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Direction‐changing nystagmus on positional testing is classically ascribed to a central pathology. We herein report a case of a patient with Benign Paroxysmal Positional Vertigo (BPPV) who demonstrated the unusual phenomenon of spontaneously reversing nystagmus, and discuss the theorised mechanisms with a novel illustration. In left lateral position, our patient's Videonystagmography (VNG) demonstrated an initially fast‐phase geotropic nystagmus (leftward‐beating, SPV 29°/s) which then paused for 8 s, then spontaneously reversed direction into a slow‐phase ageotropic nystagmus (rightward‐beating, SPV 7°/s). The rest of the neurootological examination and audiometry were normal. An MRI Brain scan also revealed no intracranial pathology. In subsequent reviews the vertigo resolved after repositioning manoeuvres for Left Horizontal Canal BPPV. With review of existing literature, this case may have exhibited coexistent left canalolithiasis and cupulolithiasis, resulting in simultaneous ampullopetal then ampullofugal forces in a single head position. Other posited theories include that of Endolymphatic Reflux and short‐term central adaptation of the Vestibulo‐Ocular Reflex. This case highlights a diagnostic challenge the otolaryngologists and neurologists may face with an atypical spontaneously reversing nystagmus in BPPV. However it remains a priority to rule out central pathologies first, and calls for specialists to take care in diagnosing horizontal canal BPPV by observing for a period of latency and spontaneous reversal of nystagmus first, so as to perform the appropriate repositioning manoeuvres. Laryngoscope, 135:373–376, 2025 [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to assess the clinical significance of the Bow and Lean Test (BLT) for the diagnosis of different variants of vertical canal Benign Paroxysmal Positional Vertigo (BPPV). BLT is commonly used for diagnoses of lateral semicircular canal (LSC) BPPV. However, vertical nystagmus in the BLT may indicate the presence of other variants such as PSC‐BPPV. Methods: 567 patients with vertical canal BPPV were recruited. Patients with anterior semicircular canal (ASC) or PSC‐BPPV were weekly examined until the negativization of BPPV. Nystagmus characteristics during BLT were analyzed. Results: Of 567 patients with vertical canal BPPV, 1.4% had ASC‐BPPV. BLT was positive in 155 patients, showing patterns like down‐beating nystagmus in bowing and no nystagmus in leaning (15.52% of patients), and down‐beating in bowing and up‐beating in leaning (6.17%), which was predominantly present in PSC‐canalolithiasis. Statistically significant differences were observed in the direction of nystagmus provoked by BLT in PSC‐BPPV subtypes. No significant differences were found in nystagmus latency or duration during BLT positions. Among BPPV subtypes, there was a significant difference in nystagmus duration and latency, especially between cupulolithiasis and other variants. BLT's sensitivity was 0.93 in bowing and 1 in a leaning position, while specificity was 0.93 and 0.82 respectively. Conclusion: Beyond the LSC, the BLT has expanded to other variants. However, study results differ likely due to variations in patient characteristics and test execution. Currently, no specific features for ASC have been found to differentiate it from PSC‐BPPV limiting the test's use for this variant. Level of Evidence: 3, according to Oxford Center for Evidence‐Based Medicine Laryngoscope, 134:2405–2410, 2024 [ABSTRACT FROM AUTHOR]

Objective: To evaluate the extent to which Benign Paroxysmal Positional Vertigo (BPPV) is associated with a higher prevalence of depression and anxiety in patients. Data Sources: Three databases including PubMed, Embase, and The Cochrane Library were searched by two independent authors from inception to June 12, 2022 for observational studies and randomized controlled trials investigating the association between BPPV and depression and anxiety. We included studies published as full‐length articles in peer‐reviewed journals with an adult population aged at least 18 years who have BPPV, detected through validated clinical methods like clinical diagnosis, interview and Dix‐Hallpike test. Results: A total of 23 articles met the final inclusion criteria and 19 articles were included in the meta‐analysis. BPPV was associated with a 3.19 increased risk of anxiety compared to controls, and 27% (17%–39%) of BPPV patients suffered from anxiety. Furthermore, the weighted average Beck's Anxiety Inventory score was 18.38 (12.57; 24.18), while the weighted average State–Trait Anxiety Index score was 43.08 (37.57; 48.60). Conclusion: There appears to be some association between BPPV and anxiety, but further studies are required to confirm these associations. Laryngoscope, 134:526–534, 2024 [ABSTRACT FROM AUTHOR]

Objectives: One-third of older adults suffer from dizziness and vertigo. Benign positional paroxysmal vertigo (BPPV), which occurs due to otoconia moving into the semicircular canal, is the most common vestibular disorder. We evaluated the connection between BPPV and geriatric symptoms., Methods: A comprehensive geriatric evaluation included daily living activities, Mini-Mental State Examination (MMSE), and Geriatric Depression Scale tests for all patients. Patients' nutritional status was assessed using the Mini-Nutritional Assessment. Body weight and fat free mass were determined from the bioimpedance analyzer. Hand grip strength was measured using an electronic hand dynamometer to determine muscle strength. Sarcopenia was assessed using the European Working Group on Sarcopenia in Older People-2 recommendations. The patients were divided into three groups as BPPV-positive, BPPV-negative, and healthy (control)., Results: Obesity, low muscle mass, dynapenia, gait speed, low gait speed, and history of falling statistically significantly differed between the three groups, but age, gender, smoking, alcohol consumption, body mass index, MMSE, depression, number of falls, and comorbid diseases did not differ. The BPPV-positive group had greater rates of obesity, low muscle mass, dynapenia, and sarcopenia than the control group (p = 0.008, 0.007, 0.01, 0.03). In the unadjusted univariate analysis, low muscle mass, sarcopenia, and obesity were risk factors for "BPPV" (Odds Ratio [OR]: 3.43, Confidence Interval [Cl]: 1.25-9.37, p = 0.016; OR: 3.47, Cl: 1.32-9.13, p = 0.011; OR: 2.71, Cl: 1.09-6.70, p = 0.031)., Conclusions: Obesity, sarcopenia, and low muscle mass are risk factors for BPPV, and we urge the older population to adopt healthy diet and exercise regimens to reduce BPPV-related falls., Level of Evidence: Level 3 Laryngoscope, 2025., (© 2025 The American Laryngological, Rhinological and Otological Society, Inc.)

