Revisiting benign paroxysmal positional vertigo pathophysiology.

Department of Otolaryngology-Head and Neck Surgery, Edith Wolfson Medical Center, Tel-Aviv University Sackler School of Medicine, Holon, Israel.
American journal of otolaryngology (Impact Factor: 1.08). 07/2009; 30(4):250-5. DOI: 10.1016/j.amjoto.2008.06.009
Source: PubMed

ABSTRACT Benign paroxysmal positional vertigo is the most common peripheral cause of vertigo. Although its pathophysiologic mechanisms remain unclear, different locations have been attributed throughout the last century, from the days of Bárány. Disease was initially located by Dix and Hallpike in the utricle, but later, Schuknecht's works elicited the cupulolithiasis and canalolithiasis theories, localizing the pathology to the semicircular canal system and mainly to the posterior one. However, conflicting evidences from temporal bone studies accumulated against this theory, which suggest other explanations. Although this clinical entity is well defined, and can usually be effectively treated with certain physical maneuvers, its pathophysiology is still obscure and is being critically discussed in this article, which reviews the milestones of benign paroxysmal positional vertigo understanding.

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    ABSTRACT: OBJECTIVE: To evaluate the prevalence of benign paroxysmal positional vertigo (BPPV), defined as positionally induced nystagmus (PIN) with associated symptoms on provocative testing, in the young healthy adult population. DESIGN: A prospective, cohort, screening study. SETTING: A community-based hospital located in a small Midwestern city with a greater metropolitan population of approximately 125,000. PARTICIPANTS: One hundred ninety-eight young adults (99 men and 99 women), ages 18 to 34 years and not being treated for dizziness or balance problems, recruited from November 2009 to April 2010. METHODS: Participants completed questionnaires detailing demographics, medical and surgical history, sports/activity participation history, and baseline symptoms commonly associated with BPPV. Participants were screened for inclusion with an ocular motor assessment in room light, followed by a vestibular positional assessment for BPPV with infrared camera-equipped goggles recorded on DVD. MAIN OUTCOME MEASURE: The prevalence of BPPV, defined as PIN along with symptoms, in study participants. RESULTS: The prevalence of BPPV was 9% in this young adult population. Symptoms during testing were reported in 14% of all subjects (22% of women, 5% of men). Of 22 women reporting symptoms, 12 had PIN (P = .519), whereas the 5 men reporting symptoms all had PIN (P = .001). PIN characteristic of that seen in BPPV (with or without associated symptoms) was identified in 53% of subjects, with 43% of subjects having posterior canal involvement, 10% having anterior canal involvement, and 8% having horizontal canal involvement. Eleven percent of subjects had bilateral semicircular canal involvement. CONCLUSION: Nine percent of our young adult subjects were diagnosed with previously unrecognized BPPV, with provoked symptoms of dizziness, headache, nausea, or imbalance-symptoms that may cause significant physical and psychosocial limitations if left untreated. This is an important finding because BPPV is an often overlooked diagnosis that has known, very effective treatment.
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May 22, 2014