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Background/Objectives: Accurate head positioning is essential for diagnostics of benign paroxysmal positional vertigo (BPPV). This study aimed to quantify the head angles and angular velocities during traditional manual BPPV diagnostics in patients with positional vertigo. Methods: A prospective, observational cohort study was conducted at a tertiary university hospital outpatient clinic. One trained examiner performed the Supine Roll Test (SRT) and the Dix–Hallpike test (DHT) on 198 adults with positional vertigo. The primary outcomes included head angle variability and accuracy and angular velocity variability. The secondary outcomes examined the relationship between the head angle accuracy and participant-reported limitations. Results: The absolute variability for all head angles ranged from ±8.7° to ±11.0°. The yaw axis head angles during the DHT, particularly on the left side, had the highest relative variability (left DHT: coefficient of variance 0.29). Systematic errors included the yaw axis head angles undershooting the target (90°) by 19.7–23.8° during the SRT and the pitch axis head angles undershooting the target (120°) by 7.8–8.7° during the DHT. The left-sided yaw axis in the DHT was undershot by 11.8°, while the right-sided DHT angle was slightly overshot (2.5°). Right-sided yaw axis angles in the SRT and DHT were more accurate than the left-sided ones (right SRT: 19.9°; left SRT: 23.9°; p < 0.0001) (right DHT: 7.0°; left DHT: 13.2°; p < 0.0001). The regression analysis found no association between the participant-reported limitations and head angle accuracy. Conclusions: This study highlights the substantial variability and inaccuracies in head positioning during traditional manual BPPV diagnostics, supporting the relevance of a guidance system to improve BPPV diagnostics. Level of evidence: III. Trial registration: ClinicalTrials.gov identifier: NCT05846711. [ABSTRACT FROM AUTHOR]

Background: Following successful canalith repositioning procedures (CRPs), some patients with benign paroxysmal positional vertigo (BPPV) may experience residual symptoms. There is currently no consensus on whether these residual symptoms are related to the disease duration. Objective: To examine the impact of BPPV duration on the persistence of residual symptoms following successful CRP. Methods: A total of 102 idiopathic BPPV patients were enrolled and categorized into short-course and long-course groups based on the duration of the disease. The course of disease in the short-course group was less than or equal to 7 days. The long course of disease was longer than 7 days. All patients underwent swivel-chair-assisted CRP and were followed up 7–10 days after successful CRP. The Dizziness Handicap Inventory (DHI) questionnaire was administered to all patients before and after CRP. Results: Before CRP, significant differences were observed between the two groups in total DHI score and its subdomains: Physical (DHI-P), Functional (DHI-F), and Emotional (DHI-E) (p < 0.05), indicating that long disease duration significantly affected all patient aspects. After CRP, significant differences remained in total DHI, DHI-P, DHI-F, and DHI-E scores (p < 0.05), with the long-course group consistently scoring higher. However, no significant differences were found in the changes in DHI scores across dimensions before and after CRP between the two groups. Conclusion: The duration of BPPV did not influence CRP outcomes, but patients with a longer disease course were more likely to experience residual symptoms after successful CRP. [ABSTRACT FROM AUTHOR]

Background: Benign paroxysmal positional vertigo (BPPV) is the most frequent cause of peripheral vertigo that constitutes more than half of all occurrences of vestibular disorders. Objective: The objective of this study was to find out the effectiveness of transcranial direct current stimulation (tDCS) along with vestibular rehabilitation therapy (VRT) on dizziness, anxiety, and various cardiovascular parameters. Methods: The present study will be a parallel-group single-blinded randomized controlled trial with concealed allocation. The participants will be randomized into three groups: Group A (VRT group), Group B (tDCS group), and Group C (tDCS + VRT group). The outcome variables will be the Dizziness Handicap Inventory Scale, Beck Anxiety Inventory Scale, and cardiovascular parameters. The outcome variables will be assessed at the baseline, at week 4, and a follow-up at week 6. Results: The result will be presented in the form of mean, standard deviation, median, and P value. Conclusions: The application of cerebellar tDCS along with Brandt-Daroff exercises can be seen as a potent approach to improve the symptoms of BPPV. [ABSTRACT FROM AUTHOR]

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Background: Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause of peripheral vertigo, with frequent recurrence, particularly pronounced among middle-aged and elderly populations, significantly affecting patients' quality of life. This study aimed to identify predictive factors for recurrence in middle-aged and older patients with BPPV and to develop a nomogram prediction model based on these predictors. Methods: This retrospective study included 582 participants aged ≥45 years who were selected from the electronic medical records system of the First Hospital of Changsha between March 2021 and March 2024. Randomly chosen participants (n = 407, 70%) constituted the training group, whereas the remaining participants (n = 175, 30%) formed the validation group. This study used LASSO binomial regression to select the most predictive variables. A predictor-based nomogram was developed to calculate the risk of BPPV recurrence. The performance of the nomogram was evaluated using the area under the receiver operating characteristic curve (AUC) and calibration curves with 1,000 bootstrap resampling validations. Decision curve analysis (DCA) was conducted to assess the clinical usefulness of the nomogram. Results: According to findings from least absolute shrinkage and selection operator (LASSO) binomial regression and logistic regression screening, older age, higher levels of uric acid (UA) and homocysteine (HCY), diabetes, migraine, anxiety, and insomnia were identified as independent factors associated with an increased recurrence risk of BPPV. A nomogram model for predicting recurrence risk was developed based on these predictors. The nomogram achieved an AUC (C-statistic) of 0.8974 (95% CI: 0.8603–0.9345) in the training group and 0.8829 (95% CI: 0.8253–0.9406) in the validation group. Calibration curves, after 1,000 bootstrap resamples, demonstrated good agreement between the predicted and actual probabilities in the development and validation cohorts. DCA indicated that the nomogram had clinical utility. Conclusion: The nomogram model incorporating age, UA, HCY, diabetes, migraine, anxiety status, and insomnia demonstrated a strong predictive capability for estimating the probability of BPPV recurrence in middle-aged and elderly patients. This tool is valuable for identifying individuals at high risk of BPPV recurrence and can aid physicians in making informed treatment decisions aimed at reducing recurrence rates. [ABSTRACT FROM AUTHOR]

