It is even more difficult in the geriatric population as increased comorbidity may cause multiple, non-specific symptoms. The evaluation of a patient with dizziness can be difficult because of the broad etiology and wide array of questions and tests necessary to come to a diagnosis. Besides diagnostic positional maneuvers, patient history is critical for the recognition of BPPV and for classifying the etiology ( 7, 8). The gold standard for the diagnosis of posterior canal BPPV is the Dix-Hallpike maneuver, whereas horizontal canal BPPV is mostly diagnosed with the supine roll test ( 5). This is most common in elderly patients ( 6).īPPV is diagnosed by provoking vertigo by positional testing and via observation of typical nystagmus ( 5).

For example, some patients present with complaints of prolonged unsteadiness instead of the typical brief vertigo sensation. However, several alternative presentations are possible. The typical presentation of BPPV consists of recurrent, brief attacks of vertigo generally provoked by changes in head position, such as looking up, bending over, lying down, or rolling over in bed ( 3– 5). Unlike younger patients, elderly patients with BPPV do not only perceive the dizziness as vertigo, but also as a feeling of instability.īenign paroxysmal positional vertigo (BPPV) is the most common vestibular type of vertigo, with an estimated incidence of 64 cases per 100,000 people per year and a lifetime prevalence of 2.4% ( 1, 2). In younger patients, light-headedness and instability decreased the likelihood of BPPV compared to vertigo.Ĭonclusion: The most reliable predictors for BPPV in patient history are a short duration of the dizziness spell and provocation of dizziness by rolling over in bed. Overall, the way patients perceived their dizziness (vertigo, light-headedness or instability) was not independently associated with the diagnosis BPPV. Q2 showed a sensitivity of 43%, and a specificity of 75% Q4 scored 81% and 68%, respectively. The duration of dizziness spells <1 min (Q2) and dizziness provoked by rolling over in bed (Q4) were independently associated with the diagnosis BPPV. Results: We included a total of 885 patients, 113 of whom (13%) were diagnosed with BPPV. Subgroup analysis was performed for patient age, and the type of BPPV. Symptoms strongly suggesting BPPV were tested with multivariable analysis to determine their independent associations with BPPV. All patients completed a questionnaire, underwent vestibular testing and received a diagnosis. Methods: We included adult patients with dizziness referred to our dizziness center, Apeldoorn, the Netherlands, from December 2018 to November 2019. Introduction: This prospective cohort study determined which questions in patient history are most likely to identify symptoms that are independently associated with a diagnosis of benign paroxysmal positional dizziness (BPPV) in patients presenting with dizziness, and to evaluate whether the patient's age and type of BPPV are of influence. 2Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, Leiden, Netherlands.1Apeldoorn Dizziness Centre, Gelre Hospital, Apeldoorn, Netherlands.

Positional vertigo