Diagnosis and rehabilitation of anterior canal benign paroxysmal positional vertigo

Abstract

To assess clinical symptoms and rehabilitation of anterior canal benign paroxysmal positional vertigo (aBPPV) in comparison to horizontal canal BPPV (hBPPV) and posterior canal BPPV (pBPPV). The study included 22 patients with aBPPV, 450 patients with pBPPV and 88 patients with hBPPV from total 640 patients with definite BPPV. Rehabilitation of BPPV included different manual repositioning maneuvers. In case of unsuccessful reposition during the visit the patients practiced various home-based repositioning maneuvers and underwent reposition in multipositional mechanical chair. Clinical symptoms and repositioning process in patients with aBPPV were compared to patients with hBPPV and pBPPV, nystagmus was analyzed in aBPPV during the rehabilitation. ABPPV is a rare type of otolithiasis (3.4% of all BPPVcases). aBPPV typically has no association with middle and inner ear pathology and head trauma. Clinical symptoms in aBPPV are equal to pBPPV and less severe than in hBPPV. In aBPPV cases dominates cupulolithiasis type of canal involvement, which leads to treatment resistance and complex rehabilitation process, which includes repeat visits, multiple repeat maneuvers by specialist, home-based treatment and use of multipositional mechanical chair. Residual dizziness with duration more than a week after successful reposition occurs more often in patients with aBPPV compared to hBPPV and pBPPV cases. In aBPPV cases atypical change of nystagmus could be observed which could be due to canal switch from anterior to posterior canals, primary location of otoliths in common crus of vertical canals or masking chronic otolithiasis of anterior short arm of posterior canal.