BPPV Simulation: A Powerful Tool to Understand and Optimize the Diagnostics and Treatment of all Possible Variants of BPPV

Abstract

BPPV is a mechanical disorder caused by the displacement of otolith debris into the semicircular canals. The treatment involves different repositioning maneuvers to bring the debris back into the utricle. This study aims to show how dynamic simulation models based on fluid dynamics and MRI, can help to visualize and understand the movement of the debris within the canals during head movement in 3D as a function of time. The user can define the rotation angle and plane at each step of the maneuver and then the model visualizes the canal and the otoconial movement in 3D. The simulation developed also allows alteration of various parameters like the rotational head acceleration, the duration of each step of the maneuver, the initial position of the otoconial debris in the canal, the size and the number of the particles and fluid dynamics of endolymph. The clod movement is visualized in such a way that it allows a better understanding of the impact and efficacy of various liberation maneuvers and why certain maneuvers might fail when not applied properly in the clinic. The model allows simulation of multi-canal BPPV. In this paper we demonstrate the power of the model applied on the maneuvers of Semont and Yacovino when executed in different ways. The model aims to provide a visual explanation for the need of specific maneuvers for each type of BPPV. The simulator presented here can be used to test the efficacy of existing maneuvers and help in the development of new maneuvers to treat different BPPV variants.

Design and Analysis of Posterior Semicircular Canal BPPV Diagnostic Test Based on Physical Simulation

“…The nystagmus characteristics of BPPV include latency, direction of nystagmus, duration, reversal, and fatigability [1][3] [7] .…”

“…BPPV simulation model is an important tool to study BPPV [7] . Its premise is to establish the membrane labyrinth model in standard spatial coordinate system.…”

Diagnostic and Therapeutic Maneuvers for Anterior Canal BPPV Canalithiasis: Three-Dimensional Simulations

“…Based on reconstructed MRI images and fluid dynamics, a 3D dynamic simulation model (as a function of time) was developed and applied [for more details, refer to Bhandari et al (23)] The simulation allowed placement of the debris at variable positions within the canal and also in more than one canal simultaneously. The time between the two steps of the maneuver required for the debris to reach the desired position is accelerated for better understanding and ease of demonstration.…”

“…In this article, we present the simulation of ac-BPPV in the three-dimensional space to optimally visualize the movement of the head, labyrinth, and otoconial debris for practical clinical use. We used a software-based simulator (4,21,23) to study different positional tests and liberatory maneuvers in ac-BPPV by demonstrating the continuous dynamic movement of the otoconial debris in the anterior canal as a function of time and angulation. The simulation depicts the movement of the debris in the canal at each step.…”

“…It is important to note that these are true simulations of the debris movement based on the biophysics of BPPV and not simple animations. Basic assumptions regarding the debris size and distribution, endolymph viscosity, and canal geometry have been taken into consideration (4,23).…”