title: Sitting-up vertigo and trunk retropulsion in patients with benign positional vertigo but without positional nystagmus.
abstract: BACKGROUND
  Presently, the unambiguous diagnosis of benign paroxysmal positioning vertigo (BPPV) requires the detection of positioning or positional nystagmus provoked by Dix-Hallpike (for vertical semicircular canals) or supine roll (for horizontal semicircular canals) manoeuvres, which indicates canalo- or cupolithiasis of affected semicircular canals. There are patients, however, in whom--despite typical complaints of BPPV--no positional nystagmus can be documented; this is called 'subjective BPPV' (sBPPV). These patients usually complain of short vertigo spells during and after sitting up, sometimes with abnormal retropulsion of the trunk.
  
  
  OBJECTIVE
  In this study, the authors aimed to ascertain whether these patients in fact demonstrate abnormal sitting-up trunk oscillations when measured by posturography. Of 200 unselected patients with vertigo or dizziness, 43% had sBPPV with vertigo spells while sitting up, and 20% classical BPPV.
  
  
  METHODS
  Posturographic recordings were performed in 20 patients with sBPPV and sitting-up vertigo.
  
  
  CONCLUSIONS
  Seven of the 20 patients had trunk oscillations during the act of sitting up and for a short time immediately afterwards. Based on their findings, the authors propose a new type of BPPV, the so-called Type 2 BPPV (typical complaints of BPPV, no nystagmus in Dix-Hallpike positions but short vertigo spell while sitting up), which may be the result of chronic canalolithiasis within the short arm of a posterior canal. Furthermore, the authors suggest that Type 2 BPPV, which could be identical to sBPPV or constitute a major subgroup of it, occurs frequently among patients with vertigo. For therapy, the authors recommend repetitive sit-ups from the Dix-Hallpike positions to liberate the short arm of the posterior canal from canaloliths.
authors.affiliation: Otorhinolaryngology Department, General Hospital of Krems, Austria. bukibela@hotmail.com
authors.forename: Béla
authors.initials: B
authors.lastname: Büki
authors.forename: László
authors.initials: L
authors.lastname: Simon
authors.forename: Sándor
authors.initials: S
authors.lastname: Garab
authors.forename: Yunxia W
authors.initials: YW
authors.lastname: Lundberg
authors.forename: Heinz
authors.initials: H
authors.lastname: Jünger
authors.forename: Dominik
authors.initials: D
authors.lastname: Straumann
mesh_terms: D000368:Aged; D065635:Benign Paroxysmal Positional Vertigo; D003627:Data Interpretation, Statistical; D004244:Dizziness / Q000209:etiology; D004424:Ear Canal / Q000473:pathology; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D020347:Lithiasis / Q000150:complications; D008297:Male; D008875:Middle Aged; D009760:Nystagmus, Physiologic; D011187:Posture / Q000502:physiology; D013909:Thorax / Q000502:physiology; D014717:Vertigo / Q000503:physiopathology / Q000628:therapy; D014724:Vestibular Function Tests