Introduction to Benign Paroxysmal Positional Vertigo: Difference between revisions

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Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo that arises from a peripheral vestibular disorder. It accounts for 20 to 30 percent of all patients seen for vertigo in clinics that specialise in dizziness.<ref name=":0">von Brevern M, Radtke A, Lezius F, Feldmann M, Ziese T, Lempert T et al. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2117684/ Epidemiology of benign paroxysmal positional vertigo: a population based study]. J Neurol Neurosurg Psychiatry. 2007;78(7):710-5. </ref>
Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo that arises from a peripheral vestibular disorder. It accounts for 20 to 30 percent of all patients seen for vertigo in clinics that specialise in dizziness.<ref name=":0">von Brevern M, Radtke A, Lezius F, Feldmann M, Ziese T, Lempert T et al. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2117684/ Epidemiology of benign paroxysmal positional vertigo: a population based study]. J Neurol Neurosurg Psychiatry. 2007;78(7):710-5. </ref>


While the overall incidence of BPPV in the general population is around 2.5 percent,<ref name=":0" /> it is more common in older adults. Some studies show that 50 percent of older adults have BPPV.<ref>Balatsouras DG, Koukoutsis G, Fassolis A, Moukos A, Apris A. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6223343/ Benign paroxysmal positional vertigo in the elderly: current insights]. ''Clin Interv Aging''. 2018;13:2251-66.</ref>
While the overall incidence of BPPV in the general population is around 2.5 percent,<ref name=":0" /> it is more common in older adults. Some studies show that 50 percent of older adults have BPPV.<ref name=":2">Balatsouras DG, Koukoutsis G, Fassolis A, Moukos A, Apris A. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6223343/ Benign paroxysmal positional vertigo in the elderly: current insights]. ''Clin Interv Aging''. 2018;13:2251-66.</ref>


Symptoms tend to be provoked by head movements, such as:<ref name=":1">Tonks B. Benign Paroxysmal Positional Vertigo Course. Physioplus, 2021.</ref>  
Symptoms tend to be provoked by head movements, such as:<ref name=":1">Tonks B. Benign Paroxysmal Positional Vertigo Course. Physioplus, 2021.</ref>  
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BPPV is a biomechanical problem in which one or more of the semicircular canals is inappropriately excited, resulting in vertigo, nystagmus and occasionally nausea.<ref name=":1" /> It occurs when there is displacement of calcium-carbonate crystals or otoconia from the utricle into one of the three fluid-filled semicircular canals of the inner ear.<ref name=":1" /><ref>Palmeri R, Kumar A. Benign Paroxysmal Positional Vertigo. [Updated 2020 Jun 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: [[/www.ncbi.nlm.nih.gov/books/NBK470308/|https://www.ncbi.nlm.nih.gov/books/NBK470308/]] </ref> For more information on the anatomy of the vestibular system, please click [[Introduction to Vestibular Rehabilitation|here]].
BPPV is a biomechanical problem in which one or more of the semicircular canals is inappropriately excited, resulting in vertigo, nystagmus and occasionally nausea.<ref name=":1" /> It occurs when there is displacement of calcium-carbonate crystals or otoconia from the utricle into one of the three fluid-filled semicircular canals of the inner ear.<ref name=":1" /><ref>Palmeri R, Kumar A. Benign Paroxysmal Positional Vertigo. [Updated 2020 Jun 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: [[/www.ncbi.nlm.nih.gov/books/NBK470308/|https://www.ncbi.nlm.nih.gov/books/NBK470308/]] </ref> For more information on the anatomy of the vestibular system, please click [[Introduction to Vestibular Rehabilitation|here]].
== Aetiology ==
It is not yet known what causes BPPV. The majority of cases are idiopathic, but it is more likely to recur in older adults.<ref name=":2" />
The two primary theories about its aetiology are that it is:
# Related to ischaemia and cardiovascular disease<ref>Zhang D, Zhang S, Zhang H, Xu Y, Fu S, Yu M, Ji P. Evaluation of vertebrobasilar artery changes in patients with benign paroxysmal positional vertigo. Neuroreport. 2013;24(13):741-5. </ref>
# Related to vitamin D deficiency and calcium metabolism (seasonal variations may be present)<ref>Jeong SH, Kim JS, Shin JW, Kim S, Lee H, Lee AY et al. [https://www.researchgate.net/publication/232699444_Decreased_serum_vitamin_D_in_idiopathic_benign_paroxysmal_positional_vertigo Decreased serum vitamin D in idiopathic benign paroxysmal positional vertigo]. J Neurol. 2013;260(3):832-8. </ref><ref name=":3">Chen J, Zhao W, Yue X, Zhang P. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7324663/ Risk factors for the occurrence of benign paroxysmal positional vertigo: A systematic review and meta-analysis]. ''Front Neurol''. 2020;11:506. </ref>
Predisposing factors include:
* Head trauma in all age groups<ref name=":3" />
** In a younger population head trauma is a leading predisposing factor
* The recurrence rate may be higher and treatment may not be as effective in a head trauma population<ref name=":1" />
* Surgical trauma to the inner ear<ref name=":4">Kansu L, Aydin E, Gulsahi K. Benign paroxysmal positional vertigo after nonotologic surgery: case series. J Maxillofac Oral Surg. 2015;14(Suppl 1):113-5.</ref>
* Vestibular labyrinthitis / neuritis<ref name=":4" />
* Migraines<ref name=":0" />
* Ischaemia of the anterior vestibular artery and cardiovascular disease<ref name=":1" /><ref>Li S, Wang Z, Liu Y, Cao J, Zheng H, Jing Y et al. [https://journals.sagepub.com/doi/10.1177/0145561320943362?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed Risk factors for the recurrence of benign paroxysmal positional vertigo: a systematic review and meta-analysis]. Ear Nose Throat J. 2020:145561320943362.</ref>
The majority of BPPV occurs in the posterior canals  (85 to 95 percent). 5 to 15 percent occurs in the horizontal canals and 1 to 5 percent occurs in the anterior canals.<ref>Bhattacharyya N, Gubbels SP, Schwartz SR, Edlow JA, El-Kashlan H, Fife T et al. [https://journals.sagepub.com/doi/10.1177/0194599816689667?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed Clinical practice guideline: benign paroxysmal positional vertigo (update)]. Otolaryngol Head Neck Surg. 2017;156(3_suppl):S1-S47.</ref>
== References ==
[[Category:Course Pages]]
[[Category:Course Pages]]
[[Category:Neurology]]
[[Category:Neurology]]