Objectives: To evaluate the success rates of canalith repositioning maneuvers (CRM) in the treatment of patients diagnosed with bilateral benign paroxysmal positional vertigo (BiBPPV). Study Design: Systematic review. Methods: A comprehensive search of only English studies in PubMed, Ovid (1946 to the present), and Embase (1974 to the present) databases was done up until January 1, 2021. Studies that diagnosed patients with BiBPPV specifically and evaluated the CRM success from all published years were included. Studies were excluded if follow‐up was less than 6 months or if they failed to distinguish BiBPPV from ipsilateral multi‐canal BPPV. A total of nine studies were included with a total study population of 325 patients. Included studies were evaluated for bias with the National Institutes of Health (NIH) Study Quality Assessment Tool. Success rates of CRM, number of treatments required, and disease recurrence rates were extracted. Results: The overall success rate was compiled using a fixed‐effect binary inverse variance model and was 95.2% (CI: 92.9%–97.5%). A qualitative review suggested treating the more affected side first on separate visits until resolved, followed by contralateral treatment (recommendation). The mean number of treatments was 2.9 (CI: 2.4–3.4), and the recurrence rate was 19.8% (CI: 11.7%–27.9%). There was a higher proportion of trauma etiology of BiBPPV compared to unilateral, with an odds ratio of 8.9 (CI: 5.1–15.3). Conclusions: Overall, this meta‐analysis shows high success rates for CRM in the treatment of BiBPPV. Rates are similar to CRM efficacy for unilateral BPPV. Laryngoscope, 132:640–647, 2022 [ABSTRACT FROM AUTHOR]

Objectives: Head trauma may cause dislodgement of otoconia and development of benign paroxysmal positional vertigo (BPPV). The risk of developing BPPV is expected to be highest shortly after the trauma, then decrease and approach the risk seen in the general population. The aim of this study was to estimate the risk‐time curve of BPPV development after head trauma. Study Design: Prospective observational study. Methods: Patients with minimal, mild, or moderate head trauma treated at the Department of Neurosurgery or the Department of Orthopedic Emergency at Oslo University Hospital, were interviewed and examined for BPPV using the Dix‐Hallpike and supine roll maneuvers. BPPV was diagnosed according to the International diagnostic criteria of the Bárány Society. Telephone interviews were conducted at 2, 6, and 12 weeks after the first examination. Results: Out of 117 patients, 21% developed traumatic BPPV within 3 months after the trauma. The corresponding numbers were 12% with minimal trauma, 24% with mild, and 40% with moderate trauma. The difference in prevalence between the groups was significant (P =.018). During the first 4 weeks after the trauma, it was observed 20, 3, 0, and 1 BPPV onsets, respectively. No BPPV cases were seen for the remainder of the 3‐month follow‐up. Conclusion: The risk of developing BPPV after minimal‐to‐moderate head trauma is considerable and related to trauma severity. Most cases occur within few days after the trauma, but any BPPV occurring within the first 2 weeks after head trauma are likely due to the traumatic event. Level of Evidence: 3 Laryngoscope, 132:443–448, 2022 [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: The need for class I and II studies on the efficacy of liberatory maneuvers in the treatment of lateral canal benign paroxysmal positional vertigo (LC‐BPPV) motivated the present double‐blind randomized trial on the short‐term efficacy of the forced prolonged position (FPP). Study Design: Double‐blind, randomized controlled trial. Methods: Two hundred twenty‐one patients with unilateral LC‐BPPV met the inclusion criteria for a multicentric study. Patients were randomly assigned to treatment by FPP (116 subjects) or sham treatment (105 subjects). Subjects were followed up at 24 hours with the supine roll test by blinded examiners. Results: Among the sample, 67.4% and 32.6% of the patients showed respectively geotropic and apogeotropic variant of LC‐BPPV. At the 24‐hour follow‐up, the effectiveness of FFP compared to the sham maneuver was, respectively, 57.8% versus 12.4% (P <.0001) in the total sample, 76.9% versus 11.3% (P <.0001) in the geotropic variant group, and 60.5% versus 17.6% (P =.0003) in the apogeotropic variant group, including resolution or transformation to geotropic variant. Conclusions: FPP proved highly effective compared to the sham maneuver. The present class 2 study of the efficacy of the FPP changes the level of recommendation of the method for treating LC‐BPPV into a strong one. Level of Evidence: 2 Laryngoscope, 131:E1296–E1300, 2021 [ABSTRACT FROM AUTHOR]

Objectives: Few studies have reported that mood disorders increase the risk of benign paroxysmal positional vertigo (BPPV). The purpose of our study was to demonstrate whether the incidence of BPPV in those with mood disorders differs from that in a matched control group.Study Design: Nationwide cohort observational study.Methods: Korean Health Insurance Review and Assessment Service-National Patient Samples were collected from 2002 to 2013. A 1:4 matched mood disorder group (n = 59,340) and control group (n = 237,720) were selected. The crude and adjusted (cerebral stroke, ischemic heart disease, anxiety disorder, and osteoporosis histories) hazard ratios (HRs) for depression and BPPV were analyzed using a stratified Cox proportional hazard model. The results were stratified by age, sex, income, region of residence, hypertension, diabetes, and dyslipidemia in these analyses.Results: The incidence of BPPV was significantly higher in the mood disorder group than in the control group (3.2% vs. 2.1%, P < .001). Mood disorder increased the risk of BPPV (adjusted HR = 1.31, 95% confidence interval [CI] = 1.23-1.39, P < .001). In subgroup analyses, the incidence of BPPV in all age groups and in both sexes was significantly higher in the mood disorder group than in the control group.Conclusion: This population-based cohort study demonstrates that mood disorder was significantly associated with BPPV.Level Of Evidence: N/A. Laryngoscope, 131:380-385, 2021. [ABSTRACT FROM AUTHOR]

