medbridge BPPV

Question 1

What does BPPV stand for

Answer 1

benign, paroxysmal (recurrent, sudden symptoms), positional (placement of ear), vertigo (sensation of rotation)

Question 2

what type of symptoms do patients report with BPPV

Answer 2

• position or movement related (not spontaneous)
• getting up, rolling to side, looking up, washing hair
• NOT spontaneous
• Last 15-20 seconds

Question 3

Which canals articulate with the utricle

Answer 3

All of them

Question 4

what is canalithiasis

Answer 4

• free floating octoconia within the canals resulting in abnormal edolympahtic flow
• as the otoconia (which have a different specific gravity than endolymph) float through the canal they cause a pressure wave to travel through the fluid stimulating the cupula
  once they settle they will stop causing the symptoms (15-30 seconds in duration)

Question 5

What are some predisposing factors to BPPV

Answer 5

1. head trauma/sudden acceleration or deceleration of the head
2. inner ear disease (labryrinthitis, vestibular neurities, ischemic event, Meniere’s, (B) incomplete ototoxicity, stapedectomy)
3. Genetic
4. Osteopenia/osteoporosis
5. Prolonged ear depenedency
6. sleeping position/ prolong immobility

Question 6

What is the prevalence of BPPV

Answer 6

9-11% of geriatric population

Question 7

How would you differentiate between posterior, anterior and horizontal canal BPPV

Answer 7

1. Posterior - dix halpike

2. horizontal - roll test

Question 8

Describe the roll test

Answer 8

• Supine with the head in 30 degrees of flexion, face towards ceiling
• quickly rotation head the side and observe for nystagmus
• return to neutral and repeat to the side

Question 9

what is the difference between canalithiasis and cupulothiasis

Answer 9

1. cupulolithiasis - debris is attached to the cupula of one of the canals. When the cupula is horizontal, there is no nystagmus or dizziness. When the cupula is non-horizontal (most of the time), there is a constant input from the inner ear and dizziness.
2. canalithiasis - Debris is loose within the fluid filled pathways of the inner ear. When the head is repositioned with respect to gravity, the particles move to the new lowest portion of the inner ear.

Question 10

how does nystagmus vary with canalithiasis and cupulothiasis

Answer 10

• eyes beat down (geotrophic) with canalithiasis

- eyes beat up (adeotrophic) with cupulothiasis

Question 11

What type of nystagmus occurs with each canal

Answer 11

1. posterior - iplsilateral torsion and down with upbeat
2. anterior - ipsalateral torsion and up with downbeat
3. horizontal - contralateral lateral deviation with opposite beat

Question 12

Describe the Epley maneuver and its indications

Answer 12

• posterior canal BPPV
• Seated and rotate head towards pathological side, lay straight back with head rotated, rotate head to the other side, role on to the other side keeping head rotated, sit up

Question 13

Describe Gufoni’s Maneuver

Answer 13

• horizontal canal BPPV

- Seated, to side lying unaffected side down, turn head down towards table, sit up

Question 14

Describe the efficacy of canalith repositioning maneuvers

Answer 14

• 70-90% resolution
• typically provides rapid relief of symptoms
• condition may recur
• spontaneous remission of the condition is common