Exam 2: BPPV Lecture Flashcards
What are the 5 structures in the membranous labyrinth?
3 Semi Circular Canals (horizontal, posterior, anterior) and 2 Otolith Organs (saccule, utricle)
What type of acceleration do the SCCs detect?
Angular acceleration
What are SCCs filled with
Endolymph
What is the ampulla?
The enlarged end of each SCC
What is within the ampulla?
The gelatinous cupula that contains stereocilia and kinocilia
What are the two types of sensory hair cells?
Stereocilia and kinocilia
Where do the hair cells sit?
In the crista ampullaris
What causes the hair cells to move when the head is turned?
Head turning causes the endolymph to move, which causes the cupula to move, which causes the hair cells to move
What happens when stereocilia are deflected toward kinocilia?
Excitation
What happens when stereocilia are deflected away from kinocilia?
Inhibition
What is the Push-Pull Mechanism?
SCC on side that head is turned to is excited and opposite is inhibited
What is happening in the SCC at rest?
Tonic firing so that we know our head is still and balanced
What is the resting firing rate of a healthy vestibular system?
70-100 spikes/second
What type of acceleration do the otolith organs detect?
Linear acceleration
What type of acceleration does the utricle detect?
Horizontal acceleration and head tilt
What type of acceleration does the saccule detect?
Vertical acceleration
Where do the otoconia sit?
In the otolith organs
What is oscillopsia?
When stationary objects in the environment appear to be in motion when the patient is in motion causing blurred vision
What is diplopia?
Double vision
What is tinnitus?
Ringing in the ears
What does BPPV stand for?
Benign Paroxysmal Positional Vertigo
What is the general pathophysiology with BPPV?
Otoconia is dislodged from the otolith organs and float in the SCC that disrupt the vestibular signals to the brain
What is the most common type of vestibular disorder?
BPPV
What percentage of people spontaneously recover from BPPV after 1 month and 3 months?
20% and 50%
What does paroxysmal mean?
Rapid and sudden onset, short spell
What are possible causes of BPPV?
No known cause, but associated with aging, head trauma, migraine, diabetes, or lying in bed for long periods due to illness or surgical procedure
What canal is most commonly affected by BPPV?
Posterior
What canal is least commonly affected by BPPV?
Anterior
What is canalithiasis?
When the otoconia are free floating in the SCC
How long does vertigo last with a canalithiasis?
30-90 seconds and then fatigues
What is cupulothiasis?
Otoconia are adhered to the cupula
How long does vertigo last with a cupulothiasis?
> 90 seconds and does not fatigue
What are typical symptoms a patient will present with if they have BPPV?
Nystagmus and vertigo with change in head position that lasts less than 15 seconds, occasional nausea, disequilibrium
What is nystagmus?
Involuntary eye movements
When is it normal to have nystagmus?
After lots of spinning, optokinetic reflex
When is having nystagmus atypical?
CNS pathology, BPPV
What are the three tests used to examine BPPV?
Dix-Hallpike, Sidelying, Roll Test
What canal does the Dix-Hallpike Test examine?
Posterior or anterior canal
What canal does the Sidelying Test examine?
Posterior or anterior canal
What canal does the Roll Test examine?
Horizontal canal
What are precautions and relative contraindications for BPPV testing?
Cervical stenosis, spondylosis, radiculopathy, severe kyphoscoliosis, limited cervical ROM with pain, Down Syndrome, RA, unstable cardiac conditions, Paget’s disease, ankylosing spondylitis, low back dysfunction, spinal cord injuries, morbid obesity, VBI, retinal detachment
What two things should be screened before testing for BPPV?
Cervical spine and vertebral artery function
How doe you assess the cervical spine prior to BPPV testing?
Assess general AROM and PROM to ensure the patient has the available range without pain
What is Vertebrobasilar Insufficiency?
Occlusion of the vertebral artery resulting in loss of blood flow to the brain
How do you screen for VBI?