The purpose of this case report was to describe the evaluation and management of atypical benign paroxysmal positional vertigo (BPPV) in an adult with severe osteogenesis imperfecta. A 29-year-old male was referred to a physical therapist with extensive experience in vestibular rehabilitation who provided horizontal canal BPPV treatment with a canalith repositioning maneuver over two treatment sessions. The individual's symptoms had reduced by 65% and his nystagmus during the roll test was reduced. Extreme care is needed to safely reposition individuals living with severe osteogenesis imperfecta, but the repositioning can reduce symptoms and improve quality of life. Laryngoscope, 130:2241-2244, 2020. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: The present study aimed to evaluate the optimal reassessment time for treatment response in posterior canal benign paroxysmal positional vertigo (PC-BPPV) following the initial Epley maneuver.Study Design: Prospective, single-blinded, randomized study.Methods: One hundred eight patients with PC-BPPV agreed to participate. These patients received a single modified Epley maneuver (recommended by the 2008 American Academy of Otolaryngology-Head and Neck Surgery guidelines) daily until positional nystagmus disappeared during the Dix-Hallpike maneuver 24 hours after the treatment. Repeated Dix-Hallpike testing to reassess the treatment response was performed at 1 hour (post-1 hour), every 24 hours (post-24 hours) until the positional nystagmus resolved, 1 week (post-1 week), and 1 month (post-1 month) following the therapeutic maneuver. The difference in the resolution rates at post-1 hour and post-24 hours reassessment was analyzed, and the recurrence rates at post-1 week and post-1 month were evaluated.Results: The resolution rate was 67.6% at post-1 hour, which increased to 79.6% at post-24 hours reassessment. There was a statistically significant difference in the results of the Dix-Hallpike test between post-1 hour and post-24 hours follow-up. After complete resolution, nine out of 108 patients (8.3%) demonstrated recurrence within 1 month.Conclusions: Reassessment after 24 hours following the initial Epley maneuver is more advantageous than a 1-hour follow-up in patients with PC-BPPV. This information may be helpful for clinicians in deciding the appropriate follow-up period after treatment for PC-BPPV.Level Of Evidence: 1b Laryngoscope, 130:496-499, 2020. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: Each year, the United States spends over $4 billion on emergency department visits for evaluation of dizziness. Benign paroxysmal positional vertigo (BPPV) is a common cause of dizziness that can easily be diagnosed by observing characteristic eye movements during the Dix-Hallpike test (DHT). The DHT is easily performed; however, interpretation requires more advanced training. This may be part of the reason it is not commonly performed in emergency departments, and instead, patients undergo costly imaging tests. We evaluated whether smartphone-based video recordings of DHT could be assessed telemedically for screening of nonacute dizziness.Study Design: Feasibility study.Methods: Dizzy patients underwent objective vestibular testing, but also had videos of their eye movements recorded via a smartphone during the DHT. The videos were remotely reviewed by two neuro-otologists for BPPV screening and were compared to objective and in-person exam findings.Results: Overall, 30 dizzy patients were evaluated with seven cases of BPPV. The sensitivity for diagnosing BPPV via a smartphone-recording of eye movements of the DHT was 92.86%, with a specificity of 100% and a negative predictive value of 97.87%.Conclusions: Our initial proof-of-concept study shows that remote screening of BPPV is possible with high specificity. Because the DHT is easily taught, having a remote otolaryngologist interpret the resulting eye movements may increase usage of the test and may lead to cost savings.Level Of Evidence: 4 Laryngoscope, 129:466-469, 2019. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: To investigate the role of the bow and lean test (BLT) in the diagnosis of benign paroxysmal positional vertigo (BPPV).Study Design: Retrospective case-control study.Methods: Between March 2015 and June 2017, we enrolled 113 patients with posterior semicircular canal (PSCC) BPPV, 74 patients with lateral semicircular canal (LSCC) canalolithiasis, 53 patients with LSCC cupulolithiasis, and 32 patients with light cupula. We retrospectively assessed bowing nystagmus (BN) and leaning nystagmus (LN).Results: In PSCC BPPV, 75% of the patients showed at least one of BN and LN, and direction of nystagmus provoked by a Dix-Hallpike test on the affected side was consistent with that of LN and opposite to that of BN. In LSCC canalolithiasis, 65% (48 of 74) of the patients showed both BN and LN, which were in the same direction in 38 patients (of 48) and in the opposite direction in 10 patients (of 48). The affected side can be determined according to the results of THE BLT in 74% (55 of 74) of LSCC canalolithiasis patients, and among them, the side determined according to the results of head-roll test was discordant with that according to the BLT in 20 of 55 patients (36%). In LSCC cupulopathy (n = 85), both BN and LN were persistent and observed in all cases, but we could not distinguish LSCC cupulolithiasis from light cupula according to nystagmus direction in the BLT.Conclusions: Although a BLT yields better lateralization in LSCC canalolithiasis, it may be more useful in predicting the diagnosis and lateralization of PSCC BPPV than LSCC canalolithiasis.Level Of Evidence: 4 Laryngoscope, 2600-2604, 2018. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: Although it is generally considered that benign paroxysmal positional vertigo (BPPV) is associated with changes in female sex hormone levels, no direct data have been reported until now. The purpose of this article was to provide direct data showing the distinct relationship between female sex hormone fluctuations and BPPV in postmenopausal female patients.Study Design: Prospective analysis in humans and basic research in animals.Methods: Blood samples were analyzed to determine the levels of estradiol, progesterone, follicle-stimulating hormone, and luteinizing hormone in 50- to 80-year-old postmenopausal female patients newly diagnosed with idiopathic BPPV based on history compatible with BPPV and positive provocative maneuvers. Animal models of bilateral ovariectomy and female sex hormone replacement therapy were used to further confirm the relationship between BPPV and female sex hormone levels by determining the expression levels of otoconin 90, the protein suggested as essential in the dislocation of otoconia.Results: Statistically significant differences between the estradiol level of BPPV patients and the control group were found (P < .001). Moreover, in bilateral ovariectomy in rats, 17β-estradiol replacement reversed the decrease of otoconin 90 levels.Conclusions: Our results suggest that estradiol deficiency may be an important risk factor for idiopathic benign paroxysmal positional vertigo in postmenopausal female patients.Level Of Evidence: NA. Laryngoscope, 128:948-953, 2018. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: Repair of superior canal dehiscence (SCD) often results in the resolution of preoperative auditory and vestibular symptoms; however, many patients experience dizziness in the postoperative period. Postoperative dizziness may be the result of new-onset benign paroxysmal positional vertigo (BPPV). This study aims to investigate the prevalence of BPPV before and following SCD repair.Study Design: Retrospective chart review at a tertiary care center.Methods: Electronic medical records were reviewed for patients with a diagnosis of SCD syndrome (SCDS) between January 2002 and May 2015. Collected information included demographic data, incidence of BPPV diagnosed by Dix-Hallpike maneuver before and following surgery, operative technique, repair material, and the duration of time to BPPV onset.Results: A total of 180 patients with a diagnosis of SCDS were identified: 84 patients underwent surgery (operated subjects) and 96 were observed (nonoperated, control group). In operated subjects, 20 of 84 (23.8%) developed BPPV following SCD repair versus 6.2% of nonoperated (P < 0.005). Benign paroxysmal positional vertigo lateralized to the operated side in all but one subject whose laterality was unknown (P < 0.0001). There were no associations of BPPV with surgical approach (P = 0.50) or repair material (P = 0.33). The majority of subjects (58%) were diagnosed with BPPV within 3 months of surgery.Conclusion: New-onset BPPV occurs commonly after SCD repair and may be the result of mobilized otoliths from inner ear pressure changes. Although the exact etiology of post-SCD repair BPPV remains unknown, postoperative dizziness is important to discuss with patients during preoperative counseling.Level Of Evidence: 4. Laryngoscope, 126:2092-2097, 2016. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: Using network meta-analysis, we aimed to compare the efficacy and safety of Epley and Semont maneuvers as treatment options for posterior canal benign paroxysmal positional vertigo.Study Design: Network meta-analysis.Methods: Randomized controlled studies with a Jadad score ≥ 3 that used an Epley or Semont maneuver in posterior canal benign paroxysmal positional vertigo patients were analyzed in this project. The following efficacy outcomes included 1-week recovery rate and end of study recovery rate. Recurrence rate was used to assess the safety of each treatment.Results: Of 589 articles, 12 studies that enrolled 999 posterior canal benign paroxysmal positional vertigo patients were selected. The pooled analysis revealed that the Epley maneuver was as efficacious as the Semont maneuver, in both the 1-week recovery rate and end of study recovery rate (odds ratio [OR] = 1.8, 95% confidence interval [CI] = 0.48-7.00; OR = 1.8, 95% CI = 0.47-7.20), and had a similar recurrence rate (OR = 1.00, 95% CI = 0.33-4.4). These two techniques were both better than sham-controlled treatment in the two efficacy indicators. No difference was observed in recurrence rate for treatments.Conclusions: The Epley maneuver was similar to the Semont maneuver in both efficacy and safety for posterior canal benign paroxysmal positional vertigo in short-term effects, and both were superior to the sham-controlled treatment.Level Of Evidence: NA. