What does BPPV stand for?
B
doesn’t cause further illness, not life-threatening
P
sudden and intense episodes
P
symptoms are triggered by changes in body position
V
false sense of you or your environment moving
Results from damage to the. delicate sensory units of the:
Inner ear
SSC
______ organs
Which is more common with BPPV:
Persistent dizziness
Episodic dizziness
dizziness
vertigo
lightheadedness
imbalance/disequilibrium
nausea
postural instability
The illusion that you or your environment is moving or spinning.
Occurs with:
rolls into a lateral position in bed
gazing upward
bending forward
fast neck turn
[Most common symptom]
B
Displacement of otoconia causing them to be free-floating in a semicircular canal
Otoconia migrating into SSC
Most common form of BPPV
Nystagmus:
Later onset (10-40 seconds)
A shorter duration of nystagmus will be seen
A
Rare form of BPPV
Displacement of otoconia causing them to attach to the cupula in a semicircular canal
Nystagmus:
Immediate onset and longer duration of nystagmus will be seen
Canalithiasis and cupulothiasis are causative factors
Down side ear is affected during Dix-Hallpike
Geotropic (beating toward the earth) rotary nystagmus
Up facing ear is provoked during Dix-Hallpike
Ageotropic (beating away from earth)
Best provoked by having patient lay flat in supine position and then move head quickly to the ear-down position
(right and left)
Horizontal geotropic nystagmus is observed while the patient is vertiginous (suffering from vertigo)
Common causes of BPPV:
______ ______ (most common cause of BPPV in people under 50)
Degeneration of vestibular system (more common as people age)
Viral
________
Prolonged Bed Rest
________: following surgery or ototoxic medications
A battery of eye-movement tests given to people with dizziness, vertigo and/or balance disorders
Identify or rule out other vestibular dysfunction or neurological problems
Measures nystagmus (involuntary side-to-side eye movement) which helps distinguish type of BPPV
Standard clinical test for BPPV
Helps reveal which canal is involved
Differentiate canalithiasis or cupulolithiasis
Steps for Pt:
Turn head 45 degrees toward presumed affected side
Clinician rapidly brings pt from upright to supine position with head hanging off table
Particles will drift into posterior canal—nystagmus occurs within 10 seconds and fatigues within 30 seconds
Pt is returned to upright position
Can help with detecting presence and timing of nystagmus
Caloric test is abnormal in 32 to 47% (Valente, p652)
often normal
cochlea not affected
Recurrent attacks1 of positional vertigo or positional dizziness provoked by lying down or turning over in the supine position.
Duration under < 1 min
Positional nystagmus elicited after a latency of one or few seconds by the Dix-Hallpike maneuver or side-lying maneuver (Semont diagnostic maneuver).
The nystagmus is a combination of torsional nystagmus with the upper pole of the eyes beating toward the lower ear combined with vertical nystagmus beating upward (toward the forehead).
Recurrent attacks of positional vertigo or positional dizziness provoked by lying down or turning over in the supine position.
Duration < 1 minute
Positional nystagmus elicited after a brief latency or no latency by the supine roll test
Beating horizontally toward the undermost ear, with the head turned to either side (geotropic direction changing nystagmus)
Recurrent attacks of positional vertigo or positional dizziness provoked by lying down or turning over in the supine position.
Positional nystagmus elicited after a brief latency or no latency by the supine roll test,
Beating horizontally toward the uppermost ear with the head turned to either side (apogeotropic (ageotropic) direction changing nystagmus)
Lasting > 1 min
Recurrent attacks of positional vertigo or positional dizziness provoked by lying down or turning over in the supine position.
Duration of attacks < 1 min.
No observable nystagmus and no vertigo with any positional maneuver.
Benign so can resolve on its own
Or over weeks or months
provides minimal relief to some patients
does not stop vertigo
first choice in treatment
cure rate of approximately 80%
desensitizes balance system to movements that provoke symptoms
exercises may increase symptoms at first but will diminish later
Each position in a manuerver is held for _________
Maneuvers:
Epley maneuver
Semont liberatory maneuver
Brandt-Daroff exercises
Relocate debris from SSC into the vestibule through a sequence of head movements.
Patients with posterior, anterior, and horizontal canalithiasis
Patients with anterior and posterior cupulolithiasis
Not common in U.S ~90% success rate after 4 sessions
Patients with horizontal cupulolithiasis
Use when side of BPPV is unclear
95% success rate
Only indicated for patients when both office maneuvers and home exercises were ineffective
Block posterior canal without affecting functions of other canals or parts of the ear
3% risk of unilateral hearing loss 85-90% success rate