ENT Flashcards
Definition of Benign Paroxysmal Positional Vertigo
Sudden onset of dizziness and vertigo triggered by changes in head position
Typical age of onset forBPPV
55 years old
Pathophysiology of BPPV
Crystals of calcium carbonate (otoconia) become displaced into the semicircular canals
Crystals disrupt normal flow of endolymph through the canals > confuses vestibular system
Head movement creates flow of endolymph > vertigo
Where is most common for otoconia to become displaced in BPPV
Posterior semicircular canal
Causes of BPPV
- Viral infection
- Head trauma
- Ageing
- Idiopathic
Presentation of BPPV
Vertigo triggered by change in head position
Nausea
How long do episodes of BPPV often last
10-20 second episodes with symptoms settling around 20-60 seconds
Asymptomatic between attacks
Episodes may occur over several weeks and then resolve but reoccur weeks or months later
Risk factors for BPPV
- Increasing age
- Female sex
- Migraine
- Recent viral infection (upper respiratory)
- Low serum vit D
What test is done to confirm BPPV?
how is it performed?
Dix-Hallpike Manoeuvre
Patient sat upright with head turned 45 degrees to one side (turned to right = testing right ear)
Support patient’s head to stay in 45 degree position while rapidly lowering patient backwards until head is hanging off end of couch (extended 20-30 degrees)
Hold patient’s head still and watch eyes closely for 30-60 seconds looking for rotary nystagmus
Repeat test facing other direction
Differential diagnosis of BPPV
Vestibular neuritis
Stroke
Management of BPPV
Epley manoeuvre
- Follow steps of Dix-Hallpike until patient lying position with head extended off the end of the bed, still rotated 45 degrees
- Rotate the patient’s head 90 degrees past central position
- Patient rolls onto side so head rotates further 90 degrees in same direction
- Patient sit up sideways with legs of side of couch
- Position head in central position with the neck flexed 45 degrees with chin towards chest
- At each stage, support head in place for 30 seconds and wait for any nystagmus or dizziness to settle
Brandt-Daroff Exercises
- Sitting on end of a bed and lying sideways from one side to the other
- Whilst rotating head slightly to face the ceiling
- Exercises repeated several times a day until symptoms improve
Medication
- Betahistine
Another name for acoustic neuroma
Vestibular schwannoma
Define acoustic neuroma
Benign tumours of the Schwann cells surrounding the auditory nerve (vestibulocochlear) that innervates inner ear
Classic history of acoustic neuroma
- Vertigo
- Hearing loss
- Tinnitus
- Absent corneal reflex
Where do acoustic neuromas occur
Cerebellopontine angle
