Can you discuss BPPV prevalence and any contraindications to testing?
Demographics & Prevalence
BPPV is probably something most of us have seen. It's one of the most common vestibular disorders. To make sure we are all understanding, BPPV stands for benign paroxysmal positional vertigo. Benign meaning "non-threatening" which is very important to teach your patients. People are afraid when they're dizzy. It is really important to teach them about it being benign. Paroxysmal meaning "sudden; sudden and intense" and positional meaning related to the position of the head. Finally, vertigo and if it's true BPPV the complaint of spinning is the hallmark sign.
BPPV is the most common cause of dizziness seen by otolaryngologists and the most common adult vestibular disorder. The age of onset is 50 to 70 but anyone can get BPPV. It is more common in women and the recurrence rate after the first treatment is 10-18%. Lifetime population prevalence is 2.4%. There's two kinds of BPPV. Canalithiasis where the otoconia are free-floating and cupulolithiasis where the otoconia adhere to the cupula. BPPV of the posterior canal in canalithiasis accounts for 80-90% of all cases of BPPV.
Contraindications to Testing
Why wouldn't you test someone even if the history suggests it?
- OA instability
- History of aneurysm clipping
- Arnold Chiari Malformation
- Vertebrobasilar insufficiency
- New onset SAH or SDH
- Presence of a V-P shunt (unless cleared by neurosurgery)
- BP greater than 145/90
- cervical spondylosis
This Ask the Expert is an edited excerpt from the course, Series: Physical Therapy Examination and Treatment of the Vestibular System, by Kathleen Kelley, PT, EdD, NCS