Background: Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause of vertigo. While various techniques and technologies have improved BPPV diagnostics and treatment, optimizing BPPV healthcare pathways requires a comprehensive understanding of the diagnostic modalities across diverse clinical settings. Objective: To compare traditional manual BPPV diagnostics (MD) with diagnostics done with the aid of a mechanical rotation chair (MRC) when using videonystagmography goggles with both modalities. Methods: This prospective, open-label, randomized diagnostic crossover study involved 215 adults with typical BPPV symptoms at a tertiary University Hospital-based outpatient clinic (Aalborg University Hospital, Denmark). Participants referred by general practitioners or otorhinolaryngologist clinics underwent both traditional manual and MRC diagnostics with the aid of videonystagmography goggles. The order of the diagnostic modalities was randomly assigned, and the two modalities were separated by a minimum of 30 min. The primary outcomes included sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of traditional MD compared to MRC diagnostics. The secondary outcome was the agreement between the two modalities. Results: The MRC demonstrated a significantly higher sensitivity for BPPV detection in general for all participants (p = 0.00). Compared to MRC diagnostics, traditional MD displayed a sensitivity of 69.5% (95% confidence interval (CI): 59.8–78.1), specificity of 90.9% (95% CI: 83.9–95.6), PPV of 88.0% (95% CI: 83.9–95.6), and NPV of 75.8% (95% CI: 67.5–82.8). The overall inter-modality agreement was 80.5% (95% CI: 75.2–85.8, Cohen's kappa 0.61). While both modalities detected unilateral posterior canal BPPV equally good (p = 0.51), traditional MD underperformed for non-posterior BPPV (significantly) and in subgroups referred by ENTs (trend) or with impaired cooperation during traditional MD (significantly). Conclusion: Traditional manual BPPV diagnostics remains a valuable first-line approach for most patients. However, MRC diagnostics offers advantages for complex BPPV cases, patients with impaired cooperation, patients referred from otorhinolaryngologist clinics, and those with negative traditional MD but an evident BPPV history. MRC may be useful as a second opinion diagnostic tool for treatment-resistant BPPV. Clinical trial registration: ClinicalTrials.gov identifier: NCT05846711. [ABSTRACT FROM AUTHOR]

Background/Objectives: Benign Paroxysmal Positioning Vertigo (BPPV), diagnosed in 46% of older adults with complaints of dizziness, causes movement-related vertigo. This case-control study compared physical activity, frailty and subjective well-being between older adults with BPPV (oaBPPV) and controls. Methods: Thirty-seven oaBPPV (mean age 73.13 (4.8)) were compared to 22 matched controls (mean age 73.5 (4.5)). Physical activity was measured using the MOX accelerometer and the International Physical Activity Questionnaire. Modified Fried criteria assessed frailty. The Dizziness Handicap Inventory, Falls Efficacy Scale, and 15-item Geriatric Depression Scale assessed subjective well-being. A post-hoc sub-analysis compared all variables compared between frail oaBPPV, robust oaBPPV and robust controls. Significance level was set at α = 0.05. Results: oaBPPV were significantly less physically active and were more (pre-)frail (p < 0.001) compared to controls. They performed significantly less active bouts (p = 0.002) and more sedentary bouts (p = 0.002), and a significantly different pattern of physical activity during the day. OaBPPV reported significantly less time in transportation activities (p = 0.003), leisure (p < 0.001), walking (p < 0.001) and moderate-intensity activities (p = 0.004) compared to controls. Frail oaBPPV were even less active (p = 0.01) and experienced more fear of falling (p < 0.001) and feelings of depression (p < 0.001) than robust oaBPPV and controls. Conclusions: BPPV can induce a vicious cycle of fear of provoking symptoms, decreased physical activity, well-being and consequently frailty. It is also possible that frail and less physically active older adults have an increased prevalence of BPPV. Post-treatment follow-up should assess BPPV, frailty and physical activity to determine if further rehabilitation is needed. [ABSTRACT FROM AUTHOR]

Objective: To explore alterations in functional connectivity (FC) focusing on hippocampal subfields in benign paroxysmal positional vertigo (BPPV) patients with residual dizziness (RD) after successful canalith repositioning procedure (CRP). Methods: We conducted resting‐state functional magnetic resonance imaging (fMRI) on 95 BPPV patients, comprising 50 patients with RD and 45 without. Seed‐to‐voxel and seed‐to‐seed analyses were employed to examine changes in FC between the two groups. The hippocampal subfields, including the bilateral dentate gyrus (DG), cornu ammonis (CA), entorhinal cortex (EC), subiculum, and hippocampal amygdalar transition area (HATA) were selected as seeds. Additionally, we assessed the relationship between abnormal FC and clinical symptoms. Results: Seed‐to‐voxel analysis indicated that, compared to non‐RD patients, those with RD exhibited decreased FC between the right DG and right parietal operculum cortex, right HATA and right precuneus, left HATA and left precuneus, left EC and cerebellar vermis 8/−crus 1, and between the left subiculum and left angular gyrus. Conversely, we observed increased FC between the left CA and left lingual gyrus, as well as between the right CA and right fusiform gyrus in RD patients. Furthermore, these variations in FC were significantly correlated with clinical features including the duration of RD and scores on the Hamilton Anxiety Scale and Dizziness Handicap Inventory. Conclusion: BPPV patients with RD exhibited altered FC between hippocampal subfields and brain regions associated with spatial orientation and navigation, vestibular and visual processing, and emotional regulation. These findings offer novel insights into the pathophysiological mechanisms in BPPV patients with RD following successful CRP. [ABSTRACT FROM AUTHOR]

Vestibular syncope is a rare condition in which vertigo may cause syncopal attacks; however, the term has been associated with confusion because it has been ascribed to completely different vestibular and neurological conditions, from dizziness to Menière disease (MD), to the neurovegetative symptoms in benign paroxysmal positional vertigo (BPPV) and central vertebrobasilar hyperfusion. A 75‐year‐old woman with vasodepressive vasovagal syncope, confirmed by a tilt test with trinitrine administration, was referred for an audiological and vestibular assessment showing an acute unilateral peripheral vestibular deficit on the right side. The diagnosis is peripheral acute vestibular deficits. Interventions and outcomes are vestibular treatment and rehabilitation. The patient's vasovagal symptoms immediately improved and were completely resolved. Peripheral vestibular deficits might also trigger syncopal episodes and must be considered and studied by a complete audiological and vestibular evaluation. By restoring the peripheral vestibular function of the right labyrinth after vestibular treatment, a complete long‐term resolution of multiple vasovagal syncopal episodes was observed together with normalization of the tilt test. [ABSTRACT FROM AUTHOR]

Background: We present a feasibility study on the development of a 3D-printed (3DP) model of benign paroxysmal positional vertigo (BPPV) and its validation as an educational tool for training in therapeutic maneuvers. Methods: A 1.5:1 3DP model of the human labyrinth, supplemented by a 1:1 3DP model of the skull, was obtained from a computed tomography scan. We presented the model to 15 Emergency Medicine residents, 15 medical students, 15 Otolaryngology residents, and 15 Otolaryngology practitioners from two academic referral centers. Participants performed the Semont and Epley maneuvers on the model twice, once before and once after observing the biomechanics of BPPV using this tool. A specific survey was then administered to assess both performance improvement and satisfaction. Results: All the trainees demonstrated an improving trend on the second attempt. The medical students ameliorated significantly after the training in both Epley (p = 0.007) and Semont maneuvers (p = 0.0134). The Emergency Medicine residents improved significantly in Semont maneuvers (p = 0.0134). Self-reported understanding of the BPPV mechanics improved significantly after training in all the groups (p < 0.05). Conclusions: The preliminary data highlighted the potential benefits of training on the 3DP model for practitioners involved in the first-line management of BPPV. [ABSTRACT FROM AUTHOR]

