Horizontal canal benign paroxysmal positional vertigo: diagnosis and treatment of 37 patients (original) (raw)

2015, Arquivos De Neuro-psiquiatria

Benign paroxysmal positional vertigo (BPPV) is the most frequent type of vertigo 1,2,3 with prevalence between 10.7 and 64.0 per 100,000 population, and lifetime prevalence estimated of 3.2% in females, 1.6% in males, and 2.4% overall 1. BPPV generally has the highest age distribution in the sixth decade of life 3,4 , with a prevalence approaching 9% among the elderly population 5. It is characterized by brief, recurrent episodes of vertigo triggered by changes in head position. Its pathophysiology, so called the "vestibular stones, " concept, is either due to abnormal stimulation of the dome caused by free-floating otoliths within semicircular canals (canalolithiasis), or otoliths clinging in the dome (cupulolithiasis) 4,6,7. The duration, frequency and intensity of symptoms, as well as the nystagmus phenotype, vary depending on the canal in question and the location of the debris within them. The idiopathic form is the most frequent and the average duration of episodic symptoms is about two weeks 8. The right ear is usually more involved 9. Eighty-six percent of affected individuals seek medical care but only 8% receive effective treatment 8. When considering the frequency of affected semicircular canals, certainly for anatomical / positional reasons, BPPV of the horizontal canal (HC-BPPV) is four times less frequent than the posterior canal (PC-BPPV) 6,10 , but this frequency is increasing and currently, depending on the study, the recognition of HC-BPPV ranges from 10% to 42.7% 11,12. Although the symptoms in HC-BPPV and PC-BPPV are similar, important