BACKGROUND: Benign positional paroxysmal vertigo (BPPV) stands as the commonest cause for vertigo. It accounts for 20% of all cases of vertigo, even with its high prevalence rate it often goes underdiagnosed and undertreated. Development of the consensus document by the Bárány society\'s International Classification of Vestibular Disorders (ICVD)significantly facilitates the diagnosis of BPPV and its variants. This study assesses the utilisation of ICVD criteria for managing BPPV.
METHODS: This is a cross-sectional descriptive study conducted at a tertiary care hospital in Northern India spanning from November 1, 2022, to November 30, 2023. A total of 110 participants diagnosed with BPPV were enrolled consecutively. All participants underwent Dix-Hallpike and supine log roll positional maneuvers. Diagnosis was made based on the history and type of nystagmus seen, and classified as per the ICVD criteria.
RESULTS: Posterior semicircular canalolithiasis (pc-BPPV) accounted for 25.45% of cases and horizontal canal canalolithiasis (hc-BPPV) accounted for 20.91% of cases. Probable BPPV, spontaneously resolved (pBPPVsr) was diagnosed in 16.36% of participants and possible BPPV(pBPPV) was diagnosed in 18.18% of participants. Multiple canal BPPV (mc-BPPV) accounted for 17.27% of cases. One participant was diagnosed with horizontal canal cupulolithiasis and anterior canal canalolithiasis respectively. No participant was diagnosed with posterior canal cupulolithiasis.
CONCLUSIONS: The most common type of BPPV was pc-BPPV followed by hc-BPPV. The affected canal in possible BPPV, can be identified, and appropriate repositioning maneuvers are effective in treating them as well as aids in confirming the diagnosis. The diagnostic clarity provided by ICVD, aids in effective management of BPPV. More studies with larger sample size are required to further validate its clinical utility.

UNASSIGNED: To investigate the characteristics of positional nystagmus in posterior semicircular canal (PSCC) benign paroxysmal positional vertigo (BPPV) patients with longer durations, and to discuss the possible underlying mechanism of this nystagmus.
UNASSIGNED: We conducted a retrospective review, and enrolled 118 consecutive patients with unilateral PSCC BPPV. The duration of nystagmus during a Dix-Hallpike test was classified into short (<1 min) and long (≥1 min) durations. For the identification of a neutral point in PSCC BPPV patients with long durations, the patient\'s head was turned 45° to the lesioned side to set the affected PSCC on the sagittal plane, and the disappearance of positional nystagmus was investigated in a pitch plane.
UNASSIGNED: Among 118 patients with PSCC BPPV, positional nystagmus during a Dix-Hallpike test showed short durations (<1 min) in 112 patients and long durations (≥1 min) in 6 patients. Of 6 PSCC BPPV patients with a long duration, a neutral point was identified in 5 patients whose nystagmus lasted for longer than 2 min; interestingly, a neutral point was observed when the patient\'s head was slightly tilted backward in all 5 patients.
UNASSIGNED: Considering that a neutral position was identified when the patient\'s head was slightly tilted backward while keeping the head turned 45° to the right or left, we assume that the light cupula condition of the ipsilateral PSCC or the contralateral anterior semicircular canal, and not PSCC BPPV cupulolithiasis, could be responsible for the occurrence of persistent torsional-upbeating nystagmus in a Dix-Hallpike test.
UNASSIGNED: 4.

Vestibular rehabilitation therapy (VRT) mainly comprises physical therapies that encourage head, eye, and truncal movements, accelerating the recovery of patients with acute peripheral labyrinthine dysfunction. VRT aims to improve vestibular hypofunction by reinforcing vestibulo-ocular, vestibulospinal, and vestibulocollic reflexes. An asymmetry in peripheral vestibular inputs from the pair of membranous labyrinths to the central nervous system frequently results from vestibular lithiasis, causing benign paroxysmal positional vertigo (BPPV). The article discusses the pathophysiology, subtypes, and diagnostic oculomotor patterns generated during positional tests in each subtype of BPPV. Accurate identification of the pathophysiology (canalolithiasis versus cupulolithiasis) as well as the involved semicircular canal (localization and lateralization) is crucial for the unerring VRT of BPPV by physical therapies and/or repositioning maneuvers. The article elaborates the currently known variants of BPPV, the anatomico-physiological correlation between otoconial location and oculomotor patterns generated during the diagnostic positional tests in terms of the direction, latency, and duration of the elicited positional nystagmus [Figures 1 and 2; Table 2]. A detailed description of the treatment of different BPPV subtypes with repositioning maneuvers and/or physical therapy is given [Figures 3-8; Table 3].