Introduction Benign Paroxysmal Positional Vertigo (BPPV) is defined as a disorder of the inner ear characterised by repeated episodes of positional vertigo. BPPV is one of the most prevalent vestibular disorders in the general population, accounting for one-third of all vestibular disorders. The prevalence of BPPV is higher in females than males and this prevalence increases with increasing age. The common non-surgical treatments of BPPV are repositioning manoeuvres and habituation exercises. This review aimed to explore the effectiveness of Brandt-Daroff exercises in patients with BPPV. Methods Two search engines, PubMed and Cochrane, were used. Articles focusing on Brandt-Daroff exercises as management of BPPV were included in this review. All articles were published in English and results up to February 2023 were included. Results Epley’s repositioning manoeuvre is a better treatment option for posterior canal BPPV. Epley’s manoeuvre is more effective if applied alone as compared to its application along with Brandt-Daroff exercises or with medication. Epley’s manoeuvre was more effective than any other repositioning manoeuvre, such as the Semontmanoeuvre. The application of Brandt-Daroff was ineffective when applied alone. However, it was effective when applied in combination with the Cawthorne-Cooksey exercises in reducing the symptoms of BPPV. Conclusions Brandt-Daroff exercises have inconsistent results in the treatment of BPPV; hence, high-quality randomised controlled trials should be carried out to investigate their efficacy.

Abstract Background Benign paroxysmal positional vertigo is the most common neurootologic disorder, characterized by brief attacks of vertigo aggravated by certain head positions. During the last two decades, several studies were performed in different countries trying to find a relationship between benign paroxysmal positional vertigo and vitamin D3 (25 hydroxyvitamin D) deficiency. Objectives This study aimed to find the relationship between vitamin D3 deficiency and total serum calcium with benign paroxysmal positional vertigo. Patients and methods A case–control study conducted from January 2021 to December 2021, consisted of 62 participants; 30 patients with posterior canal benign paroxysmal positional vertigo and 32 healthy persons considered as a control group. The age and sex of both groups were matched, and diagnosis was made by history and examination (Dix-Hallpike’s maneuver). A blood sample was taken to evaluate serum vitamin D level and total serum calcium. The results were compared between both groups. Results The mean levels of vitamin D3 in patients and control groups were 18.57 ± 9.88 ng/ml and 64.12 ± 24.64 ng/ml, respectively, with a statistically significant difference at p ≤ 0.0001. Moreover, regarding vitamin D3 deficiency below 20 ng/ml between patients and control groups, there was a statistically significant difference p = 0.001. Furthermore, there was no significant difference regarding total serum calcium between the two groups, the mean of both groups was 8.57 ± 0.68 mg/dl and 8.93 ± 0.92 mg/dl for patients and control, respectively, at p = 0.084. Conclusion There might be an association between benign paroxysmal positional vertigo and vitamin D3 deficiency. Moreover, there was no significant difference concerning total serum calcium levels between the patient and control groups.

Key Clinical Message: Repositioning maneuvers for benign paroxysmal positional vertigo (BPPV) designed to induce otoconial movement in one canal can trigger and sometimes unwittingly treat BPPV in other canals. Patients with BPPV are best managed by precisely diagnosing the canal variant and using correctly performed, standardized testing and treatment maneuvers. [ABSTRACT FROM AUTHOR]

Barany Society includes bilateral typical posterior semicircular canal benign paroxysmal positional vertigo (PSC-BPPV) in its classification of multicanal subtype. In the past decade, less-common and atypical subtypes of PSC-BPPV, like short-arm and non-ampullary arm posterior semicircular canalolithiasis, have emerged, requiring the conduct of conventional and auxiliary positional tests on both sides to uncover their bilaterality. Authors hereby report three atypical less-common subtypes of bilateral PSC-BPPV, discussing their clinicodemographic profiles, management by repositioning maneuvers and physical therapy, and follow up. Both Case 2 and Case 3 are precisely tri-canalolithiasis (bilateral ampullary arm posterior semicircular canalolithiasis with co-occurring right non-ampullary arm posterior semicircular canalolithiasis in Case 2 and bilateral short arm with co-occurring left ampullary arm posterior semicircular canalolithiasis in Case 3), which has not been reported previously in the literature. There has been only one previously reported case of bilateral non-ampullary arm semicircular canalolithiasis, and it is now observed in Case 1. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to analyze the features of resting‐state functional magnetic resonance imaging (rs‐fMRI) and clinical relevance in patients with benign paroxysmal positional vertigo (BPPV) that have undergone repositioning maneuvers. Methods: A total of 38 patients with BPPV who have received repositioning maneuvers and 38 matched healthy controls (HCs) were enrolled in the present study from March 2018 to August 2021. Imaging analysis software was employed for functional image preprocessing and indicator calculation, mainly including the amplitude of low‐frequency fluctuation (ALFF), fractional ALFF (fALFF), percent amplitude of fluctuation (PerAF), and seed‐based functional connectivity (FC). Statistical analysis of the various functional indicators in patients with BPPV and HCs was also conducted, and correlation analysis with clinical data was performed. Results: Patients with BPPV displayed decrease in ALFF, fALFF, and PerAF values, mainly in the bilateral occipital lobes in comparison with HCs. Additionally, their ALFF and fALFF values in the proximal vermis region of the cerebellum increased relative to HCs. The PerAF values in the bilateral paracentral lobules, the right supplementary motor area (SMA), and the left precuneus decreased in patients with BPPV and were negatively correlated with dizziness visual analog scale (VAS) scores 1 week after repositioning (W1). In addition, in the left fusiform gyrus and lingual gyrus, the PerAF values show a negative correlation with dizziness handicap inventory (DHI) scores at initial visit (W0). Seed‐based FC analysis using the seeds from differential clusters of fALFF, ALFF, and PerAF showed reductions between the left precuneus and bilateral occipital lobe, the left precuneus and left paracentral lobule, and within the occipital lobes among patients with BPPV. Conclusion: The spontaneous activity of certain brain regions in the bilateral occipital and frontoparietal lobes of patients with BPPV was reduced, whereas the activity in the cerebellar vermis was increased. Additionally, there were reductions in FC between the precuneus and occipital cortex or paracentral lobule, as well as within the occipital cortex. The functional alterations in these brain regions may be associated with the inhibitory interaction and functional integration of visual, vestibular, and sensorimotor systems. The functional alterations observed in the visual cortex and precuneus may represent adaptive responses associated with residual dizziness. [ABSTRACT FROM AUTHOR]

