Question
Is there any clinical significance as to the time of onset of the nystagmus and dizziness when doing the Hallpike for example, 10 seconds versus 40 seconds?
Answer
The pattern of nystagmus, including latency, can shed some light on whether the BPPV is cupulolithiasis or canalithiasis. Typically, the nystagmus associated with cupulolithiasis (where the otoconial debris is attached to the cupula) has a shorter latency, but the nystagmus is more persistent and consistent. By that, I mean that the intensity of nystagmus remains steady over a duration usually exceeding thirty seconds. The nystagmus associated with canalithiasis (free floating otoconia) has a latency of several seconds, then the nystagmus build in a crescendo pattern, then gradually abate. Squires et al (2004), through mathematical computation estimate that it takes approximately five seconds for free floating otoconia to settle in a typical semi-circular canal, explaining the latency of response in BPPV. This difference in nystagmus response can influence the choice of treatment. Many specialists use the Semont maneuver if they suspect Cupulolithiasis, but use a modified Epley procedure for canalithiasis.
Squires et al (2004) A mathematical model for top shelf vertigo: the role of sedimenting otoconia in BPPV. J biomech. Aug:37(8):1137-46
Alan Desmond, Au.D is the director of Blue Ridge Hearing and Balance Clinic in Bluefield and Princeton, WV. Thieme Medical Publishers released his book Vestibular Function: Evaluation and Treatment in April 2004. He can be reached atBRHBC@comcast.net
Alan L. Desmond, AuD
audiologist and author
Related Courses
1https://www.audiologyonline.com/audiology-ceus/course/addressing-fall-risk-pt-ot-38144Addressing Fall Risk: PT, OT, and Audiology Assessment and Intervention, presented in partnership with Salus UniversityMultidisciplinary assessment and intervention of individuals at risk of falls is crucial in identifying functional and diagnostic factors as well as effective rehabilitation and prevention of future falls. This series identifies areas of collaboration and supportive information-sharing strategies between professions who commonly see individuals who fall and are likely to be injured due to a fall.auditory, textual, visual129USDSubscriptionUnlimited COURSE Access for $129/yearOnlineOnlyAudiologyOnlinewww.audiologyonline.comAddressing Fall Risk: PT, OT, and Audiology Assessment and Intervention, presented in partnership with Salus UniversityMultidisciplinary assessment and intervention of individuals at risk of falls is crucial in identifying functional and diagnostic factors as well as effective rehabilitation and prevention of future falls. This series identifies areas of collaboration and supportive information-sharing strategies between professions who commonly see individuals who fall and are likely to be injured due to a fall.38144OnlinePT180M
Multidisciplinary assessment and intervention of individuals at risk of falls is crucial in identifying functional and diagnostic factors as well as effective rehabilitation and prevention of future falls. This series identifies areas of collaboration and supportive information-sharing strategies between professions who commonly see individuals who fall and are likely to be injured due to a fall.
2https://www.audiologyonline.com/audiology-ceus/course/contemporary-concepts-in-pediatric-vestibular-35586Contemporary Concepts in Pediatric Vestibular Assessment and Management, presented in partnership with Seminars in HearingThis 5-part webinar series is focused on the growing evidence of the need for pediatric vestibular evaluation, as well as the availability of successful treatment options for children. Guest editors, Dr. Devin McCaslin and Dr. Jennifer Christy along with a team of leading experts will present on select articles from a recent issue of the journal Seminars in Hearing (Issue 03 · Volume 39 · 2018).auditory, textual, visual129USDSubscriptionUnlimited COURSE Access for $129/yearOnlineOnlyAudiologyOnlinewww.audiologyonline.comContemporary Concepts in Pediatric Vestibular Assessment and Management, presented in partnership with Seminars in HearingThis 5-part webinar series is focused on the growing evidence of the need for pediatric vestibular evaluation, as well as the availability of successful treatment options for children. Guest editors, Dr. Devin McCaslin and Dr. Jennifer Christy along with a team of leading experts will present on select articles from a recent issue of the journal Seminars in Hearing (Issue 03 · Volume 39 · 2018).35586OnlinePT300M
Presented by Sharon Cushing, MD, FRCSC, Katheryn Bachmann, PhD, Violette Lavender, AuD, Jennifer B. Christy, PhD, PT, Steven M. Doettl, AuD, PhD, Devin L. McCaslin, PhD, Kristen L. Janky, PhD, Amanda I. Rodriguez, PhD, AuD
AudiologyOnline
Presenters
Sharon Cushing, MD, FRCSCKatheryn Bachmann, PhDViolette Lavender, AuDJennifer B. Christy, PhD, PTSteven M. Doettl, AuD, PhDDevin L. McCaslin, PhDKristen L. Janky, PhDAmanda I. Rodriguez, PhD, AuD
This 5-part webinar series is focused on the growing evidence of the need for pediatric vestibular evaluation, as well as the availability of successful treatment options for children. Guest editors, Dr. Devin McCaslin and Dr. Jennifer Christy along with a team of leading experts will present on select articles from a recent issue of the journal Seminars in Hearing (Issue 03 · Volume 39 · 2018).
