Objective: To investigate adherence, characteristics, and first clinical experiences of capturing ictal nystagmus at home, which can be performed to complement the diagnostic process in patients with episodic vestibular symptoms. Methods: Patients were recruited at a tertiary referral center in case capturing ictal nystagmus could contribute to the diagnostic process (e.g., to detect or rule out BPPV). They were asked to capture ictal nystagmus with their own smartphone at home, using a smartphone-based adapter (Nystagmocatcher, Balansdiagnos, Stockholm, Sweden). All recordings were analyzed by the last author (RvdB), and the adherence, characteristics, and first clinical experiences were evaluated. Results: Seventy patients with vestibular symptoms were asked to participate in this study. Sixty-two (89%) agreed to participate. The median period of participation was 86 days. Fifty-one patients experienced attacks during the study period. Eventually, 51% of them provided eye movement recordings sufficient for analysis. Different types of nystagmus were observed: positional nystagmus related to BPPV, positional nystagmus not related to BPPV, functional eye movements, and the absence of nystagmus or functional eye movements. Capturing ictal nystagmus could contribute to the diagnostic process in several ways, including to detect or rule out BPPV, to detect or rule out vestibular origin of symptoms, to determine the affected side, telemedicine, to monitor attack frequency, and to detect malingering. Furthermore, strict guidance of patients was necessary, which could be time-consuming. Conclusion: Capturing ictal nystagmus can contribute to the diagnostic process in several ways, which motivates to rethink current clinical workflow in vestibular medicine. However, strict guidance is necessary and not all patients provide ictal recordings. In an outpatient setting, it would be advised to use ictal nystagmus recordings on indication, to complement the diagnostic process.

Objectives. This systematic review was performed to investigate the co-occurrence of otologic disorders and benign paroxysmal positional vertigo (BPPV).Methods. Searches were conducted in PubMed and Web of Science. The review included all original English-language studies—ranging from full-text clinical trials to case reports—enrolling participants aged ≥18 years. Articles were classified into two groups: group 1 comprised studies reporting otologic disorders in patients diagnosed with BPPV; group 2 comprised studies reporting instances of BPPV among patients with otologic disorders. The frequency of each condition was analyzed using descriptive statistics. Meta-analyses were performed using a random-effects model to estimate overall prevalence in both groups.Results. The initial search yielded 3,407 records, of which 68 articles were included in the analysis. In group 1 (19 studies), 11.4% of patients with BPPV (932/8,157) had co-occurring otologic disorders. Sudden sensorineural hearing loss (present in 11.9% of patients in relevant included studies) and acute unilateral vestibulopathy/vestibular neuritis (5.0%) were most frequently reported. Meta-analysis produced pooled prevalence rates of 11.8% (95% CI, 3.1%–35.7%) for sudden sensorineural hearing loss and 6.5% (95% CI, 3.7%–11.2%) for acute unilateral vestibulopathy/vestibular neuritis. In group 2 (49 studies), 9.7% of patients with otologic disorders (1,106/11,457) experienced concurrent BPPV, with Menière’s disease exhibiting the highest rate of concurrence (10.2%). Meta-analyses showed pooled prevalence rates of 10.4% (95% CI, 6.2%–16.8%) for acute unilateral vestibulopathy/vestibular neuritis and 9.1% (95% CI, 4%–19.1%) for Menière’s disease.Conclusion. The co-occurrence of otologic disorders and BPPV is prevalent. These findings underscore the need for mutual clinical screening and may inform understanding of the etiologies underlying BPPV.

