Vertigo is often a challenge for the generalist ENT practitioner. Even with computer tools, doubt can persist between central and peripheral origin and about the need to carry out a maneuver for VPPB. The HINTS protocol, applied in the emergency rooms, has been the reference for several years and is more sensitive than an MRI within the first 48 hours. Many vertiginous patients are mishandled, making them worse. The HINTS protocol should be applied as well in general ENT. After a quick introduction on nystagmus, will follow a step by step videos presentation of the HINTS protocol.

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.