Revision as of 11:17, 13 June 2021

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Original Editor - Bernard Tonks Top Contributors - Jess Bell, Kim Jackson, Rucha Gadgil, Lucinda hampton, Robin Tacchetti and Tarina van der Stockt

Introduction[edit | edit source]

Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo that arises from a peripheral vestibular disorder. It accounts for 20 to 30 percent of all patients seen for vertigo in clinics that specialise in dizziness.[1]

While the overall incidence of BPPV in the general population is around 2.5 percent,[1] it is more common in older adults. Some studies show that 50 percent of older adults have BPPV.[2]

Symptoms tend to be provoked by head movements, such as:[3]

  • Looking up
  • Lying down flat quickly
  • Bending forwards
  • Rolling in bed

BPPV is a biomechanical problem in which one or more of the semicircular canals is inappropriately excited, resulting in vertigo, nystagmus and occasionally nausea.[3] It occurs when there is displacement of calcium-carbonate crystals or otoconia from the utricle into one of the three fluid-filled semicircular canals of the inner ear.[3][4] For more information on the anatomy of the vestibular system, please click here.

Aetiology[edit | edit source]

It is not yet known what causes BPPV. The majority of cases are idiopathic, but it is more likely to recur in older adults.[2]

The two primary theories about its aetiology are that it is:

  1. Related to ischaemia and cardiovascular disease[5]
  2. Related to vitamin D deficiency and calcium metabolism (seasonal variations may be present)[6][7]

Predisposing factors include:

  • Head trauma in all age groups[7]
    • In a younger population head trauma is a leading predisposing factor
  • The recurrence rate may be higher and treatment may not be as effective in a head trauma population[3]
  • Surgical trauma to the inner ear[8]
  • Vestibular labyrinthitis / neuritis[8]
  • Migraines[1]
  • Ischaemia of the anterior vestibular artery and cardiovascular disease[3][9]

The majority of BPPV occurs in the posterior canals  (85 to 95 percent). 5 to 15 percent occurs in the horizontal canals and 1 to 5 percent occurs in the anterior canals.[10]

References[edit | edit source]

  1. ↑ 1.0 1.1 1.2 von Brevern M, Radtke A, Lezius F, Feldmann M, Ziese T, Lempert T et al. Epidemiology of benign paroxysmal positional vertigo: a population based study. J Neurol Neurosurg Psychiatry. 2007;78(7):710-5.
  2. ↑ 2.0 2.1 Balatsouras DG, Koukoutsis G, Fassolis A, Moukos A, Apris A. Benign paroxysmal positional vertigo in the elderly: current insights. Clin Interv Aging. 2018;13:2251-66.
  3. ↑ 3.0 3.1 3.2 3.3 3.4 Tonks B. Benign Paroxysmal Positional Vertigo Course. Physioplus, 2021.
  4. ↑ Palmeri R, Kumar A. Benign Paroxysmal Positional Vertigo. [Updated 2020 Jun 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470308/
  5. ↑ Zhang D, Zhang S, Zhang H, Xu Y, Fu S, Yu M, Ji P. Evaluation of vertebrobasilar artery changes in patients with benign paroxysmal positional vertigo. Neuroreport. 2013;24(13):741-5.
  6. ↑ Jeong SH, Kim JS, Shin JW, Kim S, Lee H, Lee AY et al. Decreased serum vitamin D in idiopathic benign paroxysmal positional vertigo. J Neurol. 2013;260(3):832-8.
  7. ↑ 7.0 7.1 Chen J, Zhao W, Yue X, Zhang P. Risk factors for the occurrence of benign paroxysmal positional vertigo: A systematic review and meta-analysis. Front Neurol. 2020;11:506.
  8. ↑ 8.0 8.1 Kansu L, Aydin E, Gulsahi K. Benign paroxysmal positional vertigo after nonotologic surgery: case series. J Maxillofac Oral Surg. 2015;14(Suppl 1):113-5.
  9. ↑ Li S, Wang Z, Liu Y, Cao J, Zheng H, Jing Y et al. Risk factors for the recurrence of benign paroxysmal positional vertigo: a systematic review and meta-analysis. Ear Nose Throat J. 2020:145561320943362.
  10. ↑ Bhattacharyya N, Gubbels SP, Schwartz SR, Edlow JA, El-Kashlan H, Fife T et al. Clinical practice guideline: benign paroxysmal positional vertigo (update). Otolaryngol Head Neck Surg. 2017;156(3_suppl):S1-S47.
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