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis Persistent direction-changing positional nystagmus (DCPN) during the supine head-roll test is a typical finding of cupulopathy. The aim of this study was to introduce a simple method of evaluating patients with cupulopathy (light cupula and heavy cupula), which is performed in a seated position, and investigate its diagnostic utility and use for lateralization. Study Design Retrospective case series. Methods Using video-oculography, nystagmus during head roll in the leaning and bending head positions while seated upright was evaluated in 26 patients with cupulopathy (five light cupula and 21 heavy cupula). The diagnosis of cupulopathy was confirmed with the supine head-roll test. Results Spontaneous nystagmus while seated upright was directed toward the ipsilesional side in heavy cupula and the contralesional side in light cupula. The first null point was identified when the head was slightly bent in the pitch plane in all 26 patients. Head rolling elicited a persistent geotropic DCPN in light cupula patients and persistent apogeotropic DCPN in heavy cupula patients during both leaning and bending head positions. In both light and heavy cupula, nystagmus disappeared when the head was turned slightly toward the affected side in both leaning (second null point) and bending (third null point) head positions. Conclusions Cupulopathy and its affected side can be diagnosed by identifying the three null points while seated upright. Level of Evidence 4. Laryngoscope, 125:1921-1925, 2015 [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis To evaluate the short-term efficacy of the computer-controlled canalith repositioning procedure (CRP) for treatment of posterior canal benign paroxysmal positional vertigo (BPPV) compared with the current standard CRP. Study Design Prospective case series. Methods One hundred thirty-two patients diagnosed as having idiopathic posterior canal BPPV, with an age range of 28 to 86 years (mean 56 years), 47 men and 85 women, were treated with computer-controlled CRP mimicking the Epley maneuver. Resolution of vertigo and nystagmus on the Dix-Hallpike test at 1-week follow-up after treatment was the main outcome measure to assess the efficacy of treatment. Results At 1-week follow-up after treatment with computer-controlled CRP, 108 (81.8%) of 132 patients had complete resolution of vertigo and nystagmus, nine (6.8%) had resolution of vertigo but presence of nystagmus, and 15 (11.4%) had provoked vertigo and nystagmus on the Dix-Hallpike test. The 81.8% success rate was comparable to those who received current standard CRP treatment in randomized controlled trials at about 80%. No significant adverse effects or complications occurred in the patients treated with computer-controlled CRP, aside from two patients (1.5%) with conversion into lateral canal BPPV. Conclusions Computer-controlled CRP is effective for the treatment of posterior canal BPPV, with a success rate similar to those treated with the Epley maneuver, and is safe and easy to perform on patients. Level of Evidence 4 Laryngoscope, 125:715-719, 2015 [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: To investigate the characteristics of residual symptoms and to evaluate the effects of adjuvant vestibular suppressants on residual symptoms after successful canalith repositioning procedures (CRPs). Study Design: Individual randomized controlled trial. Methods: One hundred fifty patients with idiopathic benign paroxysmal positional vertigo who achieved successful CRPs on initial visit participated in this study. Dizziness Handicap Inventory (DHI) questionnaires were completed before CRPs. All study populations were divided into three groups after successful CRPs on the initial visit day: the medication (V) group (treated with a vestibular suppressant [dimenhydrinate 50 mg per day]), the placebo (P) group, and the no medication (N) group. One week after successful CRPs, residual symptoms were checked and repeated DHI questionnaires were completed to compare residual symptoms. Results: Among the 138 patients who did not show positional nystagmus at follow-up, 67 (48.5%) complained of residual symptoms. The presence of residual symptoms was more prevalent in the P and N group compared with the V group (P = .035, P = .017, respectively). The most frequent residual symptom was lightheadedness (n = 42). Moreover, in the V group, lightheadedness was significantly reduced compared with the P group (P = .029). However, in the analysis of DHI, total and subscale scores did not differ across the three groups before or after successful CRP. Conclusions: Vestibular suppressants significantly reduced residual symptoms compared to both placebo and no medication after CRP. However, there was no significant reduction in DHI score compared with the control group, suggesting that the residual symptoms could not be evaluated by DHI score alone. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis To investigate the characteristics of residual symptoms and to evaluate the effects of adjuvant vestibular suppressants on residual symptoms after successful canalith repositioning procedures (CRPs). Study Design Individual randomized controlled trial. Methods One hundred fifty patients with idiopathic benign paroxysmal positional vertigo who achieved successful CRPs on initial visit participated in this study. Dizziness Handicap Inventory (DHI) questionnaires were completed before CRPs. All study populations were divided into three groups after successful CRPs on the initial visit day: the medication (V) group (treated with a vestibular suppressant [dimenhydrinate 50 mg per day]), the placebo (P) group, and the no medication (N) group. One week after successful CRPs, residual symptoms were checked and repeated DHI questionnaires were completed to compare residual symptoms. Results Among the 138 patients who did not show positional nystagmus at follow-up, 67 (48.5%) complained of residual symptoms. The presence of residual symptoms was more prevalent in the P and N group compared with the V group ( P = .035, P = .017, respectively). The most frequent residual symptom was lightheadedness (n = 42). Moreover, in the V group, lightheadedness was significantly reduced compared with the P group ( P = .029). However, in the analysis of DHI, total and subscale scores did not differ across the three groups before or after successful CRP. Conclusions Vestibular suppressants significantly reduced residual symptoms compared to both placebo and no medication after CRP. However, there was no significant reduction in DHI score compared with the control group, suggesting that the residual symptoms could not be evaluated by DHI score alone. Level of Evidence 1b Laryngoscope 124:2400-2403, 2014 [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis The clinical features and treatment outcomes of benign paroxysmal positional vertigo (BPPV) are known to be different depending on the type of and involved canal. This difference could be due to differences in the functional change of the otolith organ. Study Design Case series. Methods Forty-nine patients were diagnosed to primary BPPV; 18 were categorized as posterior canal canalolithiasis (PC canalolithiasis), and 31 were categorized as horizontal canal (HC) BPPV with canalolithiasis or cupulolithiasis (HC canalolithiasis or HC cupulolithiasis). Diagnostic interventions to measure vestibular functions were performed such as electronystagmography (ENG), videonystagmography (VNG), and static and dynamic subjective visual vertical (SVV). BPPV was confirmed with nystagmus during positioning/positional test under ENG and VNG. Static SVV was recorded with a light-emitting diode (LED) bar located in front of the patients before eccentric rotation and dynamic SVV was recorded during eccentric rotation with the LED bar. SVV angles were read by the examiner and analyzed. The measured values were compared to those of normal controls and each other. Results Dynamic SVV toward the lesion side in all subtypes of BPPV were significantly different from those of the controls; HC cupulolithiasis showed significantly lower values than those of PC canalolithiasis and HC canalolithiasis. Conclusions HC cupulolithiasis shows a lesser degree of utricular dysfunction compared with other subtypes. It could postulate the difference of pathophysiology between canalolithiasis and cupulolithiasis. Level of Evidence 4. Laryngoscope, 124:984-988, 2014 [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis The aim of this study was to characterize the clinical features and typical positional nystagmus in patients with persistent geotropic direction-changing positional nystagmus (DCPN) and address the possible pathophysiology of the disease. Furthermore, the proportion of light cupula among the patients showing geotropic DCPN was investigated to assume the incidence of light cupula in those patients. Study Design Prospective case series. Methods We conducted a prospective case series study in 19 patients with persistent geotropic DCPN. Positional nystagmus during the bow and lean test and the supine head roll test was analyzed using videonystagmography. Results All of the 19 patients showed persistent geotropic DCPN without latency. A null plane in which the nystagmus ceases was identified in all of 19 patients, and the intensity of nystagmus was stronger on one side in13 patients (68%) on supine head roll test. Overall, the affected side could be identified in 18 patients (95%). About 14.2% (19 of 134) of patients with geotropic DCPN could be diagnosed as having light cupula in the horizontal semicircular canal. Conclusions The patients with light cupula show persistent geotropic DCPN without latency. Affected side(s) can be determined by the direction and intensity of the characteristic positional nystagmus and the side of the null plane. The pathophysiology and treatment of light cupula still remain to be elucidated. Level of Evidence 4. Laryngoscope, 124:E15-E19, 2014 [ABSTRACT FROM AUTHOR]