UNASSIGNED: Patients with benign paroxysmal positional vertigo of the posterior canal (pc-BPPV) exhibit BPPV fatigue, where the positional nystagmus diminishes with the repeated performance of the Dix-Hallpike test (DHt). BPPV fatigue is thought to be caused by the disintegration of lumps of otoconial debris into smaller parts and can eliminate positional nystagmus within a few minutes [similar to the immediate effect of the Epley maneuver (EM)]. In this study, we aimed to show the non-inferiority of the repeated DHt to the EM for eliminating positional nystagmus after 1 week.
UNASSIGNED: This multicenter, randomized controlled clinical trial was designed based on the CONSORT 2010 guidelines. Patients who had pc-BPPV were recruited and randomly allocated to Group A or Group B. Patients in Group A were treated using the EM, and patients in Group B were treated using repeated DHt. For both groups, head movements were repeated until the positional nystagmus had been eliminated (a maximum of three repetitions). After 1 week, the patients were examined to determine whether the positional nystagmus was still present. The groups were compared in terms of the percentage of patients whose positional nystagmus had been eliminated, with the non-inferiority margin set at 15%.
UNASSIGNED: Data for a total of 180 patients were analyzed (90 patients per group). Positional nystagmus had been eliminated in 50.0% of the patients in Group A compared with 47.8% in Group B. The upper limit of the 95% confidence interval for the difference was 14.5%, which was lower than the non-inferiority margin.
UNASSIGNED: This study showed the non-inferiority of repeated DHt to the EM for eliminating positional nystagmus after 1 week in patients with pc-BPPV and that even the disintegration of otoconial debris alone has a therapeutic effect for pc-BPPV. Disintegrated otoconial debris disappears from the posterior canal because it can be dissolved in the endolymph or returned to the vestibule via activities of daily living.
UNASSIGNED: This study provides Class II evidence of the non-inferiority of repeated DHt to the EM for eliminating positional nystagmus after 1 week.
UNASSIGNED: UMIN000016421.

UNASSIGNED: To study the frequency of canal switch in posterior canal benign paroxysmal positional vertigo (BPPV) treated by canalith repositioning manoeuver (CRP), quick liberatory rotation manoeuver (QLR) or Semont manoeuver (SM).
UNASSIGNED: Retrospective study on 1158 patients, 637 women and 521 men suffering from geotropic posterior canal BPPV treated by CRP, QLR, or SM, retested after 15 minutes and about seven days.
UNASSIGNED: 1146 patients recovered from the acute phase; treatments failed in 12 patients treated with CRP. We observed 12 canal switches from posterior to lateral canal and 2 from posterior to anterior canal during or after CRP in 13/879 cases (1.5%) and after QLR in 1/158 (0.6%) with no significant difference between CRP vs SM and QLR. We did not consider slight positional downbeat nystagmus after the therapeutic manoeuvers as a sign of canal switch into the anterior canal, but as a sign of persistent small debris in the non-ampullar arm of the posterior canal.
UNASSIGNED: Canal switch is rare for any manoeuver and it does not belong to the criteria to choose one manoeuver over another. Notably, due to the canal switching criteria, SM and QLR cannot be preferred over those with a more prolonged extension of the neck.
Lo switch canalare: possibile complicanza della terapia liberatoria per la VPPB del canale posteriore.
UNASSIGNED: Studiare la frequenza del fenomeno dello switch canalare come complicanza delle manovre terapeutiche in fase acuta della BPPV da canalolitiasi posteriore geotropa.
UNASSIGNED: Studio retrospettivo includente 1158 pazienti, 637 donne e 521 uomini affetti da BPPV da canalolitiasi posteriore in fase acuta trattati in sedi diverse con manovra di riposizionamento (CRP) (879 pazienti), Manovra di Rotazione Rapida Liberatoria (QLR) (158 pazienti) o manovra di Semont (SM) (121 pazienti). Il retest è stato effettuato 15 minuti e circa 7 giorni dopo l’esecuzione della manovra terapeutica.
UNASSIGNED: 1146 pazienti sono guariti dalla fase acuta, 12 pazienti hanno presentato persistenza dei segni e sintomi dopo l’intera procedura terapeutica. Il canal switch è stato osservato in 12 casi dal canale posteriore al canale laterale, in 2 casi dal canale posteriore al canale anteriore, durante o dopo CRP in 13/879 casi (1,5%), dopo QLR in 1/1508 casi (0,6%).
UNASSIGNED: Il rischio di switch canalare appare molto basso per tutte le manovre utilizzate, tanto da non poter essere incluso tra i criteri di scelta di una manovra rispetto ad un’altra. In particolare, il basso rischio non fa preferire la SM o la QLR rispetto a quelle con maggiore e più prolungata estensione del collo.

