Upright BPPV Protocol: Feasibility of a New Diagnostic Paradigm for Lateral Semicircular Canal Benign Paroxysmal Positional Vertigo Compared to Standard Diagnostic Maneuvers
Background: The diagnosis of benign paroxysmal positional vertigo (BPPV) involving the lateral semicircular canal (LSC) is traditionally entrusted to the supine head roll test, also known as supine head yaw test (SHYT), which usually allows identification of the pathologic side and BPPV form (geotro...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2020-11-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2020.578305/full |
| _version_ | 1819172834667134976 |
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| author | Salvatore Martellucci Pasquale Malara Andrea Castellucci Rudi Pecci Beatrice Giannoni Vincenzo Marcelli Alfonso Scarpa Ettore Cassandro Silvia Quaglieri Marco Lucio Manfrin Elisabetta Rebecchi Enrico Armato Francesco Comacchio Marta Mion Giuseppe Attanasio Massimo Ralli Massimo Ralli Antonio Greco Antonio Greco Marco de Vincentiis Marco de Vincentiis Cecilia Botti Cecilia Botti Luisa Savoldi Luigi Califano Angelo Ghidini Giulio Pagliuca Veronica Clemenzi Veronica Clemenzi Andrea Stolfa Andrea Stolfa Andrea Gallo Andrea Gallo Giacinto Asprella Libonati |
| author_facet | Salvatore Martellucci Pasquale Malara Andrea Castellucci Rudi Pecci Beatrice Giannoni Vincenzo Marcelli Alfonso Scarpa Ettore Cassandro Silvia Quaglieri Marco Lucio Manfrin Elisabetta Rebecchi Enrico Armato Francesco Comacchio Marta Mion Giuseppe Attanasio Massimo Ralli Massimo Ralli Antonio Greco Antonio Greco Marco de Vincentiis Marco de Vincentiis Cecilia Botti Cecilia Botti Luisa Savoldi Luigi Califano Angelo Ghidini Giulio Pagliuca Veronica Clemenzi Veronica Clemenzi Andrea Stolfa Andrea Stolfa Andrea Gallo Andrea Gallo Giacinto Asprella Libonati |
| author_sort | Salvatore Martellucci |
| collection | DOAJ |
| description | Background: The diagnosis of benign paroxysmal positional vertigo (BPPV) involving the lateral semicircular canal (LSC) is traditionally entrusted to the supine head roll test, also known as supine head yaw test (SHYT), which usually allows identification of the pathologic side and BPPV form (geotropic vs. apogeotropic). Nevertheless, SHYT may not always allow easy detection of the affected canal, resulting in similar responses on both sides and intense autonomic symptoms in patients with recent onset of vertigo. The newly introduced upright head roll test (UHRT) represents a diagnostic maneuver for LSC-BPPV, supplementing the already-known head pitch test (HPT) in the sitting position. The combination of these two tests should enable clinicians to determine the precise location of debris within LSC, avoiding disturbing symptoms related to supine positionings. Therefore, we proposed the upright BPPV protocol (UBP), a test battery exclusively performed in the upright position, including the evaluation of pseudo-spontaneous nystagmus (PSN), HPT and UHRT. The purpose of this multicenter study is to determine the feasibility of UBP in the diagnosis of LSC-BPPV.Methods: We retrospectively reviewed the clinical data of 134 consecutive patients diagnosed with LSC-BPPV. All of them received both UBP and the complete diagnostic protocol (CDP), including the evaluation of PSN and data resulting from HPT, UHRT, seated-supine positioning test (SSPT), and SHYT.Results: A correct diagnosis for LSC-BPPV was achieved in 95.5% of cases using exclusively the UBP, with a highly significant concordance with the CDP (p < 0.000, Cohen's kappa = 0.94), regardless of the time elapsed from symptom onset to diagnosis. The concordance between UBP and CDP was not impaired even when cases in which HPT and/or UHRT provided incomplete results were included (p < 0.000). Correct diagnosis using the supine diagnostic protocol (SDP, including SSPT + SHYT) or the sole SHYT was achieved in 85.1% of cases, with similar statistical concordance (p < 0.000) and weaker strength of relationship (Cohen's kappa = 0.80).Conclusion: UBP allows correct diagnosis in LSC-BPPV from the sitting position in most cases, sparing the patient supine positionings and related symptoms. UBP could also allow clinicians to proceed directly with repositioning maneuvers from the upright position. |