For horizontal canal benign paroxysmal positional vertigo, determination of the pathologic side is difficult and based on many physiological assumptions. This article reports findings on a patient who had one dysfunctional inner ear and who presented with horizontal canal benign paroxysmal positional vertigo, giving us a relatively pure model for observing nystagmus arising in a subject in whom the affected side is known a priori. It is an interesting human model corroborating theories of nystagmus generation in this pathology and also serves to validate Ewald's second law in a living human subject. Laryngoscope, 123:3197-3200, 2013 [ABSTRACT FROM AUTHOR]

Objective/Hypothesis Idiopathic benign paroxysmal positional vertigo (BPPV) is a strong indicator of decreased bone density (osteopenia/osteoporosis) in postmenopausal women, and there is a correlation between BPPV and serum levels of biochemical markers of bone turnover. Study Design Prospective pilot clinical trial. Methods Two groups of postmenopausal women were recruited. The BPPV group consisted of 16 women with a diagnosis of BPPV. The OSTEO group consisted of 13 women with history of osteopenia/osteoporosis. Dual-energy x-ray absorptiometry scan results were compared, along with serum levels of ionized calcium (iCa), vitamin D, aminoterminal propeptide of protocollagen type I (P1NP), and aminoterminal telopeptides of collagen (sNTX). Results Prevalence of decreased bone mass density among BPPV subjects was 81%, and prevalence of BPPV among OSTEO subjects was 31%. BPPV subjects had higher P1NP levels. Multiple regression analysis showed that among BPPV subjects, there was positive correlation between P1NP and sNTX and a negative correlation between P1NP and vitamin D level. Age was positively correlated with serum levels of both biomarkers among the BPPV subjects. T score, serum iCa, and serum vitamin D levels did not appear to correlate with presence of BPPV. Conclusions Idiopathic BPPV subjects have a high prevalence of osteopenia/osteoporosis. Levels of biochemical markers of bone turnover correlate with presence of BPPV. Our results, based on a sample of U.S. subjects, support an association between idiopathic BPPV and disorders of bone turnover. Level of Evidence 2b. Laryngoscope, 123:2834-2839, 2013 [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis Benign paroxysmal positional vertigo (BPPV) frequently occurs in females over 50 years old, suggesting that a postmenopausal decrease in estrogen secretion might be involved in its onset . An estrogen deficiency is generally known to cause osteoporosis through a reduction in bone mass. This study was designed to investigate a clinical association between idiopathic BPPV and osteoporosis. Study Design Case-control study. Methods We measured the bone mineral density (BMD) at the lumbar vertebrae in 61 patients with idiopathic BPPV who were postmenopausal women over 50 years old using dual-energy x-ray absorptiometry. After being treated with the canalith repositioning maneuver, the patients were followed up for at least 1 year. Results Our results showed that the incidence of osteoporosis in patients with BPPV was 26.2%, which was similar to those observed in epidemiological surveys conducted in Japan. However, we found that in BPPV patients with osteoporosis, the incidence of recurrence was 56.3%, which was significantly higher than that observed in patients with normal bone mineral density (16.1%). Furthermore, the frequency of BPPV recurrence increased as BMD decreased. Conclusions These results suggest that osteoporosis is a risk factor for BPPV recurrence. The prognosis of BPPV might be clinically predicted by BMD reduction. Level of Evidence 3b Laryngoscope, 123:2813-2816, 2013 [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis The study evaluated the relationship between the position that initially provoked vertigo and the affected semicircular canal (SCC) in patients with benign paroxysmal positional vertigo (BPPV), and aimed to predict the side affected by BPPV through history taking regarding the provoking position. Study Design Prospective study at a tertiary hospital. Methods A total of 521 patients with BPPV involving the posterior or horizontal SCCs performed questionnaires at initial visit asking to choose the initial provoking position among the 10 positions corresponding to one of the three planes (roll, pitch, or yaw). After excluding 45 patients showing signs of simultaneous multiple canal or anterior canal involvement, the frequency of the provoking positions and the correlation between the side of the provoking position and the ear affected by BPPV were analyzed. Results There were 239 patients with posterior SCC BPPV (p-BPPV) and 237 patients with horizontal SCC BPPV (h-BPPV). The waking-up position was the most common provoking position in both types of BPPV. Statistically significant correlation was demonstrated between the side of the provoking position at the onset of vertigo and the affected side by BPPV ( P < .01) in patients with p-BPPV as well as h-BPPV (geotropic type [Geo]), but not in patients with h-BPPV (apogeotropic type [Apo]). Conclusions History taking regarding the side of provoking position at the onset of vertigo may help predict the side affected by BPPV in p-BPPV and h-BPPV (Geo). When h-BPPV (Apo) is suspected, further detailed examinations using additional localization methods should be performed. Level of Evidence 2b. Laryngoscope, 123:2259-2263, 2013 [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis The need for class I and II studies on the efficacy of liberatory maneuvers in the treatment of lateral canal benign paroxysmal positional vertigo (LC-BPPV) motivated the present double-blind randomized trial on the short-term efficacy of the Gufoni liberatory maneuver (GLM). Study Design Double-blind randomized controlled trial. Methods Seventy-two patients with unilateral LC-BPPV were recruited for a multicentric study. Patients were randomly assigned to treatment by GLM (n = 37) or sham treatment (n = 35). Subjects were followed up twice (at 1 hour and 24 hours) with the supine roll test by blinded examiners. Results At 1- and 24-hour follow-up, 75.7% and 83.8% of patients, respectively, undergoing GLM had recovered from vertigo, compared to around 10% of patients undergoing the sham maneuver ( P < 0.0001). Conclusion To the best of our knowledge, this is the first class I study on the efficacy of the GLM in the treatment of LC-BPPV in both geotropic and apogeotropic forms. GLM proved highly effective compared to the sham maneuver ( P < 0.0001). The present class I study of the efficacy of the GLM changes the level of recommendation of the method for treating LC-BPPV from level U to level B for the geotropic variant and from level B to level A for the apogeotropic variant of LC-BPPV. Level of Evidence 1b. Laryngoscope, 2013 [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: To investigate the clinical characteristics of benign paroxysmal positional vertigo (BPPV) associated with idiopathic sudden sensorineural hearing loss (ISSHL) and to compare them with the characteristics of idiopathic BPPV (i-BPPV). Study Design: Retrospective case series. Methods: We retrospectively analyzed 519 patients with ISSHL and 597 patients with i-BPPV. The ISSHL patients with recent vertigo history before or after admission were tested with video-nystagmography that included the caloric test. BPPV with same-side ISSHL was identified and categorized as secondary BPPV (s-BPPV) using the roll or Dix-Hallpike test. All members of the s-BPPV and i-BPPV groups underwent a daily canalith repositioning procedure (CRP) during the admission periods. We investigated the clinical characteristics, including the number of CRPs performed to achieve successful reposition, canal involvement type, and effect of canal paresis and made comparisons between the s-BPPV and i-BPPV groups. Results: Of the 519 ISSHL patients, 63 (12.1%) were identified as having s-BPPV. Multicanal involvement was more frequent in s-BPPV than i-BPPV patients ( P < .001). The mean number of CRPs needed to achieve successful reposition was 4.28 in s-BPPV and 1.34 in i-BPPV ( P < .001). The presence of canal paresis was also associated with a greater number of CRPs required for s-BPPV ( P < .02). Conclusions: In about 12% of ISSHL patients, s-BPPV was concurrent. More CRPs were required for successful repositioning in patients with s-BPPV than in patients with i-BPPV. Also, the presence of canal paresis in s-BPPV was associated with a greater number of required CRPs. Laryngoscope, 2012 [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: Transmastoid occlusion of the superior semicircular canal in superior semicircular canal dehiscence (SSCD) syndrome and the posterior semicircular canal in intractable benign paroxysmal positional vertigo (BPPV) will produce resolution of preoperative symptoms. Study Design: Retrospective review, quality assurance. Methods: Sixteen patients with SSCD and 61 patients (65 ears) with intractable BPPV who underwent canal occlusion were reviewed. All patients underwent occlusion of the affected semicircular canal through a transmastoid approach. Results: Preoperative symptoms (vestibular, 13 patients; pulsatile tinnitus, 2 patients; or hyperacusis, 1 patient) were greatly improved or completely resolved in 15 of the 16 SSCD patients who underwent transmastoid occlusion of the superior canal. Hearing was preserved in 14 patients and improved in two patients. Vestibular symptoms were resolved in all intractable BPPV patients who underwent transmastoid occlusion of the posterior canal. One patient had a late recurrence of atypical BPPV. Almost all BPPV patients with normal preoperative hearing have an initial transient postoperative hearing loss, which when tested for is usually a mild to moderate mixed loss. Delayed sensorineural hearing loss was noted in three patients; one loss was profound whereas two were mild. Conclusions: The transmastoid approach to canal plugging is successful in the treatment of symptoms in both SSCD and intractable BPPV, and is a familiar approach for the otologist. This is a viable alternative to the middle fossa approach for SSCD, thereby avoiding a craniotomy. Transmastoid is the definitive approach for posterior canal occlusion. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: Horizontal semicircular canal (HSC) benign paroxysmal positional vertigo (BPPV) has been reported to have a poorer prognosis than posterior semicircular canal BPPV. Incorrect determination of the affected ear appears to be one of the causes of poorer outcome. The aim of this study was to assess the efficacy of the ''bow and lean test'' (BLT) for proper determination of the affected ear followed by preferable treatment outcomes of HSC-BPPV. Study Design: A prospective study. Methods: The 211 patients (225 cases) with HSCBPPV were sequentially classified into two groups by hospital visiting time and diagnostic methods. The head roll test (HRT) group (61 cases) was treated with canalith repositioning procedure (CRP) on the basis of the results of HRT alone between 2001 and 2004. The BLT group (164 cases) was treated based on the results of both BLT and HRT from 2005 to 2008. Results: The remission rates after two sessions of CRPs in the BLT group and the HRT group were 83.1% and 67.4% (P = .041), respectively, for the canalolithiasis type and 74.7% and 61.1% (P = .250), respectively, for the cupulolithiasis type. In the BLT group, 76.8% had bowing and/or leaning nystagmus; 35.7% of them (45 of 126 cases) benefited from BLT with regard to determining the affected ears because HRT was unable to provide the definitive affected ears (17 cases) or showed different localization between two methods (28 cases). Conclusions: BLT is a useful method to improve the remission rates of HSC-BPPV, giving more corrective information regarding affected ears than the HRT alone. [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: To compare the pass rate of residents performing the Particle Repositioning Maneuver (PRM) after one of three interventions: 1) small group PRM instruction (SG); 2) standard classroom instruction (CI); and 3) Web-based learning module (WM). We hypothesize that our Web-based learning module is more effective than CI and as effective as SG. Study Design: Prospective randomized control trial. Methods: The study population includes all family medicine residents at the University of Western Ontario. On day 0, all subjects were tested. Residents were then randomized to one of three intervention groups: 1) SG, 2) CI, or 3) WM. On day 7, the residents were again tested. Observers were blinded to the intervention type. Testing (day 0 and day 7) was performed using the DizzyFIX (Clearwater Clinical Ltd., London, Ontario, Canada), a pass/fail test, and evaluation by a trained observer (correct or incorrect). Results: There were no statistically significant differences in pass rates between the three groups before the interventions (DizzyFIX: P = .2096, observer: P = .3710). After the interventions, DizzyFIX testing pass rates were 50.0% SG, 60.0% CI and 100.0% WM ( P = .3564). Observer testing pass rates were 85.7% SG, 28.6% CI, and 83.3% WM ( P = .0431). Conclusions: This study demonstrated that our Web-based learning module for the PRM is comparable to small-group clinical instruction, and superior to standard classroom instruction for teaching the PRM when evaluated by a trained observer. [ABSTRACT FROM AUTHOR]