The etiology and mechanism of persistent geotropic horizontal direction-changing positional nystagmus (DCPN) are still unclear. Whether this pattern of nystagmus is a subtype of benign paroxysmal positional vertigo (BPPV) remains controversial.
The goal of this study was to observe the clinical characteristics of persistent geotropic horizontal DCPN involving the lateral semicircular canal.
The analysis was performed to participants with episodic positional vertigo in our clinic from 2014 to 2021. Participants were included via positional test. We observed and summarized the distribution data, vertigo history, follow-up tests, and recurrence situations of 189 persistent geotropic horizontal DCPN participants.
The mean age at the first time showing of persistent geotropic horizontal DCPN was 56±14.7 and more women than men were affected by persistent geotropic horizontal DCPN (female-to-male ratio 2.4 : 1). Overall, 58.7% (57/94) of participants who came for the first-week follow-up test were asymptomatic. Thirty-three participants experienced recurrence (female-to-male ratio: 4.5 : 1). Fifty-three (28.0%) participants experienced the conversion of the patterns of DCPN in the history, the follow-up tests and the recurrence compared to the first showing of persistent geotropic horizontal DCPN. 24(12.1%) participants still experienced persistent geotropic horizontal DCPN attack in the follow-up tests and the recurrences without benign paroxysmal positional vertigo history.
Persistent geotropic horizontal DCPN affected more women than men. The persistent geotropic horizontal DCPN that with conversion to transient geotropic horizontal DCPN or to persistent apogeotropic horizontal DCPN might be a subtype of BPPV or in a stage of BPPV process. However, the persistent geotropic horizontal DCPN without conversion might be an independent disease that is not related to BPPV.

