American Journal of Oral Medicine and Radiology

DIAGNOSTIC FRAMEWORK FOR BPPV: EVALUATING KEY HISTORICAL INDICATORS

Dr. Sreenivasa Reddy D

Benign paroxysmal positional vertigo, Dix–Hallpike test, dizziness duration, diagnostic predictors, posterior canal BPPV

Benign paroxysmal positional vertigo (BPPV) is the most common cause of peripheral vertigo, with posterior canal involvement accounting for the majority of cases. Despite its prevalence, diagnosing posterior canal BPPV can be challenging, as some patients do not exhibit characteristic nystagmus during the Dix–Hallpike test (DHT + BPPV). This study aimed to identify key clinical history indicators that can enhance the accuracy of BPPV diagnosis. Methods: A structured interview-based study was conducted at Sri Lakshmi Narayana Institute of Medical Sciences in 2021. Patients presenting with dizziness underwent a detailed medical history assessment covering symptom onset, duration, triggering movements, and associated symptoms. The Dix–Hallpike test (DHT) was performed for suspected BPPV cases. Logistic regression analysis and receiver operating characteristic (ROC) curve analysis were used to identify the most predictive clinical history factors for DHT + BPPV. Results: Among 290 patients in the derivation set and 122 in the validation set, "onset when turning over in bed" and "duration of dizziness ?15 seconds" emerged as the strongest independent predictors of DHT + BPPV. The predictive model demonstrated a positive likelihood ratio of 6.81 and a negative likelihood ratio of 0.19 for diagnosing DHT + BPPV. These findings indicate that incorporating these historical factors into clinical assessments significantly enhances diagnostic accuracy. Conclusion: This study highlights the diagnostic value of two key historical indicators—dizziness lasting ?15 seconds and symptom onset when turning over in bed—in predicting posterior canal BPPV. Incorporating these elements into routine clinical evaluations can improve early BPPV diagnosis, streamline patient management, and reduce unnecessary referrals. Further research across diverse populations is recommended to validate these findings and refine diagnostic protocols