Diagnostic accuracy of the head pitch test in benign paroxysmal positional vertigo.

Mayada Elsherif, Alia E L Karaksy, Dalia Eldeeb, Mirhan Eldeeb
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Abstract

Introduction and objectives: The diagnostic accuracy and reliability of the head pitch test in differentiating between different types of BPPV require further investigation. Studying the diagnostic accuracy of the head pitch test in BPPV diagnosis can aid in the development of targeted management strategies for patients presenting with BPPV METHODS: All patients who complained of positional vertigo for seconds underwent complete videonystagmography test using ICS Chartr 200 VNG/ENG system (Otometrics, Denmark) including : spontaneous nystagmus, complete occulomotor test battery, then the head pitch test was performed in two positions: first the patient's head was bent 90 degrees forwards, then 60 degrees backwards for approximately 1 minute each. If nystagmus was observed, its direction was recorded1. All patients then underwent gold standard tests for positional vertigo including both Dix-Hallpike maneuver and the supine roll tests.

Results: The sensitivity (true positive cases) was defined as the head pitch (HPT) test being positive and showing the correct nystagmus for different categories of BPPV. The sensitivity of the experimental HPT was compared to the gold standard tests (100% sensitive) for diagnosis of different categories of vertical canal and lateral canal BPPV. It was highest (100%) for Lateral Cupulolithiasis patients (n = 12) and Anterior canal Canalithiasis (n = 3) and lowest (68%) for Typical Posterior Canalithiasis patients (n = 68).

Conclusion: This study supports the addition of the head pitch test in the routine assessment of patients with positional vertigo. As it could shorten the examination time and decrease the repositioning maneuvers which may cause severe autonomic symptoms.

前言和目的:颅距试验在区分不同类型BPPV诊断中的准确性和可靠性有待进一步研究。方法:所有体位性眩晕患者均采用ICS Chartr 200 VNG/ENG系统(Otometrics,丹麦)进行完整的视震仪测试,包括自发性眼球震颤、完全眼动测试电池,然后在两个体位进行头距测试。首先患者头部向前弯曲90度,然后向后弯曲60度,每次约1分钟。如果观察到眼球震颤,则记录其方向1。所有患者随后接受体位性眩晕的金标准测试,包括Dix-Hallpike手法和仰卧翻滚测试。结果:敏感度(真阳性病例)定义为头距(HPT)试验阳性,并正确显示不同类型BPPV的眼球震颤。将实验HPT与金标准试验(100%敏感性)对不同类型的垂直管和侧管BPPV的诊断进行比较。侧管结石患者(n = 12)和前管结石患者(n = 3)发生率最高(100%),典型后管结石患者(n = 68)发生率最低(68%)。结论:本研究支持在体位性眩晕患者的常规评估中增加头距试验。因为它可以缩短检查时间,减少可能引起严重自主神经症状的重新定位动作。
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