Mechanical rotation chair method superior to traditional manual BPPV diagnostics for diagnosing complex BPPV: Study

Benign paroxysmal positional vertigo (BPPV) is the most common vestibular disease that causes vertigo due to the dislodgement of otoconia. BPPV is classified into different types based on the anatomical location of otoliths and the endolymphatic flow. A clinician diagnoses BPPV using traditional manual diagnostics. With the advent of various diagnostic methods, the management of BPPV has improved a lot. Hence, researchers have conducted a study to compare traditional manual BPPV diagnostics (MD) with MRC when using videonystagmography goggles with both modalities.

A prospective open-label randomized diagnostic crossover study involved adults with typical BPPV symptoms at a tertiary University Hospital-based outpatient clinic in Denmark. Participants underwent traditional manual and MRC diagnostics with videonystagmography goggles by randomly assigning participants to the two modalities with a duration gap of 30 minutes between the two procedures. Identifying the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the traditional procedure with MRC was the primary outcome of measurement. Agreement between the two modalities was the secondary outcome of measurement.

Findings:

• MRC diagnostics demonstrated a significantly higher sensitivity for detecting BPPV across all participants (p=0.00).
• Compared to MRC diagnostics, traditional MD displayed a sensitivity of 69.5%, specificity of 90.9%, PPV of 88.0%, and NPV of 75.8%.
• Both the diagnostics showed an overall inter-modality agreement of 80.5%.
• Both modalities detected the unilateral posterior canal BPPV equally well (p=0.51).
• The traditional MD significantly underperformed for non-posterior BPPV.
• Underperformance was also seen in the subgroups referred by ENTs (trend) compared to MRC.
• Traditional methods significantly underperformed in uncooperative patients when compared to MRC.

Thus, the study concluded that even though traditional methods are valuable first-line diagnostic methods, MRC was equally beneficial and more helpful in specific situations like ENT referrals, uncooperative patients, and non-posterior BPPV. The researchers emphasized incorporating advanced diagnostics like MRC with traditional methods to improve diagnostic accuracy and optimize patient outcomes.

Further reading: Is Diagnostics of Benign Paroxysmal Positional Vertigo with a Mechanical Rotation Chair Superior to Traditional Manual Diagnostics? A Randomized Controlled Crossover Study. doi: 10.3389/fneur.2024.1519837.