Objective:To investigate the effects of age and involved semicircular canals on the results of caloric test in patients with primary horizontal semicircular canal benign paroxysmal positional vertigo（BPPV）. Methods:A total of 258 patients conforming to the diagnosis of primary horizontal semicircular canal BPPV were selected as the case group, and another 110 non-BPPV patients with dizziness/vertigo as the main complaint were selected as the control group. Both groups were divided into elderly group and young and middle-aged group according to their age, and the general information and the results of the caloric test were compared and analyzed for each group. Results: ①There was no statistically significant difference in gender composition and type of involved semicircular canal between the different age groups（P>0.05）；②In patients with horizontal semicircular canal canalolithiasis, there was no statistically significant difference in the rate of abnormal caloric test results between the different age groups（P>0.05）；③In patients with horizontal semicircular canal cupulolithiasis, there was a statistically significant difference in the rate of abnormal caloric test results between the different age groups（P<0.05）；④In the same age group, there was no statistically significant difference in the rate of abnormal caloric test results between the patients with horizontal semicircular canal canalolithiasis and the patients with cupulolithiasis（P>0.05）；⑤In the control group, there was no statistically significant difference between the different age groups in gender composition（P>0.05）；⑥In the control group, there was a statistically significant difference in the rate of abnormal caloric test results between the different age groups（P<0.05）；⑦Among the patients in the same age group, there was no statistically significant difference in the age distribution between the case and control groups（P>0.05）；⑧In patients of the same age group, there was no statistically significant difference in the rate of abnormal caloric test results between the case and control groups（P>0.05）. Conclusion:The involvement of the semicircular canal does not affect the results of the caloric test, but age can affect the results, especially in BPPV patients with horizontal semicircular canal cupulolithiasis.
目的：探讨年龄和受累半规管对原发性水平半规管良性阵发性位置性眩晕（BPPV）患者双温试验结果的影响。 方法：选取符合原发性水平半规管BPPV诊断的患者258例为病例组，以头晕/眩晕为主诉的非BPPV患者110例为对照组，两组均按年龄分为老年组和中青年组，对两组的一般资料及双温试验结果进行对比分析。 结果：①不同年龄组性别和受累半规管类型之间差异无统计学意义（P>0.05）；②水平半规管管石BPPV患者中，不同年龄组双温试验结果异常率差异无统计学意义（P>0.05）；③水平半规管嵴帽结石BPPV患者中，不同年龄组双温试验结果异常率差异有统计学意义（P<0.05）；④同年龄组患者中，水平半规管管石和水平半规管嵴帽结石BPPV患者双温试验结果异常率差异无统计学意义（P>0.05）；⑤对照组中，不同年龄组性别差异无统计学意义（P>0.05）；⑥对照组中，不同年龄组双温试验结果异常率差异有统计学意义（P<0.05）；⑦同年龄组患者中，病例组和对照组年龄分布差异无统计学意义（P>0.05）；⑧同年龄组患者中，病例组和对照组双温试验结果异常率差异无统计学意义（P>0.05）。 结论：半规管受累并不能影响双温试验结果，但年龄却能影响双温试验结果，尤其对水平半规管嵴帽结石BPPV患者影响较大。.

UNASSIGNED: The characteristics of horizontal and vertical components of nystagmus evoked by the supine roll test in patients with horizontal semicircular canal canalolithiasis (HSC-Can) were analyzed, according to Ewald\'s first law. It provided a basis for the study of human horizontal semicircular canal function and structure, objective diagnosis, and treatment of benign paroxysmal positional vertigo (BPPV).
UNASSIGNED: The records of patients that had been tested with 2-dimensional videonystagmography (2D-VNG) were reviewed between June 2019 and June 2021. The intensity and direction of horizontal and vertical nystagmus elicited by the supine roll test were analyzed in 189 patients with idiopathic HSC-Can.
UNASSIGNED: All the 189 patients with HSC-Can were induced horizontal nystagmus with the same direction as head-turning (geotropic) in the supine roll test, of which 119 patients (63.96%) had a weak vertical upward component of nystagmus on the affected and unaffected sides, 57 patients (30.16%) had a vertical downward component of nystagmus on the affected side and/or the unaffected side, and 13 patients (6.88%) had no vertical component of nystagmus on both the sides. The intensity values of the horizontal component on the affected and unaffected sides were 42.14 ± 24.78 (range: 6.26-138.00°/s) and 17.48 ± 10.91°/s (range: 2.40-53.83°/s), with a ratio of 2.96 ± 2.17:1, representing a significant difference (p < 0.001). We analyzed the characteristics of horizontal and vertical components in 119 patients with HSC-Can (57 L-HSC-Can and 62 R-HSC-Can) on the supine roll test. The intensity values of the horizontal component on the affected and unaffected sides were 43.17 ± 23.76 (range: 8.60-124.51°/s) and 17.98 ± 10.99°/s (range: 2.40-53.83°/s), and the intensity values of the vertical component on the affected and unaffected sides were 10.65 ± 8.46 (range: 1.90-50.83°/s) and 4.81 ± 3.45°/s (range: 0.30-20.43°/s), representing a significant difference between groups (p < 0.001). Among 119 patients with HSC-Can who had a vertical upward component on both the affected and unaffected sides in the supine roll test, unilateral weakness (UW) was normal in 53 cases and abnormal in 51 cases, and 15 cases did not undergo the caloric test. We compared the horizontal and vertical components of nystagmus induced on the affected and unaffected sides in the supine roll test in 53 patients with normal UW and 51 patients with abnormal UW, and the difference was not statistically significant.
UNASSIGNED: There is mostly a vertical upward component based on the horizontal component in HSC-Can, and the direction and intensity characteristics of nystagmus accord with Ewald\'s first law, which can provide a basis for the study of human HSC function and structure, objective diagnosis, and treatment of BPPV.