Have patient lean forward on their forearms, turn their head toward the side, and look up. Position should be held for 10 seconds
What side are you testing when assessing for VBI?
The side opposite of the direction the patient is looking
What would indicate a positive VBI test?
Nausea, syncope, dizziness, visual disturbances, dysarthria
What is the general method for performing the Dix-Hallpike Maneuver?
Have patient in long sitting with their head turned 45 degrees toward the examiner. Bring the patient quickly into supine with their neck extended to 20 degrees and hold for up to one minute
What is indicated if the patient presents with upbeating nystagmus during Dix-Hallpike?
Posterior canal of the downward ear is involved
What is indicated if the patient presents with downbeating nystagmus during Dix-Hallpike?
Anterior canal of the upward ear is involved
Which side are we examining if the patient has their head turned toward the right for the Dix-Hallpike Test?
Right posterior SCC
Briefly describe how to perform the Sidelying Test
Have the patient in short sit, then have them turn their head 45 degrees away from the side being tested as they move into sidelying. Hold for up to one minute
If Dix-Hallpike indicated a canalithiasis, what is the intervention?
Epley’s or Liberatory Semont Maneuver
If Dix-Hallpike indicated a cupulolithiasis, what is the intervention?
Liberatory Semont Maneuver
Briefly describe how to perform the roll test
Have patient in supine with their neck flexed to 20-30. Quickly turn head to left and hold for up to one minute, return to neutral until symptoms resolve, then quickly turn head to right.
What direction is geotropic nystagmus?
Fast phase is beating down, towards the earth
What does geotropic nystagmus indicate about the location of the otoconia?
The otoconia are in the canal - canalithiasis
With geotropic nystagmus, which horizontal canal is involved?
The side that the beating is toward
What direction is ageotropic nystagmus?
Fast phase is beating up, away from the earth
What does ageotropic nystagmus indicate about the location of the otoconia?
The otoconia are in the cupula - cupulothiasis
With ageotropic nystagmus, which horizontal canal is involved?
The opposite side of the strongest nystagmus
When is Epley’s Maneuver indicated?
Posterior canal BPPV
Describe how to perform Epley’s Maneuver
Start with patient in long sit with head rotated 45 degrees toward involved side, quickly transition to supine with cervical extension. Turn head toward other side, then have patient turn toward same side, then sit up
When is the Liberatory Semont Maneuver indicated?
Posterior canal cupulolithiasis
Describe how to perform Liberatory Semont Maneuver
Have patient start in short sitting with head rotated 45 degrees to uninvolved side, quickly have patient lay toward uninvolved side with nose pointing up and hold for one minute. Quickly have patient transition to opposite side with nose pointing toward the table and hold for one minute. Return to sitting
When is BBQ roll indicated?
Horizontal canalithiasis
Describe how to perform the BBQ Roll
Start with patient in supine with neck flexed to 20-30 degrees, quickly turn head towards involved side then return to midline. Have patient roll away from involved side, then prone while maintaining neck flexion. Either have patient return to sitting or complete roll
When is the Gufoni Maneuver indicated?
Horizontal canal cupulothiasis or canalithiasis
Describe how to perform the Gufoni Maneuver for horizontal cupulothiasis
Have patient start in short sitting and transition to sidelying on affected side and hold for 30 seconds, then have patient quickly turn their head up toward the ceiling and hold for 1-2 minutes. Have patient sit up keeping their head turned, then return to center
How should a patient treated for a cupulolithiasis sleep following treatment?
Laying on their involved side
How should a patient treated for a canalithiasis sleep following treatment?
Laying on their uninvolved side
True or false - the patient should attempt to keep their head in neutral, avoid fast movements, avoid sleeping on their involved side, and do not roll in bed following treatment
False
When should a patient be reassessed for BPPV?
After one month
How often will patients require a second maneuver
15% of the time
After how many attempts will the treatment be considered a failure?
Two attempts