3https://www.audiologyonline.com/audiology-ceus/course/quantitative-vestibular-function-testing-pediatrics-35334Quantitative Vestibular Function Testing in the Pediatric Population, presented in partnership with Seminars in HearingThe purpose of this presentation is to provide an overview of how to perform vestibular tests in children, including which tests are recommended based on the child’s age and any modifications or considerations that can be made.auditory, textual, visual129USDSubscriptionUnlimited COURSE Access for $129/yearOnlineOnlyAudiologyOnlinewww.audiologyonline.comQuantitative Vestibular Function Testing in the Pediatric Population, presented in partnership with Seminars in HearingThe purpose of this presentation is to provide an overview of how to perform vestibular tests in children, including which tests are recommended based on the child’s age and any modifications or considerations that can be made.35334OnlinePT60M
The purpose of this presentation is to provide an overview of how to perform vestibular tests in children, including which tests are recommended based on the child’s age and any modifications or considerations that can be made.
4https://www.audiologyonline.com/audiology-ceus/course/preview-university-pittsburgh-teaching-vestibular-32520Preview of the University of Pittsburgh Teaching Vestibular Assessment and Rehabilitation across the Lifespan ConferenceThis course will present 5 topics critical to classroom and clinical teaching in the area of vestibular assessment and rehabilitation. This is a preview to the University of Pittsburgh Teaching Conference being held June 13-15, 2019.auditory, textual, visual129USDSubscriptionUnlimited COURSE Access for $129/yearOnlineOnlyAudiologyOnlinewww.audiologyonline.comPreview of the University of Pittsburgh Teaching Vestibular Assessment and Rehabilitation across the Lifespan ConferenceThis course will present 5 topics critical to classroom and clinical teaching in the area of vestibular assessment and rehabilitation. This is a preview to the University of Pittsburgh Teaching Conference being held June 13-15, 2019.32520OnlinePT60M
Presented by Catherine Palmer, PhD, Devin L. McCaslin, PhD, Patricia Gaffney, AuD, David Jedlicka, AuD, Sam Bittel, AuD, Virginia Milne, AuD, Elaine Mormer, PhD
This course will present 5 topics critical to classroom and clinical teaching in the area of vestibular assessment and rehabilitation. This is a preview to the University of Pittsburgh Teaching Conference being held June 13-15, 2019.
5https://www.audiologyonline.com/audiology-ceus/course/minimum-stimulus-strategy-in-diagnosis-39433Minimum Stimulus Strategy in the Diagnosis of BPPVBenign Paroxysmal Positional Vertigo (BPPV) is the most common inner ear disorder, with a cumulative lifetime incidence of 10%. This course will cover the Minimum Stimulus Strategy (MSS), a nystagmus-based approach to streamline BPPV management, reducing the need for diagnostic and therapeutic maneuvers and minimizing patient discomfort.auditory, textual, visual129USDSubscriptionUnlimited COURSE Access for $129/yearOnlineOnlyAudiologyOnlinewww.audiologyonline.comMinimum Stimulus Strategy in the Diagnosis of BPPVBenign Paroxysmal Positional Vertigo (BPPV) is the most common inner ear disorder, with a cumulative lifetime incidence of 10%. This course will cover the Minimum Stimulus Strategy (MSS), a nystagmus-based approach to streamline BPPV management, reducing the need for diagnostic and therapeutic maneuvers and minimizing patient discomfort.39433OnlinePT120M
Benign Paroxysmal Positional Vertigo (BPPV) is the most common inner ear disorder, with a cumulative lifetime incidence of 10%. This course will cover the Minimum Stimulus Strategy (MSS), a nystagmus-based approach to streamline BPPV management, reducing the need for diagnostic and therapeutic maneuvers and minimizing patient discomfort.
