Improving Understanding and Treatment of Peripheral Positional Vertigo (PPV)

The suggestion to rename BPPV (Benign Paroxysmal Positional Vertigo) to Peripheral Positional Vertigo (PPV) comes from the need to more accurately reflect the clinical nature and perception of this common disease. There are three reasons which support this proposal:

1. Clarification of the Origin: Adding “Peripheral” to the nomenclature – This disorder is due to displaced otoconia within the inner ear. By using the term Peripheral, it clarifies that the origin is in the peripheral vestibular system.

2. Misleading use of the term “Benign”: While the term "benign" is meant to convey that the condition is not life-threatening, it may be misleading in suggesting that it does not impact daily life. However, the condition may be complex with potentially severe symptoms including persistent dizziness and increased fall risk. The term “benign” may also suggest that the patient does not require treatment, while it is proven that Canalith Repositioning Maneuvers are the gold standard treatment.

3. Better emphasis on peripheral versus the differential diagnosis central positional vertigo/nystagmus: Peripheral refers to the involvement of the vestibular apparatus, specifically the semi-circular canals and otolith organs. In this disorder, the otolith debris from the utricle are dislodged into the semi-circular canals. In contrast, central positional vertigo/nystagmus indicates an involvement of the central nervous system, namely cerebellum. Renaming BPPV to "Peripheral Paroxysmal Positional Vertigo (PPV)" provides a clearer distinction between peripheral vestibular disorders (like PPV) and other types of vertigo due central causes (such as strokes or multiple sclerosis).

PPV can be idiopathic, arising spontaneously without a clear cause, or it can be associated with conditions like head trauma, ear infections, prolonged bed rest, etc. Diagnosis is often made through a patient's medical history and physical examination, including specific positional tests such as the Dix-Hallpike maneuver, Supine Roll test and Supine head hanging test.

BPPV is recognized to have many sub-types according to the character of the displaced otoconia as free-floating in canalithiasis or adherent to the cupula as seen in cupulolithiasis. Besides this, classification of PPV is also dependent on the type of nystagmus generated on the positional tests for example geotropic/apogeotropic, downwardly-beating, short arm, direction-fixed. These less-common variants are being described more commonly with the recording of nystagmus by videonystagmography allowing study of the nystagmus characteristics.

Treatment involves canalith repositioning maneuvers such as the Semont- Plus, Epley, Semont, Zuma Gufoni and many more/too many named maneuvers. Furthermore, a significant number of patients report residual dizziness symptoms post-treatment, indicating a need for further investigation into the underlying causes of PPV and the development of more effective treatment strategies.

The primary aim of this Research Topic is to explore the clinical characteristics and nystagmus character of various types of PPV, particularly looking for causes of refractory cases, and to evaluate the effectiveness of various treatment maneuvers. We also aim to identify potential exacerbating factors of residual dizziness post-treatment. The ultimate goal is to enhance the understanding of pathophysiology of PPV and improve treatment outcomes for patients.

To gain further insights into the complexities of PPV, we welcome all article types accepted by the journal addressing, but not limited to, the following themes:

• Understanding of different types of PPV according to clinical characteristics and nystagmus
• The effectiveness of various treatment maneuvers for PPV.
• The underlying causes of PPPV and residual dizziness post-treatment.
• The development of new diagnostic tools and treatment strategies for PPV.

Topic Editor Anita Bhandari is Director NeuroEquilibrium Diagnostic Systems Private Limited, India. However, this research topic will be conducted in the absence of any commercial or financial relationship that could be construed as potential conflict of interest.

Keywords: Vestibular Disorders, Vertigo Treatment, Repositioning Maneuvers, Dizziness, PPV, Peripheral Positional Vertigo

Important note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.