Objective: The aim was to evaluate the value of otolith-associated protein otoconin-90 (OC90) and otolin-1 in the pathogenesis research and clinical treatment of benign paroxysmal positional vertigo (BPPV). Material and Method: The study included 50 patients with BPPV admitted to neurology and otorhinolaryngology departments and 30 healthy subjects with no history of dizziness as a control group. Results: BPPV and controls were similar in terms of gender and age. Otolin-1 concentration was significantly greater in the BPPV group than in the controls (710.44 [584.35–837.39] vs 280.45 [212.7–419.61]; p < 0.001). No statistical significance was found, although OC90 was higher in the BPPV group than in the controls. There was a strong positive correlation between otolin-1 and OC90, a moderate negative correlation between otolin-1 and vitamin D, and a strong negative correlation between OC90 and vitamin D in the BPPV patient group. Otolin-1 had high specificity and AUC values for BPPV (AUC: 0.933; 95% CI: 0.881–0.986, 79.2% sensitivity, 100% specificity with a cutoff greater than 525). Conclusions: High serum concentrations of otolin-1 were associated with an increased risk of BPPV, but high concentrations of OC90 were not. Serum concentrations of otolin-1 can potentially be used as a biomarker for the acute onset of inner ear disorders due to the significant increase in patients with BPPV. Vitamin D has high specificity and sensitivity in patients with BPPV. It also provides evidence that BPPV patients with vitamin D deficiency may improve their symptoms with replacement therapy. More large-scale prospective studies are required to confirm these associations and clarify the exact mechanisms. [ABSTRACT FROM AUTHOR]

Introduction. Benign Paroxysmal Positional Vertigo (BPPV) is defined as a disorder of the inner ear characterised by repeated episodes of positional vertigo. BPPV is one of the most prevalent vestibular disorders in the general population, accounting for one-third of all vestibular disorders. The prevalence of BPPV is higher in females than males and this prevalence increases with increasing age. The common non-surgical treatments of BPPV are repositioning manoeuvres and habituation exercises. This review aimed to explore the effectiveness of Brandt-Daroff exercises in patients with BPPV. Methods. Two search engines, PubMed and Cochrane, were used. Articles focusing on Brandt-Daroff exercises as management of BPPV were included in this review. All articles were published in English and results up to February 2023 were included. Results. Epley's repositioning manoeuvre is a better treatment option for posterior canal BPPV. Epley's manoeuvre is more effective if applied alone as compared to its application along with Brandt-Daroff exercises or with medication. Epley's manoeuvre was more effective than any other repositioning manoeuvre, such as the Semontmanoeuvre. The application of Brandt-Daroff was ineffective when applied alone. However, it was effective when applied in combination with the Cawthorne-Cooksey exercises in reducing the symptoms of BPPV. Conclusions. Brandt-Daroff exercises have inconsistent results in the treatment of BPPV; hence, high-quality randomised controlled trials should be carried out to investigate their efficacy. [ABSTRACT FROM AUTHOR]

Background and Objectives: This study reviews the current literature on ocular movements, specifically focusing on nystagmus associated with peripheral vestibular disorders, to enhance diagnostic accuracy. The evaluation of ocular movements, particularly nystagmus, provides essential insights into the function and dysfunction of the vestibular system, helping clinicians distinguish between peripheral and central causes of vertigo and imbalance. Materials and Methods: A comprehensive search of PubMed was conducted using key terms such as "ocular movements", "nystagmus", "vestibular nystagmus", and "peripheral vestibular disorders". Results: The search yielded 2739 titles, and after a rigorous selection process, 52 articles were reviewed in full. Discussion: The review highlights different classifications and types of nystagmus, including physiological and pathological forms, and their diagnostic relevance in vestibular disorders such as benign paroxysmal positional vertigo (BPPV), vestibular neuritis, and Meniere's disease. Diagnostic techniques like video/electro-oculography are emphasized for their role in assessing vestibular function and identifying abnormalities. The study underscores the importance of detailed ocular examination in the diagnosis of peripheral vestibular disorders and proposes an algorithm to aid this process. Conclusions: While not a systematic review, this study highlights the importance of detailed ocular examination in diagnosing peripheral vestibular disorders and presents an algorithm to facilitate this process. It also emphasizes the need for continued research and advancements in vestibular medicine to further understand ocular movements and their clinical significance, ultimately contributing to improved patient outcomes. [ABSTRACT FROM AUTHOR]

Background: Vertigo and dizziness can be disabling symptoms that result in sick leave. Research regarding sickness absence due to dizziness has focused on specific vestibular diagnoses rather than the nonspecific vertigo/dizziness diagnoses. Strict sick leave regulations were introduced in Sweden in 2008. The aim of this study was to describe the vertigo/dizziness sick leave prevalence and duration considering both specific and nonspecific diagnoses according to International Classification of diseases 10th revision (ICD-10) on the 3-digit level, including the less specific "R" diagnoses. Methods: Through Swedish nationwide registers we identified individuals aged 16–64 years who during the years 2005–2018 were sickness absent > 14 consecutive days – minimum register threshold – due to vertigo/dizziness diagnoses according to ICD10 codes: specific diagnoses (H81.0, H81.1, H81.2, H81.3, H81.4, G11x) and nonspecific (R42, R26, R27, H81.9). We described the demographic characteristics, prevalence and duration of such sick-leave spells. Data were stratified according to diagnostic groups: ataxias, vestibular and nonspecific. Results: We identified 52,179 dizziness/vertigo sick leave episodes > 14 days in 45,353 unique individuals between 2005–2018, which constitutes 0.83% from all sick leave episodes in the given period.The nonspecific diagnoses represented 72% (n = 37741) of sick leave episodes and specific vestibular H-diagnoses 27% (n = 14083). The most common specific vestibular codes was Benign paroxysmal positional vertigo (BPPV) 9.4% (n = 4929). The median duration of sick leave was 31 days (IQR 21–61). Women on sick leave were younger than men (47 vs 51 years, p < 0.05) and had a higher proportion of nonspecific diagnoses compared with men (74% vs 70%, p < 0.05). Conclusions: The vast majority of vertigo/dizziness sick leave episodes were coded as nonspecific diagnoses and occurred in women. BPPV, a curable vestibular condition, was the most common specific diagnosis. This suggests a potential for improved diagnostics. Women on sick leave due to dizziness/vertigo were younger and more often received nonspecific diagnostic codes. Future studies should determine the frequency of use of evidence based therapies and investigate further the gender differences. [ABSTRACT FROM AUTHOR]

