Video head impulse testing before and after canalith repositioning for benign paroxysmal positional vertigo

Abstract

Objective: To evaluate video head impulse testing (vHIT) outcomes in patients with benign paroxysmal positional vertigo (BPPV) before canalith repositioning maneuver (CRM), immediately after treatment, and 1 week post-treatment. Study design: Prospective before–after study. Setting: Tertiary referral center. Patients: Of 156 patients with vertigo and positional nystagmus, 63 were diagnosed with BPPV using standard maneuvers; 51 had posterior canal BPPV, 11 had lateral canal BPPV and 1 had anterior canal BPPV. All underwent vHIT to assess vestibulo-ocular reflex (VOR) gain across all 6 semicircular canals and completed the Dizziness Handicap Inventory before and after treatment. Interventions: CRMs specific to the affected canal. Main outcome measures: VOR gain and Dizziness Handicap Inventory scores before and after CRM. Results: At pre-treatment, 59 patients (93.7%) exhibited VOR gains within normative limits. Only four patients (6.3%) showed decreased VOR gains, all of whom were diagnosed with posterior canal BPPV. VOR gain did not differ significantly across pre-treatment, immediate post-treatment, and 1-week assessments. No corrective saccades were detected. Conclusions: vHIT showed no significant post-treatment changes and may have limited incremental value in the routine evaluation of isolated BPPV cases.