Benign Paroxysmal Positional Vertigo

Question 1

Benign paroxysmal positional vertigo presentation

Answer 1

Head movements trigger vertigo
Symptoms settle within 20 - 60 seconds
Asymptomatic between episodes

Question 2

What type of vertigo is BPPV

Answer 2

Peripheral vertigo

Question 3

Pathophysiology of BPPV

Answer 3

Caused by crystals of calcium carbonate called otoconia that become displaced into the semicircular canals, most commonly posterior semicircular canal

The crystals disrupt the flow of endolymph

Question 4

Triggers for BPPV

Answer 4

Idiopathic
Viral infection
Head trauma
Ageing

Question 5

Dix Hallpike Manoeuvre purpose

Answer 5

Diagnose BPPV

Question 6

Dix-Hallpike Manoeuvre

Answer 6

Check the patient can do the manoeuvre safely - no neck pain or pathology

1. The patient sits upright on a flat examination couch with their head turned 45 degrees to one side (turned to the right to test the right ear and left to test the left ear)
2. Support the patient’s head to stay in the 45 degree position while rapidly lowering the patient backwards until their head is hanging off the end of the couch, extended 20-30 degrees
3. Hold the patient’s head still
4. Watch the eyes closely for 30-60 seconds, looking for nystagmus
5. Repeat the test with the head turned 45 degrees in the other direction

Question 7

What type of nystagmus is triggered by the Dix Hallpike manoeuvre

Answer 7

Rotational towards the affected ear (clockwise with left ear and anti-clockwise for right ear BPPV)

Question 8

Epley Manoeuvre purpose

Answer 8

Treats BPPV

Question 9

Epley Manoeuvre

Answer 9

1. Follow the steps of the Dix-Hallpike manoeuvre
2. Rotate the patient’s head 90 degrees past the central position
3. Have the patient roll onto their side so their head rotates a further 90 degrees in the same direction
4. Have the patient sit up sideways with the legs off the side of the couch
5. Position the head in the central position with the neck flexed 45 degrees, with the chin towards the chest
6. At each stage, support the patient’s head in place for 30 seconds and wait for any nystagmus or dizziness to settle

Question 10

Brandt-Daroff Exercises

Answer 10

Exercises at home to improve the symptoms of BPPV.

These involve sitting on the end of a bed and lying sideways, from one side to the other, while rotating the head slightly to face the ceiling.

The exercises are repeated several times a day until symptoms improve.