| first_indexed | 2024-12-22T20:13:29Z |
| format | Article |
| id | doaj.art-db33b4c954d84c15ac9600fca5ef432c |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-12-22T20:13:29Z |
| publishDate | 2020-11-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-db33b4c954d84c15ac9600fca5ef432c2022-12-21T18:14:01ZengFrontiers Media S.A.Frontiers in Neurology1664-22952020-11-011110.3389/fneur.2020.578305578305Upright BPPV Protocol: Feasibility of a New Diagnostic Paradigm for Lateral Semicircular Canal Benign Paroxysmal Positional Vertigo Compared to Standard Diagnostic ManeuversSalvatore Martellucci0Pasquale Malara1Andrea Castellucci2Rudi Pecci3Beatrice Giannoni4Vincenzo Marcelli5Alfonso Scarpa6Ettore Cassandro7Silvia Quaglieri8Marco Lucio Manfrin9Elisabetta Rebecchi10Enrico Armato11Francesco Comacchio12Marta Mion13Giuseppe Attanasio14Massimo Ralli15Massimo Ralli16Antonio Greco17Antonio Greco18Marco de Vincentiis19Marco de Vincentiis20Cecilia Botti21Cecilia Botti22Luisa Savoldi23Luigi Califano24Angelo Ghidini25Giulio Pagliuca26Veronica Clemenzi27Veronica Clemenzi28Andrea Stolfa29Andrea Stolfa30Andrea Gallo31Andrea Gallo32Giacinto Asprella Libonati33ENT Unit, Santa Maria Goretti Hospital, AUSL Latina, Latina, ItalyAudiology & Vestibology Service, Centromedico Bellinzona, Bellinzona, SwitzerlandENT Unit, Department of Surgery, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, ItalyAudiology Unit, AOU Careggi, Department of Surgery and Translational Medicine, University of Florence, Florence, ItalyAudiology Unit, AOU Careggi, Department of Surgery and Translational Medicine, University of Florence, Florence, ItalyA.S.L. Napoli 1 Centro, Ospedale del Mare, Naples, ItalyDepartment of Medicine and Surgery, University of Salerno, Salerno, ItalyDepartment of Medicine and Surgery, University of Salerno, Salerno, ItalyENT Unit, Policlinico San Matteo Fondazione (IRCCS), Pavia, ItalyENT Unit, Policlinico San Matteo Fondazione (IRCCS), Pavia, ItalyENT Unit, Guglielmo da Saliceto Hospital, Piacenza, ItalyENT Unit, SS Giovanni e Paolo Hospital, Venice, Italy0Department of Neurosciences, Regional Specialized Vertigo Center, Institute of Otolaryngology, University of Padua, Padua, Italy1ENT Unit, Department of Surgery, Santa Maria Della Misericordia Hospital, Rovigo, Italy2Head and Neck Department, ENT Clinic, Policlinico Umberto I, Rome, Italy2Head and Neck Department, ENT Clinic, Policlinico Umberto I, Rome, Italy3Department of Sense Organs, Sapienza University of Rome, Rome, Italy2Head and Neck Department, ENT Clinic, Policlinico Umberto I, Rome, Italy3Department of Sense Organs, Sapienza University of Rome, Rome, Italy3Department of Sense Organs, Sapienza University of Rome, Rome, Italy4Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, ItalyENT Unit, Department of Surgery, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy5PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy6Department Infrastructure Research and Statistics, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy7Departmental Unit of Audiology and Phoniatrics, G. Rummo Hospital Group, Benevento, ItalyENT Unit, Department of Surgery, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, ItalyENT Unit, Santa Maria Goretti Hospital, AUSL Latina, Latina, ItalyENT Unit, Santa Maria Goretti Hospital, AUSL Latina, Latina, Italy3Department of Sense Organs, Sapienza University of Rome, Rome, ItalyENT Unit, Santa Maria Goretti Hospital, AUSL Latina, Latina, Italy3Department of Sense Organs, Sapienza University of Rome, Rome, ItalyENT Unit, Santa Maria Goretti Hospital, AUSL Latina, Latina, Italy3Department of Sense Organs, Sapienza University of Rome, Rome, Italy8Vestibology and ENT Unit, Giovanni Paolo II Hospital, Matera, ItalyBackground: The diagnosis of benign paroxysmal positional vertigo (BPPV) involving the lateral semicircular canal (LSC) is traditionally entrusted to the supine head roll test, also known as supine head yaw test (SHYT), which usually allows identification of the pathologic side and BPPV form (geotropic vs. apogeotropic). Nevertheless, SHYT may not always allow easy detection of the affected canal, resulting in similar responses on both sides and intense autonomic symptoms in patients with recent onset of vertigo. The newly introduced upright head roll test (UHRT) represents a