Positional nystagmus in patients with chronic dizziness

Area of Science:

• Geriatric Medicine
• Neurology
• Otolaryngology

Background:

• Chronic dizziness is a common and difficult-to-diagnose condition in the elderly.
• The origin of chronic dizziness is frequently unknown, posing assessment challenges.

Purpose of the Study:

• To determine if mild, undetected benign paroxysmal positional vertigo (BPPV) contributes to isolated chronic dizziness in elderly individuals.
• To investigate the prevalence of subtle BPPV in older adults experiencing persistent dizziness.

Main Methods:

• Evaluated 200 elderly patients with isolated chronic dizziness and 155 age-matched controls.
• Assessed for horizontal, direction-changing apogeotropic positional nystagmus (HAPN), a sign of horizontal canal BPPV, using sensitive techniques.
• Compared the prevalence of HAPN between the patient and control groups.

Main Results:

• A significantly higher prevalence of weak HAPN was observed in patients with chronic dizziness (49.0%) compared to controls (16.1%).
• This subtle nystagmus, indicative of BPPV, was present in nearly half of the dizziness patients.
• Some patients experienced symptom improvement with daily positional exercises for BPPV.

Conclusions:

• Mild, persistent benign paroxysmal positional vertigo (BPPV) is a likely cause of chronic dizziness of unknown origin in the elderly.
• The presence of HAPN suggests horizontal canal BPPV should be considered in geriatric dizziness evaluations.
• Early detection and treatment of BPPV can alleviate chronic dizziness in older populations.