Guide the diagnosis and treatment of benign paroxysmal positional vertigo from the perspective of vestibular pathophysiology

Abstract

This paper aims to explain the clinical features of benign paroxysmal positional vertigo (BPPV), the most common peripheral vertigo disease, from the view of vestibular pathophysiology. Firstly, it overviews several important principles in vestibular pathophysiology, including the relative density of otolith and endolymph and its spatial position relation with semicircular canal, Flourens' law, Ewald's second law, endolymph hydrodynamics caused by otolith shift, semicircular canals working as pairs, coupling of semicircular canal-extraocular muscle and central velocity storage. Secondly, use these principles to explain the clinical features of BPPV, differences between posterior and horizontal semicircular canal BPPV and the nystagmus characteristics during maneuver therapy. Finally, it presents some opinions on the diagnosis and treatment of BPPV, also based on these principles, including the differences between canalithiasis and cupulolithiasis, repositioning maneuver method and diagnosis of anterior semicircular canal BPPV.

DOI: 10.3969/j.issn.1672-6731.2019.02.001