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ORIGINAL RESEARCH article
Front. Neurol.
Sec. Neuro-Otology
Volume 16 - 2025 | doi: 10.3389/fneur.2025.1549407
Quantified Assessment of 3D Nystagmus in BPPV: Practical Considerations
Provisionally accepted- 1 The Ohio State University, Columbus, United States
- 2 Northwest Speech and Hearing, Arlington Heights, United States
- 3 University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
- 4 University of Pittsburgh, Pittsburgh, Pennsylvania, United States
Patients with posterior canal benign paroxysmal positional vertigo (BPPV) have a characteristic response of torsional-vertical nystagmus after a Dix-Hallpike maneuver. The nystagmus usually has a delayed onset with the intensity increasing rapidly and then subsiding over a relatively short duration of less than one minute. We recorded horizontal, vertical, and torsional eye movements with a VNG system in 15 patients with case histories consistent with BPPV. The nystagmus response patterns were quantified by the latency, peak nystagmus intensity, duration, rise time, and fall time parameters. The results showed a high degree of variability in the response parameters, which signifies that a typical response pattern is not universal in patients with BPPV. In addition to the torsional-vertical nystagmus response, all patients exhibited different levels of horizontal nystagmus. However, the direction and the timing of the responses were not consistent. Some patients showed nystagmus patterns that lasted much longer than one minute. Other patients had lower levels of nystagmus in response to the Dix-Hallpike contralateral to the affected side. The differences in response patterns may signify differences in the composition or the placement of otoconia within the canal, which may affect the patient symptoms and the outcome of the repositioning maneuvers. However, some of the variability may reflect how the test is performed and how the eye movements are recorded. The purpose of this study was to demonstrate the need for standardization of nystagmus recording protocols because responses to the Dix-Hallpike maneuver are influenced by many factors such as the gaze direction and whether the measurements are made from the ipsilateral or contralateral eye.
Keywords: BPPV, Torsion, Nystagmus, Dix-Hallpike, canaliths, Posterior canal
Received: 21 Dec 2024; Accepted: 10 Mar 2025.
Copyright: © 2025 Barin, Petrak, Cassidy and Whitney. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Kamran Barin, The Ohio State University, Columbus, United States
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