Background: Benign paroxysmal positional vertigo is the most common neurootologic disorder, characterized by brief attacks of vertigo aggravated by certain head positions. During the last two decades, several studies were performed in different countries trying to find a relationship between benign paroxysmal positional vertigo and vitamin D3 (25 hydroxyvitamin D) deficiency. Objectives: This study aimed to find the relationship between vitamin D3 deficiency and total serum calcium with benign paroxysmal positional vertigo. Patients and methods: A case–control study conducted from January 2021 to December 2021, consisted of 62 participants; 30 patients with posterior canal benign paroxysmal positional vertigo and 32 healthy persons considered as a control group. The age and sex of both groups were matched, and diagnosis was made by history and examination (Dix-Hallpike's maneuver). A blood sample was taken to evaluate serum vitamin D level and total serum calcium. The results were compared between both groups. Results: The mean levels of vitamin D3 in patients and control groups were 18.57 ± 9.88 ng/ml and 64.12 ± 24.64 ng/ml, respectively, with a statistically significant difference at p ≤ 0.0001. Moreover, regarding vitamin D3 deficiency below 20 ng/ml between patients and control groups, there was a statistically significant difference p = 0.001. Furthermore, there was no significant difference regarding total serum calcium between the two groups, the mean of both groups was 8.57 ± 0.68 mg/dl and 8.93 ± 0.92 mg/dl for patients and control, respectively, at p = 0.084. Conclusion: There might be an association between benign paroxysmal positional vertigo and vitamin D3 deficiency. Moreover, there was no significant difference concerning total serum calcium levels between the patient and control groups. [ABSTRACT FROM AUTHOR]

Background/Objectives: Chronic unilateral vestibular hypofunction (UVH) can lead to disabling vestibular symptoms and a decrease in quality of life. The aim of this study was to investigate etiologies, clinical subtypes, symptoms, and quality of life (QoL) in patients with chronic UVH. Methods: A retrospective study was performed on 251 UVH patients in a tertiary referral center. Inclusion criteria comprised reduced or absent caloric responses, with a caloric asymmetry ratio ≥25%. Patients with central vestibular pathology, symptom duration <3 months, and incomplete responses to questionnaires were excluded. Patient records were assessed for etiologies, secondary vestibular diagnoses, clinical subtypes, and questionnaires related to QoL. Additionally, multiple linear regression analysis was performed to evaluate factors influencing QoL. Results: Thirteen different etiologies were identified, with Menière's Disease as the most prevalent (31%, n = 79). The most frequently reported secondary vestibular diagnoses were benign paroxysmal positional vertigo (BPPV) (21%, n = 54) and persistent postural perceptual dizziness (PPPD) (19%, n = 47). Five distinct clinical subtypes were identified: recurrent vertigo with UVH (47%), rapidly progressive UVH (25%), idiopathic/unknown UVH (18%), slowly progressive UVH (8%), and congenital UVH (2%). Over 80% of UVH patients experienced moderate-to-severe handicap, as indicated by the Dizziness Handicap Inventory. Approximately 20–25% of UVH patients exhibited moderate-to-severe depression and anxiety, based on the Hospital Anxiety and Depression Scale. Multiple linear regression analyses demonstrated that the presence of PPPD significantly reduced QoL in chronic UVH patients. Conclusions: Chronic UVH is a heterogeneous disorder. Secondary vestibular diagnoses like BPPV and PPPD often co-exist and can significantly impact QoL. A structured diagnostic approach and tailored interventions are crucial to address the diverse needs of UVH patients. [ABSTRACT FROM AUTHOR]

Background: The relation between vestibular disorders and (quality of) sleep is underexplored scientifically and the complex interactions between vestibular and sleep disorders are far from being well understood. Some studies have been conducted on the association between patients with vestibular disorders and (the occurrence of) sleep disorders, other studies have been published on the prevalence of dizziness complaints in patients with sleep disorders. The quality of sleep in patients with vestibular disorders generally receives little attention in clinical practice. Objective: To establish what is currently known about the mutual relationship between dizziness and sleep, and to assess whether or not there is evidence of causality with regard to this relationship. Methods: After systematically searching four literature database up until 1 April 2024, selected studies were summarized and evaluated through a (critical) review. Results: Ultimately, 42 studies were selected and evaluated. Patients with dizziness in general and patients with a specific vestibular disorder like Benign Paroxysmal Positional Vertigo, Vestibular Migraine, Meniere’s disease, and vestibular hypofunction were significantly more likely to have sleep disorders than control groups. A causal relationship is not supported due to the nature of the studies. In patients with obstructive sleep apnea syndrome there were significantly more vestibular complaints, and more disorders in the vestibular system were identified. Conclusion: Dizziness complaints often co-exist with a sleep disorder. To what extent this sleep disorder influences dizziness is not clear. Paying attention to the quality of sleep in patients with a vestibular disorder seems to be important. In patients with OSAS, consideration should be given to vestibular complaints and dysfunction. [ABSTRACT FROM AUTHOR]

BackgroundBenign Paroxysmal Positional Vertigo (BPPV) is the most common cause of peripheral vertigo, with frequent recurrence, particularly pronounced among middle-aged and elderly populations, significantly affecting patients’ quality of life. This study aimed to identify predictive factors for recurrence in middle-aged and older patients with BPPV and to develop a nomogram prediction model based on these predictors.MethodsThis retrospective study included 582 participants aged ≥45 years who were selected from the electronic medical records system of the First Hospital of Changsha between March 2021 and March 2024. Randomly chosen participants (n = 407, 70%) constituted the training group, whereas the remaining participants (n = 175, 30%) formed the validation group. This study used LASSO binomial regression to select the most predictive variables. A predictor-based nomogram was developed to calculate the risk of BPPV recurrence. The performance of the nomogram was evaluated using the area under the receiver operating characteristic curve (AUC) and calibration curves with 1,000 bootstrap resampling validations. Decision curve analysis (DCA) was conducted to assess the clinical usefulness of the nomogram.ResultsAccording to findings from least absolute shrinkage and selection operator (LASSO) binomial regression and logistic regression screening, older age, higher levels of uric acid (UA) and homocysteine (HCY), diabetes, migraine, anxiety, and insomnia were identified as independent factors associated with an increased recurrence risk of BPPV. A nomogram model for predicting recurrence risk was developed based on these predictors. The nomogram achieved an AUC (C-statistic) of 0.8974 (95% CI: 0.8603–0.9345) in the training group and 0.8829 (95% CI: 0.8253–0.9406) in the validation group. Calibration curves, after 1,000 bootstrap resamples, demonstrated good agreement between the predicted and actual probabilities in the development and validation cohorts. DCA indicated that the nomogram had clinical utility.ConclusionThe nomogram model incorporating age, UA, HCY, diabetes, migraine, anxiety status, and insomnia demonstrated a strong predictive capability for estimating the probability of BPPV recurrence in middle-aged and elderly patients. This tool is valuable for identifying individuals at high risk of BPPV recurrence and can aid physicians in making informed treatment decisions aimed at reducing recurrence rates.

