New developments in the diagnosis of benign paroxysmal positional vertigo.

Abstract

Since the diagnostic criteria of benign paroxysmal positional vertigo (BPPV) were published in 2015 by the Bárány Society, many new ideas and observations have been introduced concerning the diagnostic methods, classification and related theories of pathomechanisms of this most frequent vestibular disease. The aim of the authors was to review new diagnostic methods, classification, hypothetical pathomechanisms of the recently introduced BPPV variants. To look for answers to the "Questions for the Future" published in the Consensus Document (2015) of the Committee for Classification of Vestibular Disorders of the Bárány Society, the authors reviewed the publications listed in PUBMED since 2015 on "diagnosis," "classification," "pathomechanism," of BPPV in the light of their own studies. The questions were:1. The possible role of loose otoconia within the short arm of the semicircular canals.2. Coexistence of canalithiasis and cupulolithiasis.3. Mechanism of "pseudospontaneous" nystagmus and the theory of "canalith jam".4. Mechanism of persistent geotropic direction-changing positional nystagmus and the theory of light cupula.5. Anterior canalithiasis and the posterior cupulolithiasis.New research results contribute to our understanding of previously unclassified symptoms and examination results. As a conclusion it can be stated that the newly defined entities are important for topodiagnosis and successful treatments by physiotherapy.