diagnostic maneuver for LSC-BPPV, supplementing the already-known head pitch test (HPT) in the sitting position. The combination of these two tests should enable clinicians to determine the precise location of debris within LSC, avoiding disturbing symptoms related to supine positionings. Therefore, we proposed the upright BPPV protocol (UBP), a test battery exclusively performed in the upright position, including the evaluation of pseudo-spontaneous nystagmus (PSN), HPT and UHRT. The purpose of this multicenter study is to determine the feasibility of UBP in the diagnosis of LSC-BPPV.Methods: We retrospectively reviewed the clinical data of 134 consecutive patients diagnosed with LSC-BPPV. All of them received both UBP and the complete diagnostic protocol (CDP), including the evaluation of PSN and data resulting from HPT, UHRT, seated-supine positioning test (SSPT), and SHYT.Results: A correct diagnosis for LSC-BPPV was achieved in 95.5% of cases using exclusively the UBP, with a highly significant concordance with the CDP (p < 0.000, Cohen's kappa = 0.94), regardless of the time elapsed from symptom onset to diagnosis. The concordance between UBP and CDP was not impaired even when cases in which HPT and/or UHRT provided incomplete results were included (p < 0.000). Correct diagnosis using the supine diagnostic protocol (SDP, including SSPT + SHYT) or the sole SHYT was achieved in 85.1% of cases, with similar statistical concordance (p < 0.000) and weaker strength of relationship (Cohen's kappa = 0.80).Conclusion: UBP allows correct diagnosis in LSC-BPPV from the sitting position in most cases, sparing the patient supine positionings and related symptoms. UBP could also allow clinicians to proceed directly with repositioning maneuvers from the upright position.https://www.frontiersin.org/articles/10.3389/fneur.2020.578305/fullBPPVhorizontal semicircular canal BPPVupright head roll testlateral semicircular canal BPPVhead pitch testupright BPPV protocol |
| spellingShingle | Salvatore Martellucci Pasquale Malara Andrea Castellucci Rudi Pecci Beatrice Giannoni Vincenzo Marcelli Alfonso Scarpa Ettore Cassandro Silvia Quaglieri Marco Lucio Manfrin Elisabetta Rebecchi Enrico Armato Francesco Comacchio Marta Mion Giuseppe Attanasio Massimo Ralli Massimo Ralli Antonio Greco Antonio Greco Marco de Vincentiis Marco de Vincentiis Cecilia Botti Cecilia Botti Luisa Savoldi Luigi Califano Angelo Ghidini Giulio Pagliuca Veronica Clemenzi Veronica Clemenzi Andrea Stolfa Andrea Stolfa Andrea Gallo Andrea Gallo Giacinto Asprella Libonati Upright BPPV Protocol: Feasibility of a New Diagnostic Paradigm for Lateral Semicircular Canal Benign Paroxysmal Positional Vertigo Compared to Standard Diagnostic Maneuvers Frontiers in Neurology BPPV horizontal semicircular canal BPPV upright head roll test lateral semicircular canal BPPV head pitch test upright BPPV protocol |
| title | Upright BPPV Protocol: Feasibility of a New Diagnostic Paradigm for Lateral Semicircular Canal Benign Paroxysmal Positional Vertigo Compared to Standard Diagnostic Maneuvers |
| title_full | Upright BPPV Protocol: Feasibility of a New Diagnostic Paradigm for Lateral Semicircular Canal Benign Paroxysmal Positional Vertigo Compared to Standard Diagnostic Maneuvers |
| title_fullStr | Upright BPPV Protocol: Feasibility of a New Diagnostic Paradigm for Lateral Semicircular Canal Benign Paroxysmal Positional Vertigo Compared to Standard Diagnostic Maneuvers |
| title_full_unstemmed | Upright BPPV Protocol: Feasibility of a New Diagnostic Paradigm for Lateral Semicircular Canal Benign Paroxysmal Positional Vertigo Compared to Standard Diagnostic Maneuvers |
| title_short | Upright BPPV Protocol: Feasibility of a New Diagnostic Paradigm for Lateral Semicircular Canal Benign Paroxysmal Positional Vertigo Compared to Standard Diagnostic Maneuvers |
| title_sort | upright bppv protocol feasibility of a new diagnostic paradigm for lateral semicircular canal benign paroxysmal positional vertigo compared to standard diagnostic maneuvers |
| topic | BPPV horizontal semicircular canal BPPV upright head roll test lateral semicircular canal BPPV head pitch test upright BPPV protocol |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2020.578305/full |
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