BPPV- residual dizziness BPPV- residual dizziness BPPV- residual dizziness

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.

Course description — the course will begin with a didactic overview of new developments in diagnosis and management of patients with PPPD (8 minutes), continue with a case-based discussion highlighting common challenges in diagnosis and treatment that will be conducted interactively with the audience (17 minutes), and conclude with time for open questions from the audience (5 minutes).

outcome objectives — at the conclusion of this course, audience members will be able to: (1) incorporate simple screening tools into their practices to identify patients who are at risk for developing PPPD and those who likely have the disorder, (2) confidently manage the diagnostic evaluation of patients with PPPD, (3) educate patients about pathophysiologic mechanisms underlying PPPD to help them understand the diagnosis and rationale for each treatment intervention, and (4) coordinate effective multi-disciplinary treatment plans for patients with PPPD and commonly comorbid conditions.

background — the chronic vestibular disorder of persistent postural-perceptual dizziness (PPPD) was defined by the barany society for the international classification of vestibular disorders in 2017. Since then, clinical epidemiologic investigations have found PPPD to be the most common cause of chronic vestibular and balance symptoms in otology/neurotology and vestibular medicine. Systematic research also has advanced knowledge about its differential diagnosis, likely pathophysiologic mechanisms, and expected outcomes of available treatments. This information has improved our ability to efficiently and effectively detect and treat patients with PPPD. The course will provide attendees with a review of these developments with an emphasis on practical applications for clinical practice and awareness of ongoing investigations by research teams worldwide.