BPPV Simulation: A Powerful Tool to Understand and Optimize the Diagnostics and Treatment of all Possible Variants of BPPV.

Anita Bhandari,Herman Kingma,Rajneesh Bhandari

doi:10.3389/fneur.2021.632286

Abstract

BPPV is a mechanical disorder caused by the displacement of otolith debris into the semicircular canals. The treatment involves different repositioning maneuvers to bring the debris back into the utricle. This study aims to show how dynamic simulation models based on fluid dynamics and MRI, can help to visualize and understand the movement of the debris within the canals during head movement in 3D as a function of time. The user can define the rotation angle and plane at each step of the maneuver and then the model visualizes the canal and the otoconial movement in 3D. The simulation developed also allows alteration of various parameters like the rotational head acceleration, the duration of each step of the maneuver, the initial position of the otoconial debris in the canal, the size and the number of the particles and fluid dynamics of endolymph. The clod movement is visualized in such a way that it allows a better understanding of the impact and efficacy of various liberation maneuvers and why certain maneuvers might fail when not applied properly in the clinic. The model allows simulation of multi-canal BPPV. In this paper we demonstrate the power of the model applied on the maneuvers of Semont and Yacovino when executed in different ways. The model aims to provide a visual explanation for the need of specific maneuvers for each type of BPPV. The simulator presented here can be used to test the efficacy of existing maneuvers and help in the development of new maneuvers to treat different BPPV variants.

Highlights

Benign Paroxysmal Positional Vertigo (BPPV) is amongst the most common causes of vertigo
Step 4–Particle falls back into the utricle. This maneuver is widely accepted, but when we tried the maneuver in the simulator, we found that it has a high chance of canal switch with the particle entering into the posterior canal while treating the anterior canal BPPV [27]
A simulator based on the reconstructed human MRI images works as a guidance system during the maneuvers of BPPV

Summary

Introduction

Benign Paroxysmal Positional Vertigo (BPPV) is amongst the most common causes of vertigo. It is a mechanical disorder of the inner ear caused by the displacement of calcium carbonate particles from the utricle into the semicircular canals. In BPPV patients, the presence in the canal of heavy otolith debris with a specific mass close to 2.7 makes the canal sensitive to the head orientation relative to the gravity vector. A change of Simulation Clod Movements During Manoevres head position relative to the gravity vector leads to a movement of free floating heavy debris (canalolithiasis) and induces an endolymphatic flow and an associated cupula deflection leading to nystagmus. A patient with BPPV, either Canalolithiasis or cupulolithiasis, will, experience rotatory vertigo by head tilts because the cupula deflection is interpreted by the brain as an angular acceleration [1,2,3,4,5,6,7]

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