Description: Mechanical Rotation Chairs (MRCs) have proven very successful with both diagnostics and treatments of patients with Benign Paroxysmal Positional Vertigo (BPPV). Previous studies have shown that an MRC offer superior diagnostics by being more sensitive (and thereby accurate) than traditional BPPV diagnostics. With canalith repositioning maneuver (CRM) refractory BPPV patients (retractable BPPV cases, multi-canal BPPV, cupulolithiasis subtype BPPV), MRCs provide successful treatment with overall success rates of 90+ percentages. Even very retractable BPPV cases (defined by a need of more than ten MRC treatments) can also, to a large extent, be treated successfully by individually targeted treatments.

Outcome Objectives: The primary objective is to describe results from ten years of clinical experience and research with two separate MRCs on BPPV diagnostics and -treatments. A total of twelve (seven originating from own Tertiary University Hospital based outpatient clinic) clinical trials evaluating both BPPV diagnostics and -treatments with MRCs will be included.

Background: Patients with BPPV may be seen, diagnosed, and treated by many different health care professionals, e.g. General Practitioners or Physiotherapists (primary sector), ENT Specialists (secondary sector) or Neurotologists at highly specialized University Hospital-based centers (tertiary sector). Despite an a priori good prognosis for successful treatment, ten to twenty percent of patients diagnosed with BPPV cannot be treated successfully by means of traditional CRMs carried out on an examination bed. Therefore, several new therapeutic modalities like bi- axial MRCs have been developed.

Vestibular sub-ablative and ablative treatment of Meniere's disease

BPPV - Is completely clarified?

Introduction and objectives: The diagnostic accuracy and reliability of the head pitch test in differentiating between different types of BPPV require further investigation. Studying the diagnostic accuracy of the head pitch test in BPPV diagnosis can aid in the development of targeted management strategies for patients presenting with BPPV.

Methods: All patients who complained of positional vertigo for seconds underwent complete videonystagmography test using ICS Chartr 200 VNG/ENG system (Otometrics, Denmark) including : spontaneous nystagmus, complete occulomotor test battery, then the head pitch test was performed in two positions: first the patient's head was bent 90 degrees forwards, then 60 degrees backwards for approximately 1 min each. If nystagmus was observed, its direction was recorded.1All patients then underwent gold standard tests for positional vertigo including both Dix-Hallpike maneuver and the supine roll tests.

Results: The sensitivity (true positive cases) was defined as the head pitch (HPT) test being positive and showing the correct nystagmus for different categories of BPPV. The sensitivity of the experimental HPT was compared to the gold standard tests (100% sensitive) for diagnosis of different categories of vertical canal and lateral canal BPPV. It was highest (100%) for Lateral Cupulolithiasis patients (n = 12) and Anterior canal Canalithiasis (n = 3) and lowest (68%) for Typical Posterior Canalithiasis patients (n = 68).

Conclusion: This study supports the addition of the head pitch test in the routine assessment of patients with positional vertigo. As it could shorten the examination time and decrease the repositioning maneuvers which may cause severe autonomic symptoms.