Importance of accurate diagnosis in benign paroxysmal positional vertigo (BPPV) therapy

摘要

Aim To determine the importance of accurate topological diagnosticsof the otolith and the differentiation of certain clinical formsof benign paroxysmal positional vertigo (BPPV).Methods A prospective study was conducted at the County GeneralHospital Vukovar in the period from January 2011 till January2012. A total of 81 patients with BPPV, 59 females (72.84%)and 22 (27.16%) males (p <0.001), mean age 60.1 (± 12.1) wereexamined. The diagnosis was confirmed and documented by videonystagmography(VNG). The disability due to disease and riskof falling were monitored by filling in the Dizziness Handicap Inventory(DHI) and Activities-specific Balance Confidence Scale(ABC) questionnaires at the beginning and at the end of the repositioningtreatment.Results In 79 (97.3%) patients posterior semicircular canal wasaffected, and in a small number of patients, two (2.47%) the lateralone. After the repositioning procedures were performed, therewas a significant reduction or complete elimination of symptomsin the majority of subjects, 76 (93.82%). The median total DHIsum amounted to 50.5 (± 22.2) at the beginning and 20.4 (± 18.5)at the end of the study (p <0.00). Similarly, the results of ABC questionnairesat the beginning of the study demonstrated a result of59.2% (± 22.4%), and at the end of the treatment the average resultof examinees was significantly higher, 84.9% (± 15.2%) (p<0.00).Conclusion Although a subjectively positive Dix-Hallpike or a“supine roll” test is sufficient for the diagnosis of BPPV, it is necessaryperform the VNG as well in order to precisely determine theexact localization of the otolith, so that an appropriate repositioningprocedure can be applied.