BackgroundBenign Paroxysmal Positional Vertigo (BPPV) is the most common cause of vertigo. While various techniques and technologies have improved BPPV diagnostics and treatment, optimizing BPPV healthcare pathways requires a comprehensive understanding of the diagnostic modalities across diverse clinical settings.ObjectiveTo compare traditional manual BPPV diagnostics (MD) with diagnostics done with the aid of a mechanical rotation chair (MRC) when using videonystagmography goggles with both modalities.MethodsThis prospective, open-label, randomized diagnostic crossover study involved 215 adults with typical BPPV symptoms at a tertiary University Hospital-based outpatient clinic (Aalborg University Hospital, Denmark). Participants referred by general practitioners or otorhinolaryngologist clinics underwent both traditional manual and MRC diagnostics with the aid of videonystagmography goggles. The order of the diagnostic modalities was randomly assigned, and the two modalities were separated by a minimum of 30 min. The primary outcomes included sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of traditional MD compared to MRC diagnostics. The secondary outcome was the agreement between the two modalities.ResultsThe MRC demonstrated a significantly higher sensitivity for BPPV detection in general for all participants (p = 0.00). Compared to MRC diagnostics, traditional MD displayed a sensitivity of 69.5% (95% confidence interval (CI): 59.8–78.1), specificity of 90.9% (95% CI: 83.9–95.6), PPV of 88.0% (95% CI: 83.9–95.6), and NPV of 75.8% (95% CI: 67.5–82.8). The overall inter-modality agreement was 80.5% (95% CI: 75.2–85.8, Cohen’s kappa 0.61). While both modalities detected unilateral posterior canal BPPV equally good (p = 0.51), traditional MD underperformed for non-posterior BPPV (significantly) and in subgroups referred by ENTs (trend) or with impaired cooperation during traditional MD (significantly).ConclusionTraditional manual BPPV diagnostics remains a valuable first-line approach for most patients. However, MRC diagnostics offers advantages for complex BPPV cases, patients with impaired cooperation, patients referred from otorhinolaryngologist clinics, and those with negative traditional MD but an evident BPPV history. MRC may be useful as a second opinion diagnostic tool for treatment-resistant BPPV.Clinical trial registrationClinicalTrials.gov identifier: NCT05846711.

In elderly patients, vestibular disorders are often associated with concomitant diseases and lead to falls and injuries. When treating elderly patients, it is necessary to determine an underlying cause of dizziness, and assess concomitant diseases, medications taken and their possible impact on the course of the underlying disease. In elderly patients, vascular dizziness is often misdiagnosed, while peripheral causes of dizziness are not identified, and effective treatment is not provided. Early recognition and prompt treatment of acute dizziness are important to reduce the incidence of residual dizziness, especially in elderly patients at risk of falling. In this article, we present a case of an elderly patient with acute vestibular dizziness due to benign paroxysmal positional vertigo (BPPV) against a background of comorbid orthostatic hypotension. For a long time, the patient's vertigo was mistakenly recognized as a manifestation of cerebrovascular disease. The combination of peripheral vestibulopathy with orthostatic hypotension led to a fall and injury. Recognition and effective treatment of BPPV (Epley maneuver), elimination of hypotension by optimizing antihypertensive therapy and the use of Arlevert resulted in a sustained positive effect. The efficacy of Arlevret in elderly patients is discussed.

Aim: The aim of the study is to study the outcomes of Vitamin D supplements along with Betahistine as compared to Betahistine alone in the treatment of benign paroxysmal positional vertigo (BPPV) patients. Background: BPPV is the most prevalent neuro-otological circumstance which is characterized by episodes of vertigo. Methodology: The research was performed in a tertiary care center in the department of otorhinolaryngology and head-and-neck operation at tertiary care center, India. This was a randomized controlled trial research with records of 50 cases in the year 2021–2022. The average age of the subjects was ± 18 years. A total of 50 cases were classified into two groups, each including 25 patients (Group A: 25 and Group B: 25). Group A received 60,000 IU cholecalciferol weekly along with betahistine for 3 months, whereas Group B received only betahistine. The Institute Ethics Committee (Human Studies) examined and accepted the study protocol (Approval No. JIP/IEC/SC/2016/26/861; Annexure 3). Results: A total of 50 subjects reporting to the otolaryngology clinic with complaints of frequent attacks of dizziness were evaluated for vertigo using a dizziness history questionnaire that promotes greater accountability and flexibility and which is also a well-recognized method among students, physicians who aim to establish a practice in future. After complete preoperative evaluation, the cases were randomly separated into two groups: Group A received 60,000 IU cholecalciferol weekly along with betahistine for 3 months, and Group B received only betahistine. The results of the treatment were compared between two groups. The inter-group continuous variables and intragroup quantitative variables (n = 2) were compared using suitable tools of statistics such as unpaired Student’s t-test. The categorical data were expressed in terms of percentage, rate, and ratio. The association between the result and clinical and demographic characteristics was tested using the Chi-square test or Fisher’s exact test. In the present study, Vitamin D levels were compared between Group A and Group B. Before treatment, Group A had a Vitamin D level of 16.68, whereas Group B had a Vitamin D level of 17.48, whereas Group A showed 19.68 and Group B showed 18.42 posttreatment. In the present investigation, Group A patients showed better outcomes in contrast to Group B patients. Conclusion: This study proves that the addition of Vitamin D along with betahistine in the routine treatment of BPPV reduces the number of recurrent episode of BPPV as well as help with reducing the symptoms of other comorbidities such as migraine and tinnitus.

Objective: This study’s objective was to identify the factors and impact of serums calcium 25-Hydroxy vitamin D, ferritin, uric acid, and sleeping disorders on benign paroxysmal positional vertigo (BPPV) patients. Methods: This is a case and control design study. The consecutive patients’ visits (age, older than 25 years) with idiopathic BPPV were recruited in the present study. For each patient, 3:1 sex and age-matched healthy people were assigned as the control. The study comprised 177 patients with BPPV and 656 controls. The study included biochemical, clinical, physical examinations, PSQI sleep quality, supine roll test, and Dix–Hallpike test for the diagnosis of all patients, and pure-tone audiometry (PTA) was used to assess hearing. Univariate and multivariate stepwise regression analyses were used for statistical analysis. Results: The study comprised 833 patients with 295 males (35.4%) and 538 females (64.6%) who were between 25 and 70 years old. Of a total of 833 participants, 177 were BPPV patients, and 656 subject were normal. The results shown that there were significant differences between the BPPV and the normal group in terms of BMI (p = 0.039), physical activity (p = 0.003), cigarette smoking (p = 0.035), nargile-waterpipe use (p < 0.001), diabetes (p < 0.001), hypertension (p < 0.001), congestive heart failure (CHF) (p < 0.001), neurology (p < 0.001), tinnitus (p < 0.001), dizziness (p < 0.001), headache (p < 0.001), vitamin D (p = 0.004), calcium (p = 0.004), magnesium (p < 0.001), potassium (p = 0.019), phosphorus (p < 0.001), haemoglobin (p < 0.001), serum glucose (p < 0.001), HbA1c (p < 0.001), triglyceride (p < 0.001), systolic BP (p = 0.004), diastolic BP (p = 0.008), and microalbuminuria (p = 0.005); ATP III metabolic syndrome (p = 0.038), IDF metabolic syndrome (p = 0.034), and poor sleep (p = 0.033). In terms of the type of BPPV, the posterior canal was the most commonly affected (n = 126, 71.2%), followed by the horizontal (n = 43, 24.3%) and anterior canal (n = 8, 4.5%). The analysis indicated that serum ferritin (p < 0.001), uric acid (p < 0.001), blood pressure (p < 0.001), dizziness (p < 0.001), cigarette–water-pipe smokers (p = 0.004), headaches/migraines (p = 0.005), calcium (p = 0.007), vitamin D deficiency (p = 0.008), sleepiness (p = 0.016), physical activity (p = 0.022), CHF (p = 0.024), and tinnitus (p = 0.025) were considered as risk predictors for BPPV. Conclusions: The results revealed that the serum levels of vitamin D, ferritin, uric acid, and calcium are low among the study population and supplementation could be considered as prevention in BPPV patients.

