Benign Paroxysmal Positional Vertigo - Essay Example

Benign Paroxysmal Positional Vertigo Patient Information Leaflet If you suffer from severe attacks of vertigo with a false sense of rotational motionwhen you suddenly change your position, you are suffering from benign paroxysmal positional vertigo. What is benign paroxysmal positioning vertigo (BPPV) Brief, sometimes severe attacks of rotatory vertigo with and without nausea, which are triggered by rapid changes in head position relative to gravity. What are the known triggers Typical triggers include lying down or sitting up in bed, turning around in bed, and also bending over to tie the shoelaces, or extending the head in order to look up or do something above the head. When does it occur It occurs most commonly in the morning. Many people complain that this frequently occurs with first change in position after sleep. How does it relieve Repeated changes in positions often lead to some relief of these symptoms. Why do you need to seek medical assistance for this problem The symptoms of this problem may be quite annoying and debilitating. If this occurs in upright position, there is chance of fall and injury. Why does this occur Very commonly it occurs due to benign affect on the balance organ in your ear. Thus if you rapidly extend your head or tilt the head to the diseased ear, these symptoms are prone to occur. What happens in the affected ear The actual cause is not known. However, some think that with ageing there is hardening or stone disease in the balance organ labyrinth, which leads to this problem. What will happen if you are diagnosed with benign paroxysmal positional vertigo In most cases, this vertigo spontaneously disappears. But it can remit and recur in about 20% people. In most, that is, in 70% patients, spontaneous recovery occurs within weeks or months. What treatment would you need In most cases, there is no proven medical therapy. However, many physiotherapeutic interventions are known to produce acceptable clinical results. Contact your general practitioner for further information. Information Leaflet for GPs BPPV: The Most Common Cause of Vertigo Benign paroxysmal positioning vertigo is the most common cause of vertigo. It is so frequent that about one-third of all over 70-years old have experienced BPPV at least once. This condition is characterised by brief attacks of rotatory vertigo and simultaneous positioning rotatory-linear nystagmus toward the undermost ear. It can be accompanied by nausea. Demographics of the Patients BPPV may appear at any time from childhood to senility, but the idiopathic form is typically a disease of old age, peaking in the sixth to seventh decades. More than 90% of all cases are classified as degenerative or idiopathic, with preponderance in women. Sometimes it can be secondary to other causes such as post head injury or vestibular neuritis. BPPV also occurs strikingly often in cases of extensive bed rest in connection with other illnesses or after operations. About 10% of the spontaneous cases and 20% of the trauma cases show a bilateral, generally asymmetrically pronounced BPPV. Signs and Symptoms of BPPV BPPV is elicited by extending the head or positioning the head or body toward the affected ear. Rotatory vertigo and nystagmus occur after such positioning with a short latency of seconds in the form of a crescendo/decrescendo course of maximally 30-60 seconds. The beating direction of the nystagmus depends on the direction of gaze; it is primarily rotating when gaze is to the undermost ear and mostly vertical to the forehead during gaze to the uppermost ear. The nystagmus corresponds to an excitation of the posterior canal of the undermost ear. Pathophysiology of BPPV Heavy, inorganic particles or otoconia of specific weight, which become detached as a result of trauma or spontaneous degeneration from the utricular otoliths of the cupula. These particles float freely within the endolymph of the canal instead of being firmly attached to the cupula, and the "heavy conglomerate", which almost fills the canal, is assumed to be the cause of the positioning vertigo. The movement of the conglomerate causes either an ampullofugal or an ampullopetal deflection of the endolymph depending on the direction of the sedimentation. Clinical Manifestations Three types of clinical manifestations have been described. The patient may complain of vertigo in supine position with head turned to one side in an extended position at about 30 degrees below the horizontal line, vertigo that has a delayed onset of about 40 s following the provoking position and spontaneous remission, presence of tortional nystagmus coinciding with latency and duration of the vertigo which may have a crescendo-decrescendo pattern within a period of 60 minutes. Management Vestibular suppressant medications, vestibular rehabilitation programme, and a generalized conditioning exercise programme. Questionnaire and Consent for the Patients Demographic Data Age Sex Past Medical History Consent Centre Number: Study Number: Patient Identification Number for this trial: CONSENT FORM FOR RESEARCH STUDY Title of Project: Name of Researcher: Please tick to confirm I confirm that I have read and understood the information sheet dated......................... for the above study. I have had the opportunity to consider the information, ask questions and have had these answered satisfactorily. I understand that my participation is voluntary, and that I am free to withdraw at any time, without giving any reason, without my medical care or legal rights being affected. I understand that relevant sections of any of my medical notes and data collected during the study, may be looked at by responsible individuals, from regulatory authorities, where it is relevant to my taking part in this research. I give permission for these individuals to have access to my records. I agree to my GP being informed of my participation in the study. I agree to take part in the above research study. __________________________ Name of Patient ______________ Date __________________________ Signature __________________________ Name of Person taking consent (if different from researcher) ______________ Date __________________________ Signature __________________________ Researcher ______________ Date __________________________ Signature When complete, 1 copy for patient: 1 copy for researcher site file: 1 (original) to be kept in medical notes. Questionnaire 1. When did the symptom start 2. For what duration you are having this treatment 3. On what date Epley's maneuver was performed in A&E 4. Frequency of maneuver you are currently having 5. Whether you stopped the treatment 6. If so why Symptom Rating Likert Scale Question 0 1 2 3 4 5 6 Rate your current vertigo from 0 to 6. Rate your pre-maneuver vertigo from 0 to 6 Rate your current dizziness from 0 to 6 Rate your pre-maneuver dizziness from 0 to 6 Frequency of symptoms related to erect posture 0 to 6 Frequency of symptom related to lying posture Timing of attack during morning or evening Associated nausea or vomiting Any other associated disease in the interim Details about statistical tests, what and why these test will be used The success of the Epley maneuver is described by a linear model in generalized sense. It is assumed that the probability of success at any given self-directed session would be a fixed percentage of the probability that would have existed in the previous session. It is obvious that this model is flexible, and it would depend on the success rate in the session prior. Moreover, in some patients there would be deterioration of this success rate during repetitive maneuvers in the sane patient. This is known as coefficient of reproduction, and according to this assumption, in the most efficacious case, this would not differ significantly from 100%. In such cases, it can be assumed that the said maneuver retains the same efficacy throughout repeated sessions. This model would be applied for the statistical calculation of the data, and this would be used through the method of maximum likelihood. In a regression approach, the likelihood ratio test would determine the factors which might play significant role on the 2 factors of interest. In order to assess the quality of the fit, a classic goodness of fit chi-square test will be performed that would compare the counts obtained from the questionnaire with those which may be predicted by the model for each of the categories included in the questionnaire, ultimately indicating the significance of the factors. A multivariate analysis will also be needed to discern the importance of combination of factors, and the level of significance will be set at P Read More