Vestibular Test Results in Patients With Horizontal Canal Benign Paroxysmal Positional Vertigo

Vestibular function in cases of posterior semicircular canal canalolithiasis and cupulolithiasis

Objective

To analyze and compare the vestibular function of posterior canal cupulolithiasis and canalolithiasis.

Methods

The results of posterior cupulolithiasis in 45 cases, posterior canalolithiasis in 122 cases and 19 healthy controls were analyzed retrospectively.

Results

The abnormal rates of vHIT in the canalolithiasis group and the cupulolithiasis group were 42.6 and 37.8%, respectively, both higher than those in the control group (both p < 0.05); there was no statistically significant difference between two BPPV groups (p = 0.573). The abnormal vHIT in 76.9% of the canalolithiasis cases and 82.4% of the cupulolithiasis cases showed normal gain with saccades, with no difference between the groups (p = 0.859). The lesion location of vHIT in the two groups did not show a correlation with the affected side of BPPV (both p > 0.05). 84.4% of canalolithiasis and 65.0% of cupulolithiasis had abnormal VEMP results, with no significant differences in abnormality rates or sides (both p > 0.05). Abnormal results of VEMPs did not show any correlation with side (p > 0.05). The results of pc-ca and pc-cu were both abnormal in 14 cases and 7 cases, and there was no correlation between the site and side of the injury (all p > 0.05).

Conclusion

The results of vHIT and VEMP in pc-cu and pc-ca were partially abnormal, but they did not show any correlation with side of BPPV. It can be considered that there are scattered vestibular peripheral organ damage in both groups.

Neurological update: neuro-otology 2023

Much has changed since our last review of recent advances in neuro-otology 7 years ago. Unfortunately there are still not many practising neuro-otologists, so that most patients with vestibular problems need, in the first instance, to be evaluated and treated by neurologists whose special expertise is not neuro-otology. The areas we consider here are mostly those that almost any neurologist should be able to start managing: acute spontaneous vertigo in the Emergency Room-is it vestibular neuritis or posterior circulation stroke; recurrent spontaneous vertigo in the office-is it vestibular migraine or Meniere's disease and the most common vestibular problem of all-benign positional vertigo. Finally we consider the future: long-term vestibular monitoring and the impact of machine learning on vestibular diagnosis.

Examining Migraine as a Predictor of Benign Paroxysmal Positional Vertigo Onset, Severity, Recurrence, and Associated Falls

Introduction: The comorbidity of migraine and benign paroxysmal positional vertigo (BPPV) is well-established, yet the impact of migraine on the BPPV phenotype remains understudied.

Methods: A retrospective analysis of patients at a tertiary dizziness/vertigo clinic diagnosed with BPPV from 2015 and 2020 was conducted. The study's primary outcomes were the age of BPPV onset, Dizziness Handicap Index (DHI), BPPV recurrence, and dizziness-related falls.

Results: In our cohort of 255 BPPV patients, 44.7% had a history of migraine. Those with migraine had an earlier age of BPPV onset than individuals without migraine (60.2 vs. 65.4, p = 0.0018). Migraineurs and non-migraineurs did not differ in their DHI (44.7 vs. 41.6, p= 0.44), recurrence rates (48.3% vs. 40.4%, p= 0.21), and falls (32.5% vs. 37.6%, p = 0.39). Among individuals with horizontal canal BPPV, a higher proportion of migraineurs experienced falls than non-migraineurs (50.0% vs. 6.3%, p = 0.02).

Conclusions: Migraineurs experience BPPV at a younger age than those without migraine. This finding suggests that migraine, which has been shown to cause inner ear damage, predisposes individuals to developing BPPV earlier. Migraine was also associated with a higher rate of falls among patients with horizontal canal BPPV, indicating that a migraine history may impact the phenotype of BPPV.