Chapter-06 Horizontal Benign Paroxysmal Positional Vertigo

BOOK TITLE: Understanding Benign Paroxysmal Positional Vertigo

1. Libonati Giacinto Asprella
Publishing Year
Author Affiliations
1. Ospedale di Policoro, Matera, Italy
Chapter keywords
Benign paroxysmal positional vertigo, BPPV, horizontal semicircular canal, HSC, HSC BPPV, nystagmus, horizontal BPPV, barbecue rotation technique, linear acceleration, central positional vertigo, CPV


Benign paroxysmal positional vertigo (BPPV) peak of incidence occurs between 50 and 60 years of age but it can occur at any age, even in infants. The labyrinthine mechanical disorder that causes BPPV is due to the presence of otoconial debris detached from the utricular macula and free floating inside the semicircular canals. The most used BPPV classification in clinical practice is based on the involved canal i.e. posterior semicircular canal (PSC), horizontal semicircular canal (HSC) or lateral semicircular canal, anterior semicircular canal (ASC) and multicanal BPPV. The second most common type of BPPV is HSC BPPV, accounting for 15–25% of all BPPV cases and discussed in this chapter. The HSC BPPV pathophysiology is most frequently ascribed to free floating debris inside the HSC modifying the cupula’s sensitivity to accelerations, according to the canalolithiasis theory. The diagnosis is performed identifying the HSC BPPV canalolithiasis nystagmus whose typical features are tabulated in this chapter. Persistent horizontal nystagmus in the upright position can be observed in patients suffering from HSC BPPV and it can be misinterpreted as spontaneous nystagmus due to any cause of acute vestibular imbalance such as vestibular neuritis (VN). The differential diagnosis is based on two points i.e. pseudospontaneous nystagmus and pseudospontaneous nystagmus. Many therapeutic techniques have been proposed for HSC BPPV, all of them aim to achieve the ampullofugal endocanalar progression of the otoconial debris which are broadly described in this chapter. Post-treatment complications are also covered in this chapter.

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