GGC - Primary Care
Background: BPPV is the most common cause of dizziness and incidence increases with age. Around 90% of cases can be treated in primary care. It is due to otolith debris within the inner ear. There is a high rate of recurrent symptoms but patient education can allow patients to manage their condition at home once a diagnosis is secured.
Patients will have short episodes (<30 seconds) of positional rotational vertigo, classically when turning over in bed.
How to assess: Perform Dix-Hallpike test. To do this, the patient is lowered quickly from a sitting position with the head 45 degrees to the side and 30 degrees below horizontal. The test is performed to both right and left sides. A positive result is indicated by the presence of torsional nystagmus occurring after initial latency period and lasting approximately 30 seconds. If the test is repeated there is often fatigue (symptoms and nystagmus lessens).
Other causes of short lived dizziness include:
- Postural hypotension
- Cardiac dysrhythmia
- Anxiety
If Dix-Hallpike test positive, perform epley manoeuvre on the most symptomatic side
- Left Epley NHSGGC - Vestibular Exercises 002 Epley L - YouTube
- Right Epley NHSGGC - Vestibular Exercises 001 Epley R - YouTube
Eighty percent of patients get improvement with 1 Epley manoeuvre. A repeat manoeuvre after an interval is indicated if persistent symptoms.
Referral guidance:
Patients with BPPV can be managed by Audiology or Physiotherapists. If the above measures fail, please refer to Audiology on a routine basis.
Please advise the patients to perform Brandt-Darroff and Cawthorne-Cooksey exercises daily while awaiting appointment