Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ ICD-9-CM Code ++ 386.11 Benign paroxysmal positional vertigo +++ ICD-10-CM Codes ++ H81.1 Benign paroxysmal (positional)H81.10 unspecifiedH81.11 right earH81.12 left earH81.13 bilateral +++ Preferred Practice Patterns ++ Pattern 5A: Primary Prevention/Risk Reduction for Loss of Balance and Falling1Pattern 5F: Impaired Peripheral Nerve Integrity and Muscle Performance Associated with Peripheral Nerve Injury2 +++ Key Features +++ Description ++ Disorder of the inner earVestibular part of inner ear has three semicircular canals and two otolith organs (utricle, saccule) that are interconnected and fluid-filledCalcium carbonate crystals (otoconia, otoliths, ear stones) break free from utricular macula and float into one or more of the semicircular canals, making hair cells sensitive to gravityCauses episodic feelings of rotary vertigo (illusion that the room or oneself is spinning) that occurs with head position changes and usually lasts less than one minute +++ Essentials of Diagnosis ++ Physical exam, including neurotologic exam, typically normalThorough and detailed history is essential to distinguish from other vestibular disorders and central pathologyPositive positioning tests: Dix-Hallpike maneuver, roll test, or side-lying testPositioning maneuver results in particular pattern of nystagmus and simultaneous report of vertigoMust rule out central nervous system pathology, which may mimic BPPV, especially if symptoms associated with head trauma +++ General Considerations ++ Patients feel like either they or the room is spinningTypically triggered by tilting the head backward, rolling over in bed, or bending over Can feel disoriented and off-balance between episodes of spinning +++ Demographics ++ More common in women than men (2:1 ratio)Onset can range from 11 to 84 years of age; most common age of onset between 5th and 7th decades of lifeUncommon in childrenCan run in families +++ Clinical Findings +++ Signs and Symptoms ++ Patient reports spinning sensation triggered by specific head positions or head position changesObserve nystagmus and patient reports spinning during positioning test posturesReports of dizziness (disorientation, wooziness, lightheadedness) between episodes of vertigoReports of loss of balance and falls May also have nausea and vomiting when spinning sensation is provokedNo central signs (diplopia, dysarthria, dysphagia, dysmetria, numbness, or weakness) +++ Functional Implications ++ Difficulty performing normal head movements (bed mobility, looking up, bending over) because symptoms are provoked Impedes balance and contributes to fallsReduced or lost ability to perform tasks in home, at work, driving +++ Possible Contributing Causes ++ Primarily idiopathicSecondary etiology most commonly head traumaOther secondary causes are inner ear pathologies (Meniere’s, post-acute vestibulopathy, migraines) +++ Differential Diagnosis ++... Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth