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BPPV Flashcards

1
Q

what population is BPPV seen in most frequently

A

70-79 y/o

– general trend of it being more prevalent later on into life

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2
Q

what canal is the most likely for BPPV to be in? why?

A

posterior
- gravity

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3
Q

explain the pathophys related to BPPV

A

otoconia detached from macula and fall into canal

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4
Q

explain the treatment for BPPV and its efficacy

A

1 treatment session typically with 2-3 treatments per session

  • 85% remission
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5
Q

what are the goals of BPPV treatment

A

otoconia returning to the vestibule (more so to utricle)

remission of vertigo / symptoms

normalized postural control

self management

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6
Q

what is something to be weary of when educating patient on self-management

A

canal conversion can occur and then make BPPV/symptoms worse

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7
Q

explain the symptom of vertigo?
- subjective description
- onset
- duration

A

describe themselves or the room spinning

position induced, change of head position relative to gravity

brief duration (<1 min)

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8
Q

what % of patients will also report dysequilibrium

A

50

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9
Q

classic symptoms of BPPV

A

vertigo
disequilibrium
motion sensitivity

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10
Q

when examining patient, what is important to keep in mind regarding symptoms

A

latency period of otoconia movement in the SCC

  • typically anywhere from 1 to 30 sec
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11
Q

what do we look for in a clinical exam of those with suspected BPPV

A

symptom onset
nystagmus and its direction
duration of nystagmus
– if it fatigues or not

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12
Q

what is the general duration of nystagmus in those with BPPV

A

<2 min

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13
Q

explain posterior canal and the muscles innervated by movement
- ipsilateral/contralateral

A

I - superior oblique
C - inferior rectus

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14
Q

explain anterior canal and the muscles innervated by movement
- ipsilateral/contralateral

A

I = superior rectus
C = inferior oblique

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15
Q

explain horizontal canal and the muscles innervated by movement
- ipsilateral/contralateral

A

I = medial rectus
C = lateral rectus

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16
Q

explain the nystagmus associated with posterior canal
— right vs left

A

R = up beat, right torsion
L = up beat, left torsion

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17
Q

explain the nystagmus associated with anterior canal
— right vs left

A

R = down beat, right torsion
L = down beat, left torsion

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18
Q

explain the nystagmus associated with horizontal canal
— right vs left

A

horizontal nystagmus

geotropic vs ageotropic

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19
Q

what is geotropic nystagmus? and ageotropic

A

nystagmus toward earth

nystagmus away from earth

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20
Q

canalithiasis and its effect

A

otoconia free-floating in semicircular canal that will fall to the lowest point

flow of endolymph and deflection of cupula

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21
Q

cupulolithiasis and its effect

A

otoconia adhering to cupula

increased density of cupula leads to gravity sensitivity

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22
Q

what is the test used for posterior and anterior canal assessment

A

Dix Hallpike test (DHP)

23
Q

positioning of DHP

A

patient on exam table in long sit

head is turned 45°

patient is lowered to supine with neck extension of 30°

– nystamgus and symptom reproduction is assessed

24
Q

what is a positive DHP test

A

if there is nystagmus and/or symptoms

–> testing whichever ear is closest to the ground, therefore will indicate canal issue in that ear

25
alternative assessment of anterior and posterior canal
side-lying test
26
side-lying test protocol
patient seated on edge of table patient head is turned 45° bring patient into sidelying position with head at 45° rotation -- assessment of nystagmus and/or symptom reproduction
27
explain the differentiator in canalithiasis and cupulolithiasis in nystagmus
canal = transient nystagmus (<1min) cup - persistent nystagmus
28
preferred treatment method for severe posterior canalithiasis
canalith repositioning treatment
29
what is the preferred treatment method for posterior cupulolithiasis
liberatory (semont)
30
preferred treatment method for mild posterior canal BPPV
brandt-daroff
31
explain the difference between the Epley maneuver and canalith repositioning treatment
there is not one silly
32
explain CRT/Epley maneuver
patient head is rotated 45° toward involved side patient is moved into DHP testing position with affected ear toward ground patient is rotated 90° to the other side with back flat on table patient is rolled onto contralateral shoulder patient brought up into sitting position with head maintained in 45° rotation
33
what important to maintain during epley maneuver
neck extension of 20-30°
34
what is the duration of positioning in CRT
2x the duration of nystagmus noted in DHP testing
35
what is the speed at which one should do CRT? why?
slower is better than faster --> symptoms are elicited with head movement, no need to make those worse --> endolymph is viscous, want to allow for proper movement of otoconia
36
what should the patient be educated on post CRT?
patient may feel off for 2-3 days --> can sleep on an extra pillow if they'd like go back to normal life at your own discretion
37
protocol for liberatory maneuver
head rotated 45° contralaterally from affected side move patient to ipsilateral side-lying of affected side (maintain for 1 min) patient rapidly moved 180° to opposite side-lying maintain original head position so that second sidelying has pt's nose facing the table --> maintain for 1 min
38
protocol for brandt-daroff maneuver
start in seated position rotate head 45° to either side quickly lie patient on opposite shoulder of head rotation --> remain for 30 sec repeat with head turned other way
39
what is the prescribed treatment associated with brandt-daroff maneuver
10-20x / 3x a day --> until patient is without vertigo while completing for 2 consecutive days
40
how are the horizontal canals assessed
roll test
41
protocol for roll test
patient supine with 20° of cervical flexion head turned 90° to a side --> check for nystagmus and vertigo returned to midline, repeated on other side
42
what type of nystagmus in a roll test would indicate canalithiasis? which ear would be affected?
transient geotropic nystagmus strongest nystagmus is ipsilateral
43
what type of nystagmus in a roll test would indicate cupulolithiasis? which ear would be affected?
persistent ageotropic nystagmus strongest nystagmus is contralateral
44
what treatment method is indicated for horizontal canalithiasis
CRM for horizontal liberatory maneuver
45
what treatment method is indicated for horizontal cupulolithiasis
gufoni maneuver
46
CRM for horizontal canal BPPV protocol
head in 20° cervical flexion place patient's head in 90° rotation (affected ear down) head rotated to midline with back of the head down --> maintain for 15 sec or until symptoms fade rotate patient's head 90° to the opposite side (unaffected ear down) --> maintain for 15 sec or until symptoms fade roll patient into prone position --> maintain until symptoms stop
47
what is important to remeber during CRM treatment of horizontal canal?
try to maintain 20° flexion during each transition, especially going from sidelying to prone
48
protocol for liberatory maneuver
patient in seated pt brought to unaffected sidelying position --> maintained for 2 min pt's head is turned 45° toward the table --> maintained for 2 min pt returned to seated --> repeated to the other side
49
what is the protocol for gufoni method
just kinda came up with this, not specifically listed patient in seated position patient brought to side-lying patient face rotated to toward mat
50
if someone has a history of positional vertigo, but DHP was negative, what can be indicated
horizontal canal BPPV
51
explain the recurrence rate of BPPV? what can increase this?
25-50% - highest within the first year will increase with head trauma / age
52
explain the treatment of BPPV in the 1st vs 2nd visit
1 - treat and educate -- self management via head elevation during sleep/ not to roll 2 - reassess and treat - consider teaching pt to self-treat
53
explain why BPPV treatments may not work
they don't have BPPV user error / misread of tests canal conversion
54
for treatment of BPPV in elderly populations, what are some special considerations?
neck/back range of motion and pain speed of the treatment movements cognition/understanding of treatment

Neuro Rehab (16 decks)

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