Objectives: Even though BPPV is one of the most common causes of vertigo, it is often underdiagnosed and omitted in the diagnosis of patients reporting vertigo. The aim of the study was to establish a diagnostic pattern useful in patients admitted due to vertigo, based on the most common clinical characteristics of patients suffered from posterior canal BPPV (PC-BPPV), horizontal canal BPPV with geotropic (HCG-BPPV) and apogeotropic nystagmus (HCA-BPPV). Methods: The analysis covered the results obtained in 105 patients with a positive result of the Dix-Hallpike maneuver or the supine roll test. The patients were divided into 3 groups based on the BPPV type: gr.1:PC-BPPV (60%); gr.2: HCG-BPPV (27%); gr.3: HCA-BPPV (13%). Patients before the diagnostic maneuvers filled the questionnaire concerning their symptoms and previous diseases. Results: Almost all patients had vertigo during turning over in bed and the character of the symptoms was paroxysmal. The answers to questions about the type of head movement evoked vertigo and how long vertigo lasted were differentiating. The percentages of correct diagnosis speculated by the combined answers were 69.6% in PC-BPPV, 61.8% in HCG-BPPV, and 80% in HCA-BPPV. Conclusions: Basing on those observations there is presented the diagnostic schedule which could be useful in dizziness examination. The above results indicate that a properly collected interview with the patient allows for a high percentage of accurate diagnosis. [ABSTRACT FROM AUTHOR]

Despite the high success rate of canalith repositioning maneuvers (CRMs) in the treatment of benign paroxysmal positional vertigo (BPPV), a growing number of patients report residual dizziness symptoms that may last for a significant time. Although the majority of BPPV cases can be explained by canalolithiasis, the etiology is complex. Consideration of the individual patient's history and underlying pathophysiology of BPPV may offer the potential for treatment approaches supplementary to CRMs, as well as a promising alternative for patients in whom CRMs are contraindicated. This article provides a summary of the possible underlying causes of BPPV and residual dizziness, along with suggestions for potential management options that may be considered to relieve the burden of residual symptoms. [ABSTRACT FROM AUTHOR]

Background/Objectives: Benign paroxysmal positional vertigo (BPPV) is the most common cause of recurrent vertigo and the most common peripheral vestibular disorder. It is characterized by intense vertigo triggered by head and position changes. This study investigates the risk of subsequent injury in BPPV patients and the effects of treatment. Methods: A population-based retrospective cohort study was conducted using data from the Longitudinal Health Insurance Database 2005 in Taiwan. Patients with and without BPPV were identified between 2000 and 2017. The study outcomes were diagnoses of all-cause injuries. The Kaplan–Meier method determined the cumulative incidence rates of injury in both cohorts, and a log-rank test analyzed the differences. Cox proportional hazard models calculated each cohort's 18-year hazard ratios (HRs). Results: We enrolled 50,675 patients with newly diagnosed BPPV and 202,700 matched individuals without BPPV. During follow-up, 47,636 patients were diagnosed with injuries (13,215 from the BPPV cohort and 34,421 from the non-BPPV cohort). The adjusted HR for injury in BPPV patients was 2.63 (95% CI, 2.49–2.88). Subgroup analysis showed an increased incidence of unintentional and intentional injuries in BPPV patients (aHR 2.86; 95% CI, 2.70–3.13 and 1.10; 95% CI, 1.04–1.21, respectively). A positive dose–response relationship was observed with increasing BPPV diagnoses. Treatment with canalith repositioning therapy (CRT) or medications reduced the risk of injury slightly but not significantly (aHR, 0.78; 95% CI, 0.37–1.29, 0.88; 95% CI, 0.40–1.40, respectively). Conclusions: BPPV is independently associated with an increased risk of injuries. CRT or medications have limited effects on mitigating this risk. Physicians should advise BPPV patients to take precautions to prevent injuries even after treatment. [ABSTRACT FROM AUTHOR]

Objective: The study aimed to investigate the clinical characteristics of patients with multi-canal benign paroxysmal positional vertigo (MC-BPPV). Methods: We performed a retrospective analysis of 927 patients with BPPV who were admitted to our hospital between January 1, 2016 and December 31, 2019. The clinical data of all patients were collected. The Dix-Hallpike, straight head-hanging, and supine Roll tests were performed in all patients. The nystagmus was recorded using videonystagmography. The clinical characteristics of patients with MC-BPPV and single canal BPPV (SC-BPPV) was analyzed and compared. Results: Among 927 patients included, 49 (5.29%) patients had MC-BPPV, 878 (94.71%) patients had SC-BPPV. There were significant differences in the male to female ratio (1:3.90 vs 1:1.81, P <.05), mean age (62.47±12.51 vs 59.04±13.72, P <.05), as well as the ratio of cupulolithiasis to canalithiasis (1:1.45 vs 1:4.78, P <.01) between patients with MC-BPPV and SC-BPPV. The frequency of involvement of PC, HC, and AC were involved for 66 (67.35%), 23 (23.47%), and 9 (9.18%) times, respectively, in patients with MC-BPPV, which were involved in 581 (66.17%), 281 (32.0%), and 16 (1.82%) patients, respectively, in patients with SC-BPPV. No significant difference was found in the frequency of involvement of PC and HC between patients with MC-BPPV and SC-BPPV, while there was significant difference in the frequency of AC involvement between 2 groups (P <.01). Ipsilateral PC-HC-BPPV (n = 18) and bilateral PC-BPPV (n=19) were the most common among patients with MC-BPPV. Twenty-six (53.06%) patients had ipsilateral MC-BPPV, 23 (46.94%) had bilateral MC-BPPV. Of the 26 patients with ipsilateral MC-BPPV, 7 patients combined with unilateral peripheral vestibular disorder. Conclusion: Patients with MC-BPPV had a significantly older mean age at disease onset and a higher proportion of females compared with patients with SC-BPPV. Cupulolithiasis was more common in MC-BPPV. AC involvement was also much more common in MC-BPPV than in SC-BPPV. [ABSTRACT FROM AUTHOR]

