Review of the pathology underlying benign paroxysmal positional vertigo

Abstract

The pathophysiological mechanism underlying benign paroxysmal positional vertigo (BPPV) is related to free-floating debris/otoliths in the semicircular canal (canalolithiasis) or debris/otoliths attached to the cupula (cupulolithiasis). These debris/otoliths are considered to originally accumulate after detachment from the neuroepithelium of the utricular macula secondary to a type of degeneration. An idiopathic form, which is assumed to occur spontaneously, is diagnosed when the causative pathology is obscure. However, an association between various other systemic or inner ear conditions and BPPV has been reported, indicating the existence of secondary BPPV. This study was performed to present the first review of the pathology underlying BPPV following a complete PubMed/Medline search. In total, 1932 articles published from 1975 to 2018 were reviewed. The articles were classified according to 17 potentially causative factors (aging; migraine; Meniere's disease; infection; trauma; idiopathic sudden sensorineural hearing loss; sleeping habits; osteoporosis and vitamin D insufficiency; hyperglycemia and diabetes mellitus; chronic head and neck pain; vestibule or semicircular canal pathology; pigmentation disorders; estrogen deficiency; neurological disorders; autoimmune, inflammatory, or rheumatologic disorders; familial or genetic predisposition; and allergy). A discussion of the underlying cause of BPPV for each factor is presented.

Post-concussive Dizziness: A Review and Clinical Approach to the Patient

“…For BPPV, the most common type is unilateral posterior semicircular canalithiasis—free floating otoliths in the posterior semicircular canal in one ear. However, in PCD, we see a much higher incidence of atypical canal BPPV (horizontal and anterior semicircular canals), multiple canal involvement, bilateral BPPV and recurrent BPPV ( 28 – 31 ). The symptom presentation and the diagnostic findings on the Dix-Hallpike maneuver will be quite different for these variations and are more challenging to treat.…”

“…These patients often have symptoms beyond the first three weeks but should show significant improvement by 3 months post-injury. Labyrinthine concussion, most temporal bone fractures and cochleovestibular nerve traction injuries will present clinically in this manner (27). All will have varying degrees of vertigo, hearing loss, and tinnitus.…”

“…BPPV is by far the most common inner ear condition causing PCD. Among patients with concussions, the prevalence of BPPV ranges from 10 to 57% ( 9 – 15 , 28 ). This is likely an underestimate of BPPV cases, due to either inadequate investigation or spontaneous resolution prior to evaluation.…”

Clinical effect of vestibular rehabilitation on benign paroxysmal positional vertigo

“…[ 7 – 10 ] It occurs in the inner ear because of the changes in position. [ 9 – 12 ] Although standard treatment is applied to manage such disorder, its 1-year recurrence rate is about 20%, and its 4 to 5 year recurrence rate is between 40% and 50%. [ 13 – 15 ] Thus, effective treatments are still urgent to help manage such issue.…”

Audio-Vestibular Findings in Patients with Hyperuricemia

“…In neuro-otology clinics, it is very common to encounter the benign paroxysmal positional vertigo [BPPV] [5] . It usually presented by a short, recurrent episodes of vertigo induced by certain positions of the head.…”