Vestibular neuritis is the most common cause of acute spontaneous vertigo. Vestibular neuritis is ascribed to acute unilateral loss of vestibular function, probably due to reactivation of herpes simplex virus in the vestibular ganglia. The diagnostic hallmarks of vestibular neuritis are spontaneous horizontal-torsional nystagmus beating away from the lesion side, abnormal head impulse test for the involved semicircular canals, ipsilesional caloric paresis, decreased responses of vestibular-evoked myogenic potentials during stimulation of the affected ear, and unsteadiness with a falling tendency toward the lesion side. Vestibular neuritis preferentially involves the superior vestibular labyrinth and its afferents. Accordingly, the function of the posterior semicircular canal and saccule, which constitute the inferior vestibular labyrinth, is mostly spared in vestibular neuritis. However, because the rare subtype of inferior vestibular neuritis lacks the typical features of vestibular neuritis, it may be misdiagnosed as a central vestibular disorder. Even in the patient with the typical pattern of spontaneous nystagmus observed in vestibular neuritis, brain imaging is indicated when the patient has unprecedented headache, negative head impulse test, severe unsteadiness, or no recovery within 1 to 2 days. Symptomatic medication is indicated only during the acute phase to relieve the vertigo and nausea/vomiting. Vestibular rehabilitation hastens the recovery. The efficacy of topical and systemic steroids requires further validation.

Objective: To determine the immediate and long-term therapeutic efficacies of Gufoni and head-shaking maneuvers in apogeotropic type of benign paroxysmal positional vertigo involving the horizontal semicircular canal (HC-BPPV), a randomized, prospective, sham-controlled study was conducted. Methods: In 10 nationwide dizziness clinics in Korea, 157 consecutive patients (95 women, age range: 18–89 years, mean age ± SD = 59.9 ± 13.6) with apogeotropic HC-BPPV were randomized to Gufoni (n = 52), head-shaking (n = 54), or sham maneuver (n = 51). For Gufoni maneuver, patients underwent ipsilesional side-lying and upward head-turn for migration of the debris toward the vestibule. Immediate responses were determined within 1 hour after a maximum of 2 trials of each maneuver and in the following day. The patients also had weekly follow-ups for 1 month after the initial maneuver. Results: After a maximum of 2 maneuvers on the initial visit day, Gufoni (38/52, 73.1%) and head-shaking (33/53, 62.3%) maneuvers showed better responses than the sham maneuver (17/49, 34.7%). The cumulative therapeutic effects were also better with Gufoni (p < 0.001) and head-shaking (p = 0.026) maneuvers compared with the sham maneuver. However, therapeutic efficacies did not differ between the Gufoni and head-shaking groups in terms of both immediate (p = 0.129) and long-term (p = 0.239) outcomes. Conclusion: Using a prospective randomized trial, we demonstrated that the Gufoni and head-shaking maneuvers are effective in treating apogeotropic HC-BPPV. Classification of evidence: This study provides Class II evidence that Gufoni and head-shaking maneuvers are effective in treating apogeotropic horizontal BPPV up to 1 month after initial treatment. Clinical trial registration: NCT00810641.

Objective: Causes of benign positional vertigo (BPV) are mostly unknown. The aim of this study was to elucidate an association of osteoporosis with idiopathic BPV. Methods: Two hundred nine consecutive patients with a confirmed diagnosis of idiopathic BPV underwent bone mineral densitometry of anterior–posterior lumbar spine and femur. The T scores were compared with those of 202 controls without a history of dizziness. Recurrence was defined when the patients reported two or more previous episodes of positional vertigo similar to those experienced at the time of diagnosis. Results: In both women and men, the lowest T scores were decreased in patients with BPV compared with those in controls. Furthermore, the prevalences of osteopenia (−2.5 < T score < −1.0) and osteoporosis (T score ≤−2.5) were higher in both women and men with BPV than in controls. Multiple logistic regression analyses adjusted for age, sex, alcohol, smoking, and hyperphosphatemia showed that only the existence of osteopenia/osteoporosis was associated with an increased risk of BPV (adjusted odds ratio of osteopenia = 2.0, 95% confidence interval 1.2–3.4, p = 0.011; adjusted odds ratio of osteoporosis = 3.1, 95% confidence interval 1.4–7.2, p = 0.007). In women aged ≥45 years, the lowest T scores were also decreased in the recurrent group, compared with those in the de novo group. Conclusion: Osteopenia/osteoporosis may be associated with idiopathic benign positional vertigo (BPV). The effectiveness of measuring bone mineral densitometry and restoring normal calcium metabolism for preventing recurrences of BPV requires further validation.

Objectives: To determine the immediate and long-term therapeutic efficacies of barbecue rotation and Gufoni maneuvers, a randomized, prospective, and sham-controlled study was conducted in patients with the geotropic type of benign paroxysmal positional vertigo involving the horizontal semicircular canal (HC-BPPV). Methods: In 10 nationwide dizziness clinics in Korea, 170 consecutive patients (107 women, age range 11−97 years, mean age ± SD 61 ± 15 years, median = 61 years) with geotropic HC-BPPV were randomly assigned to barbecue rotation (n = 56), Gufoni (n = 64), or sham maneuver (n = 50). An immediate response was determined within 1 hour after a maximum of 2 trials of each maneuver on the visit day. We also assessed the cumulative results of each maneuver by following up the patients for 1 month. Results: After a maximum of 2 maneuvers on the initial visit day, barbecue rotation (38 of 55 [69.1%]) and Gufoni (39 of 64 [60.9%]) maneuvers showed better responses than the sham maneuver (17 of 48 [35.4%]). The cumulative therapeutic effects were also better with barbecue rotation (p = 0.006) and Gufoni (p = 0.031) maneuvers than with the sham maneuver. However, therapeutic efficacies did not differ between the barbecue rotation and Gufoni groups in terms of both immediate (p = 0.46) and long-term (p = 0.10) outcomes. Conclusion: Using a prospective randomized trial, we demonstrated that barbecue rotation and Gufoni maneuvers are effective in treating geotropic HC-BPPV. Classification of evidence: This study provides Class I evidence that barbecue rotation and Gufoni maneuvers are effective in the treatment of geotropic HC-BPPV.