Demography, aetiology, and positional test findings of 187 consecutive patients diagnosed as having BPPV at ENT unit, Teaching Hospital Anuradhapura

Abstract

Benign Paroxysmal Positional Vertigo (BPPV) is the most common vestibular disorder encountered in balance clinics. Diagnosis by Dix-Hallpike test is straightforward. However, diagnosis can still be complicated due to the presence of number of different subtypes and negative findings. Objectives of the study are to determine demographic pattern, positional test findings in patients diagnosed as having BPPV and to discuss the reasons for positional vertigo with negative physical examination findings. A subgroup analysis was done from a cross sectional descriptive study that was carried out at ENT clinic at Teaching Hospital Anuradhapura from 1st of March 2016 to 28th February 2017. Hundred and eighty-seven (187) consecutive patients with symptoms suggestive of BPPV were assessed .Posterior semi-circular canal involvement as the commonest variant with 70% diagnosed without video Frenzels. Although symptomatic during positional testing, we could not demonstrate clear nystagmus in 24.6% patients in light. Geotrophic or apogeotrophic horizontal nystagmus on supine roll test and down beating nystagmus on Dix-Hallpike test were found 4.2% and 1% respectively.Our findings on posterior canal and positional test negative BPPV are compatible with previously published data. However, diagnosis of lateral appears to be still inadequate. Early referral, routine use of video Frenzel recording at clinics, routine use of seated pitch test, repeated testing may help in reducing false negative rates and finding a specific diagnosis.