Objective: This study's objective was to identify the factors and impact of serums calcium 25-Hydroxy vitamin D, ferritin, uric acid, and sleeping disorders on benign paroxysmal positional vertigo (BPPV) patients. Methods: This is a case and control design study. The consecutive patients' visits (age, older than 25 years) with idiopathic BPPV were recruited in the present study. For each patient, 3:1 sex and age-matched healthy people were assigned as the control. The study comprised 177 patients with BPPV and 656 controls. The study included biochemical, clinical, physical examinations, PSQI sleep quality, supine roll test, and Dix–Hallpike test for the diagnosis of all patients, and pure-tone audiometry (PTA) was used to assess hearing. Univariate and multivariate stepwise regression analyses were used for statistical analysis. Results: The study comprised 833 patients with 295 males (35.4%) and 538 females (64.6%) who were between 25 and 70 years old. Of a total of 833 participants, 177 were BPPV patients, and 656 subject were normal. The results shown that there were significant differences between the BPPV and the normal group in terms of BMI (p = 0.039), physical activity (p = 0.003), cigarette smoking (p = 0.035), nargile-waterpipe use (p < 0.001), diabetes (p < 0.001), hypertension (p < 0.001), congestive heart failure (CHF) (p < 0.001), neurology (p < 0.001), tinnitus (p < 0.001), dizziness (p < 0.001), headache (p < 0.001), vitamin D (p = 0.004), calcium (p = 0.004), magnesium (p < 0.001), potassium (p = 0.019), phosphorus (p < 0.001), haemoglobin (p < 0.001), serum glucose (p < 0.001), HbA1c (p < 0.001), triglyceride (p < 0.001), systolic BP (p = 0.004), diastolic BP (p = 0.008), and microalbuminuria (p = 0.005); ATP III metabolic syndrome (p = 0.038), IDF metabolic syndrome (p = 0.034), and poor sleep (p = 0.033). In terms of the type of BPPV, the posterior canal was the most commonly affected (n = 126, 71.2%), followed by the horizontal (n = 43, 24.3%) and anterior canal (n = 8, 4.5%). The analysis indicated that serum ferritin (p < 0.001), uric acid (p < 0.001), blood pressure (p < 0.001), dizziness (p < 0.001), cigarette–water-pipe smokers (p = 0.004), headaches/migraines (p = 0.005), calcium (p = 0.007), vitamin D deficiency (p = 0.008), sleepiness (p = 0.016), physical activity (p = 0.022), CHF (p = 0.024), and tinnitus (p = 0.025) were considered as risk predictors for BPPV. Conclusions: The results revealed that the serum levels of vitamin D, ferritin, uric acid, and calcium are low among the study population and supplementation could be considered as prevention in BPPV patients. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate the characteristics of positional nystagmus in patients with cupulolithiasis of the posterior semicircular canal-benign paroxysmal positional vertigo (PC-BPPV-cu) to improve clinical diagnostic accuracy. Methods: This study retrospectively analyzed 128 cases of PC-BPPV-cu and 128 cases of canalolithiasis of BPPV (PC-BPPV-ca). General data, intensity, distribution, and the correlation of positional nystagmus were compared between the two groups. Results: Compared to the PC-BPPV-ca group, more cases from the PC-BPPV-cu group initially presented in the emergency department (P <0.05). The most frequent positional nystagmus induced by PC-BPPV-cu was torsional-upbeat nystagmus, characterized by the upper pole of the affected eye beating toward the lower ear and vertically upward (387 cases, 59.7%). It was followed by torsional-downbeat nystagmus, characterized by the upper pole of the unaffected eye beating toward the lower ear and vertically downward (164 cases, 25.3%). The former represented posterior canal excitatory nystagmus (PC-EN), while the latter represented posterior canal inhibitory nystagmus (PC-IN). In the PC-BPPV-cu group, PC-EN was most easily caused by the Half Dix-Hallpike (HH) maneuver on the affected side, while PC-IN was most easily induced by a face-down position (FDP) on the unaffected side at approximately 45° angle (45° FDP). The vertical slow phase velocity (v-SPV) of positional nystagmus was more potent in the affected HH than in other positions with PC-EN (all P < 0.05); the v-SPV of positional nystagmus was greater in the 45° FDP than in different positions with PC-IN (all P < 0.05); the v-SPV of the affected Dix-Hallpike (DH) maneuver in the PC-BPPV-ca group was significantly greater than that of the affected HH maneuver in the PC-BPPV-cu group (P < 0.05). The a priori analysis showed that the strongest correlation with HH positional nystagmus was observed in the affected side roll test, followed by the DH maneuver. Conclusion: In the PC-BPPV-cu group, the HH maneuver most easily induced PC-EN on the affected side, and PC-IN was most easily induced by the 45° FDP. In some cases of PC-BPPV-cu, significant nystagmus was not observed to be induced in the DH position on the affected side; however, vertical rotation nystagmus was induced in the roll-test position on the affected side. In such cases, PC-BPPV-cu diagnosis should be considered, and HH and 45° FDP tests should be conducted to support the diagnosis. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to provide a comprehensive understanding of the spatial orientation of the crista ampullaris within the inner ear and its implications for the diagnosis and management of benign paroxysmal positional vertigo (BPPV). Methods: Using high-resolutionMRI scans of 55 normal inner ears, 3Dmodels of the semicircular canals were segmented. These were complemented by detailed membrane labyrinth models from micro-CT scans of human temporal bones, accessed via the Comparative Ear Bank (www.earbank.org). A statistical shape model of inner ears and eyeballs was established, and a standardized 3D spatial coordinate system was created. The horizontal plane was defined using the top of the common crus and the bottom of the eyeballs. This calibrated reference system allowed for precise quantification of crista ampullaris orientations by calculating angles between the defined crista planes and coordinate planes. Results: The plane of the ampulla and the corresponding semicircular canal plane are nearly perpendicular to each other. In the upright position, the posterior semicircular canal crista ampullaris formed an angle of 48.9? with the horizontal plane. The relative orientations of the crista ampullaris of the lateral and superior canals were also defined. Furthermore, we identified "zero-point planes" representing crista orientations perpendicular to gravity, which resulted in minimal ampullary stimulation. A 6.2? tilt to the left in the supine position resulted in the plane of the left lateral semicircular canal crista ampullaris being parallel to the direction of gravity. Conclusion: This study elucidates the precise spatial orientation of the crista ampullaris, thereby providing an anatomical basis for understanding BPPV pathophysiology and improving the accuracy of diagnostic and therapeutic maneuvers. The findings have the potential to significantly enhance the management of BPPV and other inner ear disorders. [ABSTRACT FROM AUTHOR]