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Benign Paroxysmal Positional Vertigo—Toward New Definitions

Büki, Béla

doi: 10.1097/MAO.0000000000000197
Vestibular Disorders
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Objective To review new clinical data and theories concerning atypical positional nystagmus in vertical canal benign paroxysmal positional vertigo (BPPV).

Data Sources Peer reviewed, clinical papers describing nystagmus provoked by positioning in cases with BPPV.

Study Selection Basic scientific articles detailing 3D anatomical reconstructions of the inner ear.

Conclusion In BPPV, it is hypothetically possible that otoconia become dislocated but do not fall into the common crus of the vertical canals or into the horizontal canal; in these cases, they may gravitate toward the most inferior part of the utriculus, the ampulla of the inferior canal. It is argued that in these cases, depending on their behavior (free-floating or sticking to the cupula) and the precise position of the inferior ampulla, either no nystagmus or a slow downbeat nystagmus should ensue when the patient is positioned from sitting to a Dix-Hallpike position. Such scenarios could hypothetically explain commonly seen clinical entities such as “subjective BPPV” and/or cases with a peripheral positional downbeat nystagmus.

Department of Otolaryngology, County Hospital Krems, Austria

Address correspondence and reprint requests to Béla Büki, M.D., Ph.D., HNO-Abteilung, LKH Krems, Mitterweg 10, A-3500 Krems an der Donau, Austria; E-mail: bukibela@hotmail.com

The author discloses no conflict of interest.

Copyright © 2014 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company