A comprehensive diagnosing of benign paroxysmal positional vertigo: experience of a single institution

BACKGROUND: The gold standard for diagnosing benign paroxysmal positional vertigo (BPPV) is the presence of positional nystagmus, which can be torsional, vertical, or horizontal, and the presence of characteristic features such as latency, reversibility, and fatigability during certain maneuvers such as the Dix-Hallpike or supine roll tests. Actually, the diagnosis of BPPV is often missed or inadequate, especially with conventional examination. Computerized recording of an episode of nystagmus during positioning maneuvers has become more feasible using videonystagmography (VNG) devices, so these types of approaches, in addition with caloric test, vHIT and audiometry, are becoming essential for diagnosing BPPV. The aim of this study was to investigate distribution of BPPV and subtypes BPPV in Vietnam and to contribute our experiences in diagnosing BPPV.METHODS: This is a prospective descriptive study on 668 patients, had balance disorders and vertigo, have been consulted at Tam Anh general Hospital, Hanoi from November 2018 to July 2019. All patients were clinically examined which included simple vestibular tests (Fukuda and Romberg) and a vestibular test battery composed of VNG tests, caloric test, video head impulse test and audiometry. Computerized systems VisualEyes™ EyeSeeCam were applied for automatic analysis of the recordings.RESULTS: BPPV was the most prevalent vestibular disorder and found in 282 patients (65.5%). Among 282 patients diagnosed with BPPV, there were 168 women and 114 men. The posterior semicircular canal was affected in 236 cases (83.68%), the horizontal semicircular canal in 76 cases (26.9%), the anterior canal in 41 cases (14.5%), and multi-canals were involved in 202 cases (posterior/anterior/horizontal) (71.6%). The horizontal-posterior semicircular canal was the most common BPPV subtype and observed in 174 cases (61.7%). Bilateral semicircular canal involvement was recorded in 60 cases (21.27%). BPPV combine with others peripheral vestibular disorders: Meniere disease in 37 patients (13.1%), with vestibular neuritis in 30 patients (10.6%), labyrinthitis in seven patients (2.4%).CONCLUSIONS: Our study noted initially the distribution and ratios of subtypes multi-canal BPPV in Vietnam. Simple clinical vestibular investigations, VNG tests, caloric test, video head impulse test (vHIT) and audiometry were enough to have adequate and proper diagnose BPPV, especially atypical BPPV, multi-canal BPPV, and BPPV accompanied with other vestibular disorders.