziness
• Vertigo- sudden, brief, severe
• Nausea and Vomitting
• Loss of balance or unsteadiness
• Specific provoking head movements- bending down, standing up, rolling over in bed one side

Question 5

List some of the signs of BPPV on physical examination

Answer 5

• Nystagmus
• Positive Dix-Hallpike manoeuvre (posterior canal BPPV) or positive supine lateral head turn (lateral canal BPPV)

Question 6

Describe how the Hallpike maneouvr is performed and which canal it is testing… State how the direction of nystagmus varies dependent on which ear is affected

Answer 6

1. Patient sat on couch
2. Patient’s head is turned 45° towards the ear being tested
3. Patient quickly lowered into the supine position with the head extending about 30° below the horizontal- head still turned 45° towards the ear being tested
4. Check for nystagmus
5. Return patient to seated
6. Check for reversal nystagmus

left ear BPPV has a clockwise torsional nystagmus response

right ear BPPV has an anti-clockwise response

Question 7

Describe how supine lateral head turns is performed, which semi-circular canal it tests

Answer 7

1. Place the patient in a supine position
2. Head is then rotated to one side, left for a minute, and then rotated to the opposite side
3. Observe nystagmus and ask patient about vertigo

TESTS THE HORIZONTAL SEMI-CIRCULAR CANALS

Question 8

Describe how you would differentiate between left and right culpo and canolithiasis when performing the lateral supine test

Answer 8