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Early Diagnosis of Central Disorders Mimicking Horizontal Canal Cupulolithiasis
Paula Peña Navarro1, Sofía Pacheco López1, Cristina Nicole Almeida Ayerve1
1Neurotology Unit, ENT Department, University Hospital of Salamanca, IBSAL, 37007 Salamanca, Spain.
Insights
Early evaluation in an Emergency Department (ED) for Horizontal Canal Cupulolithiasis (hc-BPPV-cu) significantly reduces symptom duration and misdiagnosis of central disorders compared to outpatient clinics.
Area of Science:
- Otolaryngology
- Neurology
- Vestibular Disorders
Background:
- Horizontal Canal Cupulolithiasis (hc-BPPV-cu) can present with symptoms mimicking central nervous system pathologies.
- Accurate diagnosis is crucial to prevent mismanagement and delayed treatment.
Purpose of the Study:
- To compare the diagnostic and treatment pathways for hc-BPPV-cu presenting to an Emergency Department (ED) versus an Outpatient Otolaryngology Clinic (OC).
- To evaluate the impact of early specialist assessment on patient outcomes.
Main Methods:
- A retrospective cross-sectional cohort study was conducted on 45 patients with suspected hc-BPPV-cu.
- Patient presentation (ED vs. OC) and treatment data were analyzed.
Main Results:
- Patients seen in the ED had significantly shorter times to assessment (3.6 days vs. 79.7 days) compared to the OC.
- ED presentation was associated with fewer required therapeutic maneuvers and a lower rate of multi-canal BPPV (3.4% vs. 43.8%).
- Unresolved cases, all with central pathologies, occurred in both settings (10.3% ED vs. 12.5% OC).
Conclusions:
- Early specialist evaluation in the ED facilitates prompt identification of central mimics of hc-BPPV-cu.
- An ED approach reduces symptom duration, the number of maneuvers, and the incidence of iatrogenic multi-canal BPPV.
- Comprehensive ED management improves treatment efficacy and early detection of central disorders.
Background:
Horizontal Canal Cupulolithiasis (hc-BPPV-cu) can mimic a pathology of central origin, so a careful examination is essential to prevent misdiagnosis.
Methods:
Retrospective cross-sectional cohort study of 45 patients suffering from suspected hc-BPPV-cu. We recorded whether patients first presented through an ENT Emergency Department (ED) or through an Outpatient Otolaryngology Clinic (OC).
Results:
We found statistically significant differences (p < 0.05) between the OC versus the ED in relation to the time between symptom onset and first assessment (79.7 vs. 3.6 days, respectively), the number of therapeutic maneuvers (one maneuver in 62.5% vs. 75.9%, and more than one in 25.1% vs. 13.7%), and multi-canal BPPV rate (43.8% vs. 3.4%). hc-BPPV-cu did not resolve in 2 patients (12.5%) from the OC and in 3 (10.3%) from de ED, all of which showed central pathology.
Discussion:
There are no prior studies that analyze the approach to hc-BPPV-cu in the ED. The benefits of early specialist input are early identification of central positional nystagmus, a decrease in symptom duration, reduced number of therapeutic maneuvers required for symptom resolution, and lower rates of iatrogenic multi-canal BPPV.
Conclusion:
A comprehensive approach to hc-BPPV-cu in the ED allows both more effective treatment and early identification of central disorder mimics.
