Unsteadiness and drunkenness sensations as a new sub-type of BPPV.

AIM: Benign Paroxysmal Positional Vertigo (BPPV) represents at least 35% of vertigo cases and perhaps much more. The aim of this study was to review a proposed new type of BPPV which may be detected by using a mechanical assistance in BPPV diagnostic and therapeutic maneuvers. MATERIELS AND METHODS: The prospective study extracted subjects from 465 patients who presented with some positional vertigo or unsteadiness. Only 152 dizzy patients, who presented with positional nystagmus but no true vertigo, were included. The TRV armchair permits rotation of patients wearing infrared video goggles in all semi-circular planes. Treatment effectiveness was defined as absence of symptoms or findings 3 days after the therapy sessions. If not initially successful, repeat therapeutic sessions were performed or patients underwent further vestibular examination and sometime MRI.

RESULTS: One hundred nine of the 152 patients demonstrated a low level canalithiasis showing nystagmus. Unusual data were collected: Ninety seven had a lateral canal and 12 had posterior canal conditions. The average of the patients was 62 and they had an average of 1.6 mechanical therapeutic maneuvres to reach the success end-point.

CONCLUSION: Some patients have persistent unsteadiness or drunkenness sensations after being treated by conventional maneuvers for BPPV. Often considered a post-BPPV otolithic syndrome an alternative possibility is BPPV with a very few otoliths in the lateral canal. The therapeutic technique using the mechanical chair permits to improved diagnosis of canalithiasis, especially that involving the horizontal canals. Some mild dizziness, which may be disabling and chronic can be better investigated and treated with mechanical assistance.