Benign Paroxysmal Positional Vertigo (BPPV), the most common vestibular disorder characterized by recurrent, brief episodes of vertigo, is attributed to the presence of otoconia in the semicircular canals. Two mechanisms contribute to its cause-canalolithiasis (otoconia freely mobile in the semicircular canal) and cupulolithiasis (otoconia adherent to the cupula). Posterior semicircular canal is the most common canal involved. Although the occurrence of BPPV in lateral and superior semicircular canal is rare, with the advancement in diagnostic techniques, their incidence is being reported in the past few years. Various diagnostic tests and therapeutic maneuvers have been described in the management of BPPV. The present report is a comprehensive review of the tests and maneuvers for BPPV written as a guide intended to help the clinicians in the accurate diagnosis and application of a canal-specific treatment maneuver for BPPV. A simplified algorithmic approach (\"The Bangalore BPPV Algorithm\") for the management of BPPV is described.

UNASSIGNED: A mono-positional persistent, direction-fixed apogeotropic nystagmus (MPosApoNy) is very challenging for the neuro-otologist. MPosApoNy can be found in patients suffering from a partially compensated acute unilateral vestibulopathy; with a normal caloric test, one can speculate the presence of \"trapped\" otolithic debris located close to the ampulla of the horizontal semicircular canal.
UNASSIGNED: Among 957 patients suffering from vertigo and dizziness, we selected 53 cases of MPosApoNy.
UNASSIGNED: In 28 patients, caloric test showed a canal paresis on the same side of the MPosApoNy. In the remaining 25 cases, MPosApoNy was the only clinical finding. We hypothesised the presence of horizonal canal lithiasis and patients were treated with a Gufoni manoeuvre, followed by a forced prolonged position.
UNASSIGNED: Performing bedside examination in a patient suffering from vertigo, the presence of MPosApoNy may be due to: a) facilitation of a subclinical nystagmus due to the mechanism of apogeotropic reinforcement; b) horizontal canal lithiasis with \'trapped\' otoliths close to the ampulla. The disappearance of MPosApoNy following a repositioning manoeuvre or conversion in a typical form of canalolithiasis may represent the best method to confirm this hypothesis.
Il significato clinico del nistagmo monoposizionale orizzontale apogeotropo.
UNASSIGNED: Il riscontro di un nistagmo monoposizionale orizzontale apogeotropo (MPosApoNy) rappresenta una sfida diagnostica per il vestibologo. Tale nistagmo può indicare, in presenza di un deficit al test calorico, una labirintopatia periferica non compensata. In assenza di tale reperto, il MPosApoNy potrebbe essere riconducibile ad una forma atipica di litiasi del canale semicircolare orizzontale (CSL).
UNASSIGNED: Su 957 pazienti con vertigini, ne abbiamo selezionati 53 che presentavano MPosApoNy.
UNASSIGNED: In 28 pazienti il test calorico evidenziò un deficit ipsilaterale al MPosApoNy. Nei rimanenti 25 in cui il test calorico risultò nella norma, si ipotizzò una litiasi del CSL con otoliti intrappolati in prossimità dell’ampolla. Questi pazienti vennero trattati con manovra di Gufoni e successiva posizione coatta.
UNASSIGNED: Il riscontro di un MPosApoNy può riconoscere una duplice causa. Esso può essere l’espressione di un nistagmo subclinico esito di labirintopatia acuta monolaterale. Tuttavia, la presenza di otoliti intrappolati in stretta vicinanza dell’ampolla ne può spiegare la genesi. In quest’ultimo caso, le manovre liberatorie, attraverso la risoluzione del MPosApoNy o per la conversione in una forma tipica di canalolitiasi, possono confermarne l’origine litiasica.