[Benign paroxysmal positional vertigo. Diagnosis, course, physiopathology and treatment]

The benign paroxystic positional vertigo (BPPV) is defined by brief attacks of rotational vertigo and concomitant rotatory-linear nystagmus, triggered by rapid extension and by lateral head tilt toward the affected ear. Cupulolithiasis of the posterior semi-circular canal from one inner ear is responsible of this peculiar type of positional vertigo. Definition diagnostic criteria are based upon the time history of the burst of rotational vertigo associated with the typical positioning nystagmus induced by rapid position changes from the setting to the head hanging right or left position during the Nylen-Barany maneuver. The nystagmus, which is a torsional nystagmus of the eye-balls rolling on the orbit's ground toward the affected and undermost ear, begins a few seconds after the head tilt, is best seen with Frentzel's glasses, preventing the suppression of the nystagmus by fixation, and the repetition of the maneuver will result in everlasting symptoms. According to the largest series of the literature the BPPV is the most frequent recognized cause of vertigo, with more than 30% of the cases of vertigo, explored in a dizziness clinic. In half of the cases, a peculiar etiology can be found, such as head trauma, ototoxic drug, or viral labyrinthitis, with a sex-ratio of one. On the contrary the sex-ratio among the idiopathic forms of BPPV is of two females for one male. The prognosis of BPPV is benign because of its recovery within weeks or months, either spontaneously, or after the liberatory maneuver. In rare cases, the vertigo recurs or persists for months or years. For some very handicapping BPPV, a surgical treatment can be proposed.