Benign paroxysmal positional vertigo can be diagnosed with proper history taking

Korea: Benign paroxysmal positional vertigo is characterized by brief spinning sensations, which are generally induced by a change in head position with respect to gravity. BPPV is estimated to affect roughly 50% of all people at some time in their lives and becomes progressively more common with age. 

BPPV is caused when loose chalk crystals get into the wrong part of the inner ear. These microscopic crystals should be embedded in a lump of jelly. The crystals weigh the jelly down and make that part of the ear sensitive to gravity. The crystals are constantly being re-absorbed and re-formed and over time fragments come loose. Lying flat can then occasionally cause some of the loose debris to fall into one of the semi-circular canals; the parts of the ear responsible for sensing rotation. Movement in the plane of the affected canal causes the crystals to move along the canal, stimulating it and giving the sensation of rotation. Diagnosis is made from characteristic history and excluding other symptoms which causes dizziness. Treatment involves canalith-repositioning manoeuvres.

A group of scientists conducted a study which included 578 patients conducted at the Dizziness Clinic of Seoul National University Bundang Hospital. The study published in the Neurology Journal included a questionnaire that consisted of 6 questions, the first 3 to diagnose BPPV and the next 3 to determine the involved canal and type of BPPV.

The first three questions asked whether the patient had

(1) a sensation that the surroundings or the patient were spinning,

(2) dizziness occurring mostly with head movement, and

(3) duration of dizziness less than 3 minutes.

Of the 578 patients, 200 were screened to have BPPV and 378 were screened to have dizziness/vertigo due to disorders other than BPPV. Of the 200 patients with a questionnaire-based diagnosis of BPPV, 160 (80%) were confirmed to have BPPV with positional tests. Of the 378 patients with a questionnaire-based diagnosis of non-BPPV, 24 (6.3%) were found to have BPPV with positional tests.

Thus, the sensitivity, specificity, and precision of the questionnaires for the diagnosis of BPPV were 87.0%, 89.8%, and 80.0%.

For further reading click on the following link,

https://doi.org/10.1212/WNL.0000000000008876