GP - Benign Paroxysmal Positional Vertigo (BPPV)

Question 1

What is Benign Paroxysmal Positional Vertigo (BPPV)?

Answer 1

An inner ear disorder causing episodes of positional vertigo (vertigo caused changes in head position)

Question 2

What age group does BPPV affect? Is it more commonly found in women or men?

Answer 2

55 yrs

More common in women

Question 3

What is the most common cause of vertigo?

Answer 3

BPPV, in particular posterior canal BPPV

Question 4

What is the prognosis of BPPV?

Answer 4

Patients usually recover from BPPV without treatment after 3 months

Recurrence is common (usually after 3 years)

Question 5

What is the pathophysiology of BPPV?

Answer 5

• Detached otoliths enter posterior semicircular canal from utricle
• Hair cells embedded in otoliths are stimulated as they are moved by the endolymph inside the semicircular canal following head movement (particularly head flexion/ extension) and terminate as movement ceases
• Detached otoliths may continue to move after the head has stopped moving, resulting in vertigo. It causes the feeling of ongoing movement despite not moving at all

Question 6

What is the cause of BPPV?

Answer 6

Idiopathic

Question 7

Give 3 risk factors for BPPV

Answer 7

Think of causes that damages the inner ear:

• Head injury
• Ear surgery
• Inner ear pathology e.g. vestibular neuronitis, labyrinthitis, meniere’s disease
• Sleep position - sleeping on the side of the affected ear

Question 8

Give 3 complications of BPPV

Answer 8

• Falls
• Anxiety and depression
• Affects ability to drive

Question 9

What symptoms do you see in BPPV?

Answer 9

• Positional vertigo triggered by head movement
  
  • Sudden onset and each episode lasts 10-20 seconds; it goes away quickly when the head becomes still (the person is asymptomatic between attacks)
  • Asymptomatic between attacks
• Lightheadedness
• N&V
• Poor balance and unsteadiness –> falls

Question 10

What signs do you see in BPPV?

Answer 10

• Examination is likely to be normal at rest in a sitting position
• Dix-Hallpike manoeuvre - used to diagnose posterior canal BPPV
  
  • Test is + if it causes vertigo and torsional upbeating nystagmus (the eyes rotate towards the affected side when the patient is looking straight ahead)

Question 11

What advice would you give for someone with BPPV?

Answer 11

Advise the person that most people recover after 3 months, even without treatment

Advise people experiencing vertigo to keep medication readily accessible, and consider the risks before undertaking activities like operating dangerous machinery, using ladders, going swimming

Advise to stay away from alcohol

Advise not to drive if they feel dizzy

Advise to inform employer if symptoms likely affect their ability to work

Safety netting: If the vertigo seems to be getting worse, or if it persists despite cessation of head movement, or if there is profuse N&V, call 999 or seek medical advice

Question 12

How would you manage BPPV?

Answer 12

Epley’s manoeuvre

Brandt-Daroff exercises (home exercises to loosen and disperse inner ear debirs)

For those unfit for Epley’s manoeuvre - give butahistine

Question 13

What are the contraindications of Dix-Hallpike manoeuvre?

Answer 13

Neck or back pathology e.g. RA, spine injury