Pathophysiology of benign paroxysmal positional vertigo (BPPV)? - correct answer Inner ear dysfunction.
Otoliths become detached and fall into the semicircular canals:
- 90% into posterior semicircular canal
- 10% into inferior semicircular canal
- very rarely into anterior semicircular ...
Otoliths become detached and fall into the semicircular canals:
- 90% into posterior semicircular canal
- 10% into inferior semicircular canal
- very rarely into anterior semicircular canals
In health, hair cells embedded in otoliths are stimulated as they are pulled/pushed by the flow of
endolymph through the semicircular canals following head movements and terminate as movement
ceases.
Detached otoliths may continue to move after the head has stopped moving and vertigo results from
the conflicting sensation of ongoing movement with other sensory inputs.
Causes of BPPV - correct answer 60% idiopathic.
Head injury.
Spontaneous labyrinth degeneration.
Post-viral illness (viral neuronitis).
Complication of stapes surgery.
Chronic middle ear disease.
BPPV epidemiology - correct answer Most common cause of vertigo.
Most commonly middle-aged.
BPPV risk factors - correct answer Female.
Ménière's disease.
Anxiety disorders.
Migraine.
, BPPV symptoms - correct answer Episodes of vertigo provoked by head movements.
Nausea common but not vomiting.
Often worse in mornings and when head tilted to particular side.
Attacks are of sudden onset and usually last 20-30 seconds with rapid resolution if head kept still.
Normally latent period (usually 5 seconds) between provocative movement and attack onset.
Lightheadedness and imbalance often reported after attack - may last several minutes or hours.
BPPV investigations - correct answer Ear and cranial nerve examination.
Dix-Hallpike test used to confirm posterior canal BPPV.
Dix-Hallpike test steps - correct answer Warn patient that transient vertigo may occur in any position.
Ask patient to keep their eyes open and stare at the examiner's nose.
Prepare couch so the headrest is down and the patient's head will overhang the end.
Begin with the patient sitting with their head turned 45° to the left to test the left posterior canal. With
their head in this position, quickly lay the patient down until the head is dependent 30° below the level
of the couch.
Observe for nystagmus in each position (30 seconds) and then return the patient to the upright position.
Repeat with the head turned to the right to test the right posterior canal.
Dix-Hallpike positive result - correct answer Short latency of a few seconds should be expected before
patient experiences vertigo and rotary nystagmus in posterior BPPV
- fast component of nystagmus is upbeat and in the direction of the affected ear
- usually lasts <30 seconds
On sitting, there is more vertigo, experienced as the room spinning in the opposite direction (with
reversal of the nystagmus).
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