Syndromic approach to benign paroxysmal positional vertigo

Purpose: Our purpose in this study is to define syndromic diagnosis components by detecting diagnostic utility of complaints and findings for Benign Paroxysmal Positional Vertigo (BPPV), which have been acquired through assesments of history, physical examination, and laboratory in patients possessing vertigo or balance disorder, and to be able to help our doctors with some evidence-based advices. Material and Method: The research has been retrospectively conducted with 147 adult patients who have defined one of the complaints of characteristic vertigo or balance disorder as their "presenting complaint" and who have complied with the conditions of inclusion. Videoelectronystagmographic outcomes along with medical history, physical examination findings, radiological and laboratory investigations in the files of patients have been collected. Sensitivity, selectivity, positive and negative likelihood ratio (LR) as well as post-test odds and probability values have been calculated. Those whose positive likelihood ratio (OO) is between 1,2 – 1,9 have been regarded as weak, those between 2,0 – 4,9 as average, and those above 5,0 have been considered as highly effective variables. Post-test probability values have been calculated for distinct variable by using the method of chain OO, and value index whose post-test probability value is high has been defined. Findings: Of one hundred and forty seven patients, 34% of them have been diagnosed with psychogenic vertigo while 22,4% with peripheric vertigo of unknown origin, and 16,3% with BPPV. Five complaints and findings statistically had a meaningful diagnostic utility for BPPV. These complaints and findings included characteristic vertigo, complaints of less than a week, vertigo's duration of less than 2 minutes, positivity of Dixhallpike test and Roll test. The sensitivity of the complaint of vertigo for the diagnosis of BPPV was 100%, and the selectivity of Roll test for BPPV was 100%. Three values displaying weak, average and high positivity for BPPV have been found. Vertigo attacks of less than 2 minutes (positive likelihood ratio is 1,71) increased the probability of BPPV to the rate of 25,01%, existence of vertigo for less than a week (positive likelihood ratio is 2,01) increased the probability of BPPV to the rate of 28,05%, and positivity of Dixhallpike test (positive likelihood ratio is 31,25) raised the probability of BPPV to the rate of 85,90%. When chain OO, and double and triple mixed indexes were calculated, post-test probability raised to the rate of 91,24% (two value positivities) when the Dixhallpike test proved positive in patients with attack duration of less than 2 minutes, post-test probability raised to the rate of 92,41% (two value positivities) when the Dixhallpike test proved positive in patients with vertigo of less than a week, and post-test probability raised to the rate of 95,44% (two value positivities) when the Dixhallpike test proved positive in patients with attack duration of less than 2 minutes and vertigo of less than a week. Conclusion: This study has revealed the diagnostic utility of Dixhallpike and Roll tests for the diagnosis of BPPV by presenting evidence-based quantitative data. The utility of these tests reaches 100% of sensitivity when it is combined with the medical history of the existence of characteristic vertigo, complaints for one week, and attack duration of less than 2 minutes.