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259: BENIGN PAROXYSMAL POSITIONAL VERTIGO

Eric Shamus, PhD, DPT, PT, CSCS; Jennifer Shamus, PhD, DPT, COMT, CSCS

CONDITION/DISORDER SYNONYM

  • Benign paroxysmal positional vertigo (BPPV)

ICD-9-CM CODE

  • 386.11 Benign paroxysmal positional vertigo

ICD-10-CM CODES

  • H81.1 Benign paroxysmal (positional)

  • H81.10 Unspecified

  • H81.11 Right ear

  • H81.12 Left ear

  • H81.13 Bilateral

PREFERRED PRACTICE PATTERNS

  • 5A: Primary Prevention/Risk Reduction for Loss of Balance and Falling1

  • 5F: Impaired Peripheral Nerve Integrity and Muscle Performance Associated with Peripheral Nerve Injury2

PATIENT PRESENTATION

A 63-year-old man presents with a 3-month history of dizziness. His dizziness comes and goes, but usually lasts for about 10 to 15 seconds. He notices that his dizziness is worse when he rolls over in bed or when he gets out of bed. One time, he became very dizzy while trying to reach for an object on a high shelf. He does not have any nausea or vomiting associated with it. When it occurs, it is severe, and he has tried to avoid sleeping on his left side. He does not have any hearing loss or tinnitus. He denies aural pressure and headache. His past medical history is otherwise unremarkable. He is not on any medications.

On physical examination, he is a healthy appearing 63-year-old man. His temperature is 37.1°C (98.8°F); pulse, 64 beats/min; and blood pressure, 124/74 mm Hg. There are no lesions or masses on his face or head. His voice is normal, and his speech is fluent. His facial nerve function is normal. His ear canals and tympanic membranes are normal appearing. His remaining head and neck examination is normal. The cranial nerve examination is normal. The remaining physical examination is normal.”3

KEY FEATURES

Description

  • Disorder of the inner ear, peripheral vestibular disorder

  • Vestibular part of inner ear has three semicircular canals (SCC) and two otolith organs (utricle, saccule) that are interconnected and fluid-filled

  • Calcium carbonate crystals (otoconia, otoliths, ear stones) break free from utricular macula and float into one or more of the SCC, making hair cells sensitive to gravity

    • Otoconia can move into the canalithiasis

    • Otoconia can adhere to the cupula

  • Causes episodic feelings of rotary vertigo (illusion that the room or oneself is spinning) that occurs with head position changes and usually lasts less than 1 minute

  • Usually lasts less than 1 minute

Essentials of Diagnosis

  • Physical examination, including neurotologic examination, typically normal

  • Thorough and detailed history is essential to distinguish from other vestibular disorders and central pathology

  • Positive positioning tests: Dix–Hallpike maneuver, roll test, or side-lying test4

  • Positioning maneuver results in particular pattern of nystagmus and simultaneous report of vertigo5

  • Can be spontaneous

  • Must rule out central nervous system pathology, which may mimic Benign paroxysmal positional vertigo (BPPV), especially if symptoms associated with head trauma

  • Can be classified to which semicircular canal involved: ...

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