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. 2021 Feb;13(2):107-112.
doi: 10.14740/jocmr4413. Epub 2021 Feb 25.

Active Head Auto-Rotations in Patients With Benign Paroxysmal Positional Vertigo

Sertac Yetiser  1 , Dilay Ince  1
Affiliations

Active Head Auto-Rotations in Patients With Benign Paroxysmal Positional Vertigo

Sertac Yetiser et al. J Clin Med Res. 2021 Feb.

Abstract

Background: Utricular degeneration is the source of traveling otoconia inside the semicircular canals in patients with benign paroxysmal positional vertigo (BPPV). The underlying pathology is not clear. The aim of this study was to analyze vestibulo-ocular reflex (VOR) during sudden head accelerations in those patients since clinical reports designating an association of BPPV with inner ear problems are increasing.

Methods: VOR reaction to impulsive head rotations were tested in 34 patients with BPPV (13 lateral, 21 posterior canal BPPV) and 15 healthy subjects in a prospective controlled study. Main outcome measure was the gain (the ratio of head and eye velocity) of vertical and horizontal head auto-rotations to the pathologic and normal sides.

Results: All patients with BPPV and control subjects had normal gain (≥ 0.9) at 1 and 2 Hz but the gain decreased at higher frequencies. No statistically significant difference was found when comparing the gain between the horizontal head rotations toward the pathologic and those toward the normal side (P = 0.89, P = 0.90, P = 0.78, P = 0.20 and P = 0.16, at 1, 2, 3, 4 and 5 Hz, respectively) and between upward and downward vertical head rotations (P = 0.28, P = 0.53 and P = 0.15, at 1, 2 and 3 Hz, respectively) in patients with lateral and posterior canal BPPV.

Conclusion: VOR gain was reduced in some patients. However, head auto-rotation test (HART) does not show any functional abnormality of VOR during head rotations toward the pathologic side. HART is not suitable as a screening test for BPPV.

Keywords: Benign paroxysmal positional vertigo; Head auto-rotation; Nystagmus; Vestibulo-ocular reflex.

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Conflict of interest statement

The authors declare that they have no conflict of interest in the manuscript.

Figures

Figure 1
Figure 1
Active head auto-rotation recording of the patient with benign paroxysmal positional vertigo (BPPV). Head and eye recordings during horizontal head rotations are seen in upper drawing. Lower recording shows vertical head and eye movement (head rotations are dark, and eye movements are light color).
Figure 2
Figure 2
Comparison of horizontal gain in patients with BPPV and control subjects (LC: lateral canal, PC: posterior canal).
Figure 3
Figure 3
Comparison of vertical gain in patients with BPPV and control subjects (LC: lateral canal, PC: posterior canal).
See this image and copyright information in PMC

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