Objective: One of the problems in the management of horizontal semicircular canal benign paroxysmal positional vertigo (HSC-BPPV) is the difficulty in determining the affected ear using Ewald's second law. The purpose of this study is to develop the new 'bow and lean test (BLT)' to easily determine the affected ear of HSC-BPPV and evaluate its efficiency. Methods: We compared the efficiency between the classic method and BLT in 26 patients with HSC-BPPV. The classic method is based on Ewald's second law comparing the intensity of nystagmus or symptoms in the head roll test. BLT is based on the direction of both 'bowing nystagmus' and 'leaning nystagmus' at the head's bowing and leaning state in a sitting position. The affected ear is the same direction of bowing nystagmus in canalolithiasis and the same direction of leaning nystagmus in cupulolithiasis. Results: In 26 patents (15 canalolithiasis, 11 cupulolithiasis), 3 (11.5%) patients did not show a prominent affected ear in the classic method, and 7 (26.9%) patients showed the different affected ear between the two methods. All 10 patients were successfully treated with just one trial of barbecue rotation based on the affected ear in BLT. Three patients did not show any bowing or leaning nystagmus. The side with canal paresis in all four patients, who showed significant canal paresis in bithermal caloric tests, was equal to the affected ear based on BLT. Conclusions: The 'bow and lean test' (also called 'Choung's test') is a new method that can easily determine the affected ear of HC-BPPV. [ABSTRACT FROM AUTHOR]