Objective: To investigate the inter-method agreement between in-person consultations and video recordings when diagnosing BPPV. Methods: Two experienced vestibular clinicians (clinician A and B) evaluated patients for the presence and type of BPPV, using the TRV chair (Interacoustics, Middlefart, DK), at a tertiary referral center. During these in-person consultations, diagnostic maneuvers and eye movements were recorded, and a diagnosis was made. Both clinicians independently evaluated their cases again, during two video review sessions (Video Review 1 and Video Review 2). These sessions were conducted one month apart. Both clinicians were blinded to patient information and medical history during the analysis and did not have access to sound recordings. They were asked to provide a new diagnosis, based on the videos alone. Inter-method and intra-observer agreement for BPPV diagnoses between in-person consultations and video reviews were assessed using the percentage of agreement and Cohen’s kappa. An independent analysis of all patients’ eye movements was conducted to identify patterns that might have influenced agreement between in-person consultation diagnoses and the two video reviews by clinicians. Results: During the in-person consultations, each clinician evaluated 100 patients. Clinician A diagnosed BPPV in 40% of the cases, while clinician B diagnosed it in 19% of the cases. Considering the inter-method agreement, clinician A agreed on 81% (95% CI (73, 89)) and 77% (95% CI (69, 85)) of the cases with associated kappa coefficients of 0.67 (95% CI (0.55, 0.79)) and 0.63 (95% CI (0.51, 0.75)) between in-person consultations and Video Reviews 1 and 2, respectively. For clinician B, the percentages of agreement were, respectively, 86% (95% CI (79, 93)) and 84% (95% CI (77, 91)), with corresponding kappa coefficients of 0.55 (95% CI (0.36, 0.74)) and 0.51 (95% CI (0.32, 0.70)). As for the intra-observer agreement, clinician A achieved an intra-observer agreement of 84% (95% CI (77, 91)) with kappa = 0.74 (95% CI (0.63, 0.85)), while clinician B achieved a slightly higher intra-observer agreement of 90% (95% CI (84, 96)) with kappa = 0.67 (95% CI (0.51, 0.83)). Descriptive analysis of the eye movement revealed that both clinicians showed high diagnostic consistency for “no BPPV” in cases without provoked nystagmus (78/86, 91%) even when spontaneous nystagmus was present, and for posterior canal BPPV (37/78, 47%) when characteristic nystagmus was observed. However, disagreement was noted for horizontal canal BPPV (15 cases) and in scenarios with subjective BPPV (2 cases) or purely vertical nystagmus (11/31 cases, 35%). Conclusions: This study showed the feasibility of using video recordings when diagnosing BPPV. It demonstrates that BPPV might be reliably diagnosed in a telemedicine setting. However, careful consideration must be given to certain factors during the protocol’s design to improve the diagnostic process.

Benign Paroxysmal Positional Vertigo (BPPV) is one of the most prevalent peripheral vestibular disorders seen in specialized dizziness clinics. Despite being a well-understood condition with effective treatment options, BPPV remains associated with significant diagnostic delays and healthcare costs. If proven reliable, telemedicine approaches could help address these challenges by improving diagnostic accessibility and efficiency. To investigate the interobserver agreement in BPPV diagnosis, when using eye movement recordings. Six vestibular medicine specialists (Specialist 1, 2, 3, 4, 5, 6) were recruited to participate in this study. The specialists were asked to evaluate the recordings of 240 patient cases who underwent assessment for BPPV (first assessment). After viewing the recordings of each case, they were required to make a BPPV diagnosis. Five specialists (2, 3, 4, 5, 6) agreed to repeat the procedure twice, to additionally evaluate the intraobserver agreement (second assessment). The proportion of agreement and Cohen's kappa were calculated for both interobserver and intraobserver agreement. Furthermore, agreement with the original diagnoses was evaluated. The interobserver agreement between experts was fair to moderate with a Cohen's kappa value of 0.40 (CI 95% [0.35, 0.45]) and a proportion of agreement of 60% (CI 95% [54, 67]). Specialists 2, 4, and 5 exhibited substantial intraobserver agreement. In contrast, Specialist 3 demonstrated fair intraobserver agreement, while Specialist 6 showed almost perfect intraobserver agreement. Regarding the first assessment, agreement with the original diagnoses ranged from fair to substantial, with kappa values between 0.40 and 0.70, and corresponding percentages between 58 and 78%. Similar results were observed for the second assessment. The interobserver agreement between specialists diagnosing BPPV using eye movement recordings, was fair to moderate. The suboptimal agreement could be related to missing clinical information (e.g. patient history and symptoms during positional maneuvers). Future studies should incorporate this information and reassess interobserver agreement.