Diagnosis of Benign Paroxysmal Positional Vertigo: Review of Different Diagnostic Methods

Benign paroxysmal positional vertigo (BPPV) is the most common cause of patient-reported vertigo. The accurate diagnosis of BPPV requires high-quality physician training and knowledge of the advantages and disadvantages of different diagnostic methods. Most studies focus on a limited number of diagnostic approaches; the purpose of this review is to consolidate and systematize the available information on the wide range of existing methods. This review includes comparative descriptions of the clinical utility of 12 different techniques used to diagnose BPPV. The diagnosis of BPPV relies primarily on a thorough analysis of clinical history and the professional application of positional tests (primarily the Dix-Hallpike and the Pagnini-McClure maneuvers). Several methods can be used to enhance the efficiency of positional testing: rotary chair, electronystagmography (ENG), videonystagmography (VNG), and potentially artificial neural networks for the analysis of VNG results. The VEMP (vestibular evoked myogenic potential) technique, vestibular caloric testing, the video head impulse test, computerized posturography, and CT and MRI of the head are all useful auxiliary methods for the differential diagnosis of BPPV in complex cases. When selecting diagnostic approaches, it is important to consider the balance between resource and time expenditure and diagnostic accuracy. This review enables a comprehensive and well-rounded understanding of a wide range of diagnostic methods, which is necessary for the development of optimal diagnostic and subsequent treatment and monitoring tactics.