BPPV

Mrs Smith is a 60 year old lady who has dizziness when turning over in bed. A medical student has taken a history and feels she has BPPV. The patient has come to see you for an explanation of the diagnosis and treatment.

Setting

  • WIPER  (wash hands, introduce yourself, permission, expose patient, reposition) 
  • Are you happy to see me today
  • Did anyone bring you today?

Perception

  • Would you mind bringing up to date with your symptoms/problems so far?
  • Also do you mind me asking what your occupation is and did you also drive here?

Knowledge

  • From what you are describing it sounds that your dizziness is caused by a condition called Benign Paroxysmal Positional Vertigo or BPPV. Have you heard of this?
  • Would you like me to tell you some more information?
  • Feel free to interrupt and ask any questions, but I’ll also give you a chance at the end.

This is an example answer. You may wish to come up with a script that works for you.

    • BPPV is the medical terminology used to describe your symptoms – when you turn to certain positions, it causes short episodes of dizziness or vertigo. This is a benign condition, so not a harmful or serious condition although I appreciate it can be quite disabling.
  • Part of your balance system is housed in your inner ear. This sends information to the brain about the position you are in and which movements you are making. Does this make sense?
  • Within the inner ear are crystals, which are in a certain position. However sometimes these crystals get dislodged e.g. if you get a knock to the head and then can cause dizziness when you turn your head as the crystals move and send signals to the brain to think you are moving which is why you feel dizzy. 
  • We can do a simple test today which can confirm if BPPV is the cause for your dizziness, and if it is there is a treatment which we can do in the clinic, possibly today, which involves some head and body movements to move the crystals back into the right place.
  • As this procedure can make you feel dizzy or unsteady, can I ask whether you drove here today? It may be that we have to reschedule to do this another time.
  • After the treatment, it is important not to lie flat on your back for 2 days and then for 5 days to sleep on the good side. Some people find putting a pillow behind your back helps rolling over.
  • It may also need to be repeated.

Answer any questions they may have

  • Can I Drive? 
    • You shouldn’t drive home after the manoeuvre as it can make you feel unsteady. The DVLA advised that if your dizziness is disabling, severe or recurrent then you shouldn’t drive. If your symptoms settle then I see no harm in returning to driving provided that you feel safe to drive.

Empathy

  • I am sorry that we can’t do it today. It’s important that you don’t drive afterwards. What I can do is arrange another appointment at a mutually convenient time and we can do the procedure then.

Strategy and Summary

  • So in summary, the cause of your dizziness is likely a condition called BPPV, where the crystals in the inner ear are in the wrong place. Although not a serious cause it can be disabling, as you’ve described. What I suggest is that we do a test to confirm the diagnosis and then we can do the Epley manoeuvres to help move the crystals back to where they should be.

Summary and safety netting

  • Today we have talked about…. – Do you have any further questions?
  • Once again my name is…
  • Secretary number
  • Offer information sheet and exercise sheet
  • It’s important that in the meantime if your dizziness is severe and disabling, not to drive (DVLA – Dizziness)
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