Prevalence of Horizontal Canal Variant in 3,975 Patients With Benign Paroxysmal Positional Vertigo: A Cross-sectional Study

Rajneesh Bhandari; Anita Bhandari; Yu-Hsiang Hsieh; Jonathan Edlow; Rodney Omron

doi:10.1212/CPJ.0000000000200191

Prevalence of Horizontal Canal Variant in 3,975 Patients With Benign Paroxysmal Positional Vertigo: A Cross-sectional Study

Neurol Clin Pract. 2023 Oct;13(5):e200191. doi: 10.1212/CPJ.0000000000200191. Epub 2023 Aug 23.

Authors

Rajneesh Bhandari¹, Anita Bhandari¹, Yu-Hsiang Hsieh¹, Jonathan Edlow¹, Rodney Omron¹

Affiliation

¹ NeuroEquilibrium Diagnostic Systems Pvt Ltd. (RB); Vertigo and Ear Clinic (AB), Jaipur, India; Johns Hopkins School of Medicine (Y-HH, RO), Baltimore, MD; and Harvard Medical School (JE), Boston, MA.

Abstract

Background and objectives: Current understanding based on older studies is that pc-BPPV is far more common than hc-BPPV. Such studies are limited by small sample sizes, and often the supine roll test for hc-BPPV is not performed. To better estimate the prevalence of hc-BPPV, we studied a large cross-section of patients with VOG-diagnosed BPPV.

Methods: Using a cross-sectional study of patients with BPPV, we investigated patients referred to NeuroEquilibrium specialty clinics throughout India between January 1, 2021, and December 31, 2021. All patients were evaluated with video oculography (VOG) during positional tests, and all diagnoses were confirmed by a neurotologist and neurologist.

Results: Of 3,975 patients with VOG-confirmed and specialist-diagnosed BPPV (median age, 51 years; 56.6% women), pc-BPPV accounted for 1,901 (47.8%), hc-BPPV was seen in 1,842 (46.3%), and anterior canal BPPV was found in 28 (0.7%) patients.

Discussion: This study found that hc-BPPV is far more common than previously reported. It is important to perform the supine roll test in addition to the Dix-Hallpike in all patients suspected with BPPV. Better training to diagnose patients with BPPV and to accurately recognize the nystagmus pattern of hc-BPPV should be a priority.