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Abstract
BPPV is one of the most common diseases of the inner ear. The cause of BPPV is mostly unknown (idiopathic) or secondary to any of the inner ear diseases (e.g., vestibular neuritis and Meniere’s disease). Head trauma is the most common cause of secondary BPPV. The aim of this study is to properly assess BPPV patients to find out if other vestibular manifestations may co-exist and could be masked by BPPV symptoms. Fifty patients diagnosed as BPPV were subjected to: history taking, otological examination, bedside examination, basic audiological evaluation, vestibular assessment including: videonystagmography (VNG), cervical vestibular evoked myogenic potentials (cVEMP), sensory organization test (SOT) via dynamic posturography. After that, patients subjected to CRM. Patients were examined one week later and if positioning nystagmus is present, CRM was repeated till nystagmus disappeared. Finally, Test(s) with positive findings prior to the repositioning maneuver were repeated after disappearance of nystagmus. Suggested aetiologies of BPPV in our study were, idiopathic in 62%, associated with unilateral canal weakness in 10%, associated with migraine in 12%, associated with Meniere{u2019}s disease in 6%, posttraumatic in 6% and associated with osteoporosis in 4% of study patients. Follow up for one month after CRM of idiopathic BPPV patients revealed that 12.9% of patients still complaining of subjective instability in spite of negative positioning tests, 3.2% still had unilateral absent cVEMP waves, 16.1 still had bilateral absent cVEMP waves and 9.7% still had decreased composite score and decreased vestibular ratio in SOT test