Benign Paroxysmal Positional Vertigo and Concomitant Otolithic Dysfunction

Abstract

Objectives:This prospective study is designed to clarify the association of Otolithic dysfunction (dysfunction of Utricle) in our outpatient service which is secondary referral otology and neurotology clinic. The parallel usage of OVEMP with ENG and VHIT is an asset to study site of lesion within vestibular system. According to our findings in 152 patients complaining of vertigo compatible with BPPV, we could expect that recurrent canalolithiasis is originated from some dysfunction in Utricle. It may be due to dysfunction of Macula in maintaining the balance of calcium carbonate crystals (Statoconia) in the utricles. As a matter of fact, dysfunction of Utricle ignites the canalolithisis resulting BPPV symptoms. We studied all of our patients with true positional vertigo lasting for seconds and we confirmed BPPV with Hallpike’s maneuver. We carried out Epley’s maneuver for all patients and visited the patients regularly for assessment of treatment and possible recurrence. We also checked all patients with oVEMP (ocular Vestibular Evoked Myogenic Potential), cVEMP (Cervical Vestibular Evoked Myogenic Potential) and ENG (Electro nystagmography). We found OVEMP abnormality without ENG abnormality that it specifically shows dysfunction of utricle. All patients are divided based on their age and recurrence and we evaluate the abnormality of OVEMP again. Rate of OVEMP abnormality is much higher in patients with recurrent BPPV and it is very high in younger age group when we compare it with age more than 50 and the first attacks. We can logically conclude that canalolithiasis is not an accidental flow of calcium carbonate in the semicircular canals but it can happen when the balance of these particles impaired in utricle. This impairment can be associated with other structural abnormalities in the hydrodynamic characteristics of semi -circular canals making recurrent or reluctant BPPV.