Posterior Canal BPPV Flashcards
What does BPPV stand for?
BPPV stands for Benign Paroxysmal Positional Vertigo.
What does ‘benign’ mean in BPPV?
Benign means it does not result in permanent vestibular dysfunction and is not due to CNS pathology.
What does ‘paroxysmal’ mean in BPPV?
Paroxysmal means the symptoms occur in sudden, brief spells.
What does ‘positional’ mean in BPPV?
Positional means the symptoms are triggered by certain head movements or positions.
What does ‘vertigo’ mean in BPPV?
Vertigo refers to a false sense of movement, usually described as room spinning.
What are the primary symptoms of BPPV?
Primary symptoms of BPPV include episodes of vertigo triggered by head movements, lasting less than a minute.
What common activities can trigger BPPV symptoms?
Common activities that can trigger BPPV include looking overhead, lying down, getting out of bed, rolling over in bed, and bending over.
How long do BPPV episodes typically last?
BPPV episodes typically last less than 1 minute.
What percentage of dizziness cases in clinics are due to BPPV?
17-42% of dizziness cases in clinics are due to BPPV.
Which age group is most commonly affected by BPPV?
BPPV is most common in individuals aged 50-70.
What are some common causes of BPPV?
Common causes of BPPV include age, head trauma, vestibular neuritis, and prolonged positioning with the ear in a dependent position.
What is the role of otoconia in BPPV?
Otoconia, or calcium carbonate crystals, become dislodged from the utricle and migrate into a semicircular canal, causing BPPV.
What are the age-related changes in otoconia that contribute to BPPV?
As we age, otoconia can hypertrophy, develop cracks, and break off, increasing the risk of BPPV.
What is canalithiasis?
Canalithiasis is caused by free-floating otoconia within a semicircular canal, leading to short-duration vertigo and nystagmus.
What is cupulolithiasis?
Cupulolithiasis occurs when otoconia adhere to the cupula, causing longer-lasting vertigo and nystagmus.
Which semicircular canal is most commonly affected by BPPV?
The posterior semicircular canal is most commonly affected by BPPV.
What is the difference between canalithiasis and cupulolithiasis in terms of symptoms?
- Canalithiasis typically results in vertigo lasting less than 1 minute.
- Cupulolithiasis causes vertigo lasting more than 1 minute.
What are the typical findings in a subjective examination for BPPV?
Subjective examination findings for BPPV include vertigo lasting less than 1 minute, triggered by head movements, with possible nausea and imbalance.
What are the expected results in a gross neuro screen for BPPV?
In BPPV, gross neuro screen results are typically normal, including normal oculomotor and head impulse tests.
What is the Dix-Hallpike test?
The Dix-Hallpike test is the gold standard for diagnosing posterior canal BPPV.
How is the Dix-Hallpike test performed?
The Dix-Hallpike test is performed by turning the patient’s head 45° to one side while in long sitting, then quickly moving the patient to a supine position with the head extended 20°.
What is a positive Dix-Hallpike test indicative of?
A positive Dix-Hallpike test, indicated by vertigo and nystagmus, suggests posterior canal BPPV.
What type of nystagmus is associated with posterior canal BPPV?
Posterior canal BPPV is associated with upbeating and torsional nystagmus.
What type of nystagmus is associated with anterior canal BPPV?
Anterior canal BPPV is associated with downbeating and torsional nystagmus.
What is the Sidelying test and when is it used?
The Sidelying test is an alternative to the Dix-Hallpike test, used for patients with limited cervical mobility.
How is the Sidelying test performed?
The Sidelying test is performed by rotating the patient’s head 45° away from the side being tested, then quickly bringing the patient into sidelying on the tested side.
What is the primary intervention for posterior canal BPPV?
The primary intervention for posterior canal BPPV is repositioning maneuvers.
What is the Epley maneuver?
The Epley maneuver, or Canalith Repositioning Maneuver, is used to treat posterior canal BPPV.
How is the Epley maneuver performed?
The Epley maneuver involves moving the patient’s head through a series of positions to move otoconia out of the semicircular canal and back into the vestibule.
What is the purpose of the Epley maneuver?
The purpose of the Epley maneuver is to reduce vertigo and nystagmus by repositioning the otoconia.
What modifications can be made to the Epley maneuver?
Modifications to the Epley maneuver include performing it on a tilt table or with the patient’s head supported on a pillow.
What is the Semont maneuver?
The Semont maneuver is another repositioning maneuver, originally designed for cupulolithiasis but also effective for canalithiasis.
How is the Semont maneuver different from the Epley maneuver?
The Semont maneuver involves rapid movements to dislodge debris, while the Epley maneuver involves more gradual head positioning.
When is the Semont maneuver typically used?
The Semont maneuver is typically used when the patient cannot tolerate the supine position.
What are the success rates for the Epley and Semont maneuvers?
Success rates for the Epley maneuver are 57.1% after one treatment and up to 91.5% after multiple treatments. The Semont maneuver has a 62.6% remission rate after one treatment and 90% after multiple treatments.
What are the recommendations for post-maneuver activity restrictions?
Post-maneuver activity restrictions are generally not recommended, though patients may be advised to avoid lying flat or looking at the ceiling for a few hours.
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What should be done if BPPV symptoms do not resolve after 3-5 visits?
If BPPV symptoms do not resolve after 3-5 visits, further evaluation or referral to a specialist may be needed.
What role does vestibular rehabilitation therapy (VRT) play in BPPV treatment?
Vestibular rehabilitation therapy (VRT) may be used as an adjunct to repositioning maneuvers, especially in patients with residual imbalance or dizziness.
What are some considerations for patients with bilateral BPPV?
For patients with bilateral BPPV, treat the more symptomatic side first and the other side in subsequent sessions.
What is the recurrence rate of BPPV?
The recurrence rate of BPPV is approximately 35%.
What are the risk factors for recurrent BPPV?
Risk factors for recurrent BPPV include older age, head trauma, Meniere’s disease, vestibular neuritis, diabetes, and low Vitamin D levels.
How should patients be educated about BPPV recurrences?
Patients should be informed that BPPV management may require repeated treatments, and recurrences are possible.
What are the contraindications for performing positional testing in BPPV?
Contraindications for positional testing include signs or symptoms of vertebrobasilar insufficiency (VBI) or cervical spine instability.
What is the significance of using infrared video goggles in BPPV diagnosis?
Infrared video goggles are useful in BPPV diagnosis because they can detect subtle nystagmus that may not be visible in room light.