Objective: To present treatment effectiveness of 923 consecutive cases of benign paroxysmal positional vertigo (BPPV) using canalith repositioning, liberatory, and log roll maneuvers combined with redistribution exercises. Study Design: Retrospective case review. Methods: Patients presented with either posterior semicircular canal (P-SCC) BPPV or horizontal semicircular canal (H-SCC) BPPV. Diagnosis was based on patient history of transient paroxysmal vertigo and a positive Dix-Hallpike response with either torsional or horizontal nystagmus. Patients with P-SCC BPPV numbered 840, and 83 patients had H-SCC BPPV. In the original study, there were 1,000 patients; however, 77 patients were dropped from the study because of lack of follow-through. Intervention was canalith repositioning, liberatory maneuvers, log roll maneuvers, and redistribution exercises. Patients numbering 607 were treated with canalith repositioning, 233 patients had liberatory maneuvers, and 83 received log roll maneuvers. All patients received redistribution exercises before treatment maneuvers. After intervention, patients were reassessed at 6 months. Results: There were 601 women and 322 men from ages 12 to 94 (median 55) years. The average duration of symptoms before intervention was 30 months. Outcome measures were considered met when symptoms of BPPV had abated and patients demonstrated a negative Dix-Hallpike response. In the repositioning group, 94% of patients were symptom free or improved, 98% in the liberatory maneuver group and 100% in the log roll group. The average number of sessions was three for all groups. Recurrence of symptoms was demonstrated in 140 (16%) patients at 6 months. Conclusions: Treatment of BPPV can be effective using either repositioning, liberatory, or log roll maneuvers in combination with redistribution exercises. [ABSTRACT FROM AUTHOR]

Objectives To analyze the incidence and characteristics of benign paroxysmal positional vertigo (BPPV) in patients with Ménière's disease who did not respond to medical treatment and to whom intratympanic gentamycin treatment was proposed. Study Design This is a retrospective analysis of the patients in our database. A complete otoneurologic bedside examination of each patient, including assessment of positional nystagmus, was performed at the time of diagnosis and during the follow-up. Results Nine of 90 patients with Ménière's disease also had BPPV, which manifested in different ways. In 3 patients, BPPV preceded the onset of Ménière's symptomatology in the same ear; in 1, BPPV manifested after treatment for Ménière's disease had ended and the patient was in complete control of the spontaneous spells of vertigo; in 5 cases, recurrences of both Ménière's disease and the positioning symptomatology coincided. Treatment for each condition was conducted independently and favorable results were obtained after long-term follow-up when Ménière's disease and BPPV did not coincide simultaneously. In the group manifesting symptoms of both disorders at the same time, gentamycin treatment with the Canalith Repositioning Procedure and/or Semont maneuver partially resolved the symptoms. Conclusions In the context of Ménière's disease, the sequence of appearance of BPPV relative to the spontaneous episodes must be taken into account when planning the treatment for each of the disorders, which should be considered independently. This pattern could also influence the prognosis for each disorder. [ABSTRACT FROM AUTHOR]

Objective To identify variables affecting outcome in patients with benign paro-ysmal positional vertigo (BPPV) treated with canalith repositioning maneuvers. Study Design Retrospective review of patients at a tertiary vestibular rehabilitation center. Methods Variables identified for statistical analysis included method of diagnosis, age, se-, onset association with trauma, semicircular canal involvement, presence of bilateral disease, treatment visits, and cycles of canalith repositioning maneuvers per treatment visit. Multivariate statistical analysis using Pearson χ2, likelihood ratio, linear-by-linear association, and cross-tabulation tests were performed. Results Two hundred fifty-nine patients with BPPV who received treatment were identified from 1996 to 1998. Average follow-up time was 16.9 months. 74.8% required one treatment visit, 19.0% required a second treatment visit, and 98.4% were successfully treated after three treatment visits. The remainder required up to seven treatment visits for relief of symptoms. Variables affecting the number of treatment visits included bilateral disease or location of disease other than in the posterior semicircular canal. Patient age, se-, method of diagnosis, and onset association with trauma had no statistically significant impact. Conclusion Patients with benign paro-ysmal positional vertigo not located in a single posterior semicircular canal are more likely to require multiple visits for canalith repositioning. [ABSTRACT FROM AUTHOR]

Objective To provide a detailed description of the coexistence of benign paroxysmal positional vertigo (BPPV) and Meniere's disease in individuals and to offer a possible mechanism that explains the findings in these patients. Study Design Retrospective. Methods Chart review. Results Of 162 patients diagnosed with Meniere's disease between January 1998 and January 1999, 9 were found to have both 'definite' Meniere's disease and 'certain' BPPV. Meniere's symptoms preceded the onset of BPPV in all of our patients. Seven of the 9 patients were female. Except for one patient who experienced BPPV bilaterally, BPPV was limited to the same ear as the Meniere's disease. All patients presented with intractable BPPV that did not respond completely to otolith repositioning procedures. A detailed description of five patients is presented. Conclusion Our data, in conjunction with that of others, suggest that Meniere's disease may predispose patients to intractable BPPV. Hydropically induced damage to the maculae of the utricle and saccule or partial obstruction of the membranous labyrinth may be possible mechanisms that explain the coexistence of Meniere's disease and BPPV. [ABSTRACT FROM AUTHOR]

Objectives To evaluate the efficacy of modifications to traditional particle repositioning maneuvers in the treatment of benign paroxysmal positional vertigo. Study Design Prospective trial of 118 patients with cupolocanalithiasis of the posterior canal treated with three different canal-repositioning techniques. Methods Results were compared with the maneuvers employed and the statistical importance of rotating patients by 360° along their longitudinal axis and head shaking on reaching each single position were evaluated. Results Treatment of patients with our maneuver, which, in comparison with traditional repositioning maneuvers, was modified by breaking the procedure up into seven positions and rotating patients by 360° along their longitudinal axis, gives a higher, but not statistically significant, number of treatment successes (84.5%) than the traditional Parnes maneuver (60%) ( P = .154); treatment of a third group of patients with our modified particle repositioning maneuver with the addition of head-shaking on reaching each single position gives a higher (95.6%), statistically significant number of treatment successes than traditional Parnes maneuver ( P = .00011). Conclusions The success rates achieved from modified particle repositioning maneuvers are statistically significant. Onset or persistence of dizziness, which patients frequently complain of after liberatory maneuvers, affects only 5.6% of the patients treated. This low incidence is statistically correlated to head-shaking. [ABSTRACT FROM AUTHOR]

