Background:Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular problem. However, demographic analysis is few.Aim:The aim of this study was to document the demographic data of patients with BPPV regarding distribution of gender, age, associated problems, most common form, symptom duration, severity of nystagmus and cure rate.Subjects and Methods:A total of 263 patients with video-nystagmography confirmed BPPV were enrolled in this retrospective study (2009-2013). The data were collected in Anadolu Medical Center. Distribution of gender, age and affected side were reviewed. Associated problems were noted. Patients were analyzed according to the canal involvement, age, duration of symptoms, duration of nystagmus and recurrence. Mean values and standard deviations were calculated. One-way ANOVA test was used for the analysis of the data (Statistical Package for the Social Sciences 17.0 version, IBM, Chicago, III, USA). Statistical significance was set at P < 0.05.Results:Women were affected more frequently than men (1:1.5). Comparative analysis of average age between the two gender groups was not statistically significant (P = 0.84). BPPV was common at middle age group. The incidence of affected side was not significant (P = 0.74). Posterior canal-BPPV (PC-BPPV) was the most leading one (129/263; 49%) followed by lateral canal (LC)-canalolithiasis (60/263; 22.8%), LC-cupulolithiasis (38/263; 14.5%) and superior canal-BPPV (9/263; 3.4%). 55.1% of patients were defined as idiopathic (145/263). Associated problems were migraine (31/263; 11.8%), trauma (19/263; 7.2%), inner ear disorders (18/263; 6.8%) and other systemic problems (50/263; 19.1%). 72.6% of patients had symptoms <2 months (191/263). 23,6% of patients had intensive nystagmus lasting more than a minute regardless of canal involvement (62/263). 33% of patients required two or more maneuvers for the relief of symptoms (87/263).Conclusion:Symptoms are prone to recur in those of traumatic origin, associated inner ear problems and systemic disorders. As the prognostic factors are illuminated, preventive measures will be more effective and more patients will be cured properly.

Vestibular evoked myogenic potential is a useful tool to study the otolithic function in patients with BPPV and should be included in the test battery.

HRM has the greatest diagnostic value of positioning tests in LC-BPPV in this study. LDPT provides some contribution in the diagnosis of LC-BPPV but much less than HRM. Patients' subjective feeling of vertigo was also a useful test. However, HBT was not as sensitive as other measures in uncertain cases.

Original Article INTRODUCTIONPositional vertigo following sudden head motion in patients with benign paroxysmal positional vertigo (BPPV) is assumed to be due to freely floating otoconia inside the semicircular canals or those adhering to the cupula which make labyrinth sensitive to gravitational forces [1] . The majority of patients have quick relief of symptoms after repositioning maneuvers, although underlying pathology is obscure. Origin of these deposits is claimed to be due to degeneration of utricular neuroepithelium. Functional studies are needed to exclusively detect possible organic pathology of the utricule. Innervation of utricule is provided by superior vestibular nerve which also collects impulses from lateral and superior semicircular canals. The inferior vestibular nerve is connected to the posterior semicircular canal and the saccule.Caloric testing was first studied by the Nobel Prize winner Robert Barany in 1906, and later it was introduced to the otologic practice by Fitzgerald and Hallpike [2] in 1942. Videonystagmograpy (VNG) with caloric stimulation has been widely used in the analysis of severity of vestibular disorders. It reflects the degree to which the vestibular system is responsive and how symmetric the responses are between left and right. Caloric irrigation through the ear canal selectively stimulates the lateral canal [3] . However, studies indicate the contribution of other semicircular canals to the final response. Gacek et al. [4] have found severe dysfunction after caloric stimulation in seven patients who had singular neurectomy. Sensitivity of caloric stimulation to detect the vestibular pathology is subject to discussion [5] . Some problems may remain undiagnosed unless they cause severe vestibular dysfunction. The aim of this study is to analyze the incidence of caloric hypo-excitability, to investigate the role of symptom duration, and to compare the caloric responses in patients with lateral canal (LC-BPPV) and posterior canal (PC-BPPV). MATERIALS and METHODS MATERIALS and METHODS:A prospective study was conducted in 65 patients with BPPV (20 LC and 45 PC) who were subjected to caloric testing. Average slow-phase velocity and nystagmus duration were analyzed. RESULTS:Caloric hypo-excitability was 20.4%. It was more evident in patients with apogeotropic-type LC-BPPV. The comparison of average slowphase velocity of the nystagmus and nystagmus duration between selected types of BPPV for pathologic, non-pathologic, and the control ears after warm and cold stimulation was not statistically significant (p>0.05). No correlation was found between caloric results and symptom duration (p>0.05). CONCLUSION:Some patients presented caloric hypo-excitability. Reliability of caloric testing to differentiate the ear with normal and abnormal vestibular function in different types of BPPV was low. No difference was found in the analysis of the impact of symptom duration. Caloric testing is not an ideal tool to study BPPV.

In patients with benign paroxysmal positional vertigo, the presence of vertical up-beating nystagmus while lying down is a unique peripheral sign and could indicate multiple canal involvement. Therefore, the seated-supine positional test should always be included in the test battery.