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Repositioning nystagmus: prognostic usefulness?

Pedro Santos Marques1, Rosa Castillo, Margarida Santos

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Orthotropic nystagmus (ON) presence predicts successful canalith repositioning maneuvers (CRMs) for benign paroxysmal positional vertigo (BPPV). Video-Frenzel CRMs offer immediate follow-up insights, but psychological support is crucial even after clinical cure.

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Area of Science:

  • Neurology
  • Otolaryngology
  • Vestibular System Disorders

Background:

  • Benign paroxysmal positional vertigo (BPPV) is a common cause of vertigo.
  • Canalith repositioning maneuvers (CRMs) are standard treatments for BPPV.
  • Predicting CRM success and understanding residual patient impact are clinically important.

Purpose of the Study:

  • To evaluate the prognostic value of orthotropic nystagmus (ON) in CRMs for BPPV.
  • To assess the relationship between ON, CRM success, and patient-reported disability and emotional distress.

Main Methods:

  • 57 BPPV patients underwent CRMs under video-Frenzel control.
  • Positional nystagmus and patient-reported outcomes (Dizziness Handicap Inventory, Cuestionario de Impacto Emocional del Vértigo) were assessed.
  • Data analyzed to correlate ON presence with CRM success and patient impact.

Main Results:

  • Posterior SCC was the most affected canal (84.2%).
  • Overall resolution after the first CRM was 56%.
  • CRM success rate was higher with ON present (63%) versus absent (42%). No significant difference in DHI or CIEV scores based on ON presence.

Conclusions:

  • Orthotropic nystagmus (ON) presence is a predictor of successful CRMs for BPPV.
  • Video-Frenzel CRMs provide valuable immediate follow-up data.
  • Psychological support should be considered for BPPV patients, even those clinically cured.