The canalith repositioning maneuver (CRP) of Epley is an effective treatment for benign paroxysmal positional vertigo (BPPV). While CRP has been advocated by some as a 'single treatment' for BPPV, others have had less uniform results for this self-limited disorder. In order to better define the role of CRP in relieving vertigo, we studied the time course of recovery in 27 consecutive cases of BPPV. We recorded nystagmus after each head maneuver and at each evaluation until complete resolution took place, using absence of nystagmus as a strict criterion for cure. We found that while 93% of patients improved, many had persistent nystagmus at the first evaluation, and in only 63% was resolution clearly related to a CRP session. We believe that in certain cases, the effect of CRP may be due to adaptive conditioning, rather than particle redistribution. [ABSTRACT FROM AUTHOR]

The pathoetiology of benign paroxysmal positional vertigo (BPPV) is controversial. Particulate matter within the posterior semicircular canal has been identified intraoperatively in patients with BPPV but has also been reported in non-BPPV patients at the time of translabyrinthine surgery (Parnes LS, McClure JA. Free-floating endolymphatic particles: a new operative finding during posterior semicircular canal occlusion. Laryngoscope 1992;102:988-92; Schuknecht HF, Ruby RRF. Cupulolithiasis. Adv Otorhinolaryngol 1973;20:434-43; Kveton JF, Kashgarian M. Particulate matter within the membranous labyrinth: pathologic or normal? Am J Otol 1994;15:173-6). The nature of the particulate matter remains unknown. The purpose of this study was to prospectively examine the posterior semicircular canal of patients with and without a clinical history of BPPV for the presence of particulate matter. Seventy-three patients without BPPV symptoms undergoing labyrinthine surgery (vestibular schwannoma excision or labyrinthectomy) and 26 patients with BPPV undergoing the posterior semicircular canal occlusion procedure were compared. Additionally, 70 archived temporal bones without a history of BPPV were examined microscopically for the presence of particulate matter within the lumen of the membranous labyrinth. No particles were observed intraoperatively in any of the 73 patients without a history of BPPV. Particulate matter was observed in 8 of 26 patients at the time of the posterior semicircular canal occlusion procedure for intractable BPPV. Of the 70 temporal bones examined, 31 did not show significant postmortem changes and also did not demonstrate cupulolithiasis or canalithiasis. Particulate matter from within the membranous posterior semicircular canal was removed from one patient at the time of posterior semicircular canal occlusion for intractable BPPV symptoms and was examined by scanning electron microscopy. The particulate matter appeared morphologically consistent with degenerating otoconia. These data show a statistically significant association between the presence of particles within the posterior semicircular canal in this study and the symptom complex of BPPV. [ABSTRACT FROM AUTHOR]

Canal switch is a complication following canalith repositioning procedure (CRP) for posterior canal benign paroxysmal positional vertigo (BPPV). Instead of being returned to the utricle, the loose otoconia migrate into the superior or horizontal semicircular canal. Patients remain symptomatic, and treatment can be ineffective unless the switch is recognized and additional repositioning maneuvers directed toward the appropriate semicircular canal are performed. This report provides the first videographic documentation of canal switch involving conversion of unilateral posterior semicircular canal BPPV to geotropic horizontal canalithiasis. Laryngoscope, 2012 [ABSTRACT FROM AUTHOR]

Vertical nystagmus occurs in patients with central vestibular system pathology. Lesions of the pons, medulla, and cerebellum lead to vertical nystagmus. Given this association, vertical nystagmus is considered pathognomonic in nature. We present a case of benign paroxysmal positional vertigo (BPPV) with positive Dix-Hallpike bilaterally, but also with upbeat purely vertical nystagmus in the straight back head hanging position. Computed tomography imaging of the typically pathologic structures in vertical nystagmus (brainstem/posterior fossa) revealed normal anatomy. We propose this case as an instance of peripheral-associated purely vertical nystagmus without central pathology, while building on our previous understanding of BPPV physiology. Laryngoscope, 2010 [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: To determine whether the Sensory Organization Test (SOT) of the computerized dynamic posturography battery or the Clinical Test of Sensory Integration and Balance (CTSIB) is more likely to indicate balance disorders in people with benign paroxysmal positional vertigo (BPPV)., Study Design: Normal controls were compared to patients with unilateral BPPV of the posterior semicircular canal., Methods: Subjects performed tests with eyes open or closed on stable and unstable surfaces, with head still or with head moving at 0.33 Hz in pitch or yaw. Dependent variables were the percent time of the standard duration each subject could perform the task, the number of head motions made, and kinematic variables measured with head- and torso-mounted inertial motion units., Results: Because equilibrium scores of control subjects improved significantly over repeated trials on SOT, patients were given only one trial per condition. For percent time between-group differences were found on CTSIB with eyes closed, on foam, head moving in yaw showing significantly reduced performance by BPPV subjects compared to controls. Compared to controls, patients made significantly fewer head movements on CTSIB, eyes closed, on foam, head still, in pitch and yaw. Kinematic data also differed between the groups on tests with eyes closed and unstable surfaces with different head movement combinations, indicating increased instability in BPPV patients., Conclusions: For screening, CTSIB with head movements is more likely than SOT to indicate balance deficits, especially when dependent measures include percent time as well as head movement counts and kinematic measures., (Copyright © 2013 The American Laryngological, Rhinological and Otological Society, Inc.)

Objectives/hypothesis: The aim of this study was to evaluate the relationship between the head position during sleep and the affected semicircular canal (SCC) in patients with benign paroxysmal positional vertigo (BPPV)., Study Design: Prospective study at a tertiary hospital., Methods: We conducted a prospective study in patients with BPPV involving posterior or horizontal SCCs. Of a total of 425 patients diagnosed with BPPV, 83 patients showing signs of simultaneous multiple canal involvement, and those having combined otologic diseases in the same ear were excluded from the study. All patients included in the study were asked to define their preferred head-lying side at the beginning of sleep among the following choices: supine, lateral (right or left), or no predominant side., Results: Our study included 174 patients with posterior SCC BPPV (p-BPPV) and 168 patients with horizontal SCC BPPV (h-BPPV). Patients habitually adopted a lateral head position during sleep in 105 cases of p-BPPV and 109 cases of h-BPPV. Statistically significant correlation was demonstrated between the head-lying side during sleep and the affected side by BPPV (P < .01) in patients with p-BPPV as well as h-BPPV., Conclusions: There is significant correlation between the head-lying side during sleep and the side affected by BPPV in h-BPPV and p-BPPV, which may provide additional clues about the pathophysiology of BPPV. Clinically, this information may be used to provide helpful guidelines for patients with BPPV concerning their sleeping positions to prevent recurrence of BPPV., (Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.)

Involvement of the superior semicircular canal (SSC) in benign paroxysmal positional vertigo (BPPV) is rare. SSC BPPV is distinguished from the more common posterior semicircular canal (PSC) variant by the pattern of nystagmus triggered by the Dix-Hallpike position: down-beating torsional nystagmus in SSC BPPV versus up-beating torsional nystagmus in PSC BPPV. SSC BPPV may be readily treated at the bedside, which is a key component in excluding central causes of down-beating nystagmus. We present an unusual video case report believed to represent refractory SSC BPPV based on the pattern of nystagmus and the absence of any other central signs., (Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.)