{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T14:27:41Z","timestamp":1786631261627,"version":"build-2736575974"},"reference-count":8,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T00:00:00Z","timestamp":1785196800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To classify the kinetic state of otoconia in canalithiasis according to the slow phase velocity (SPV) of nystagmus during the Dix\u2011Hallpike test in patients with posterior semicircular canal benign paroxysmal positional vertigo (PSC\u2011BPPV), and to evaluate the association between different subtypes and the need for a second Epley maneuver, thereby establishing a prognostic model based on kinetic classification.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Clinical data of 60 patients with unilateral PSC canalithiasis were retrospectively analyzed. Receiver operating characteristic (ROC) curves were used to determine the optimal threshold of diagnostic vertical SPV for predicting the need for a second repositioning. Patients were subsequently divided into a high\u2011SPV aggregated type and a low\u2011SPV dispersed type based on better prognostic discrimination in clinical grouping (threshold = 20%). The direction and SPV of nystagmus during each step of the Epley maneuver were recorded. The primary outcome was a positive Dix\u2011Hallpike test 24\u201348 hours after the initial maneuver, indicating the need for a second repositioning. The rates of second repositioning and the characteristics of inhibitory nystagmus during the maneuver were compared between the two types. Logistic regression was used to analyze the independent predictive value of the classification.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results and discussion<\/jats:title>\n                    <jats:p>\n                      ROC curve analysis showed that the area under the curve (AUC) of diagnostic vertical SPV for predicting a second repositioning was 0.85 (95% CI 0.76\u20130.94,\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.001). 21 patients (35.0%) were classified as high\u2011SPV aggregated type (vertical SPV \u226520\u00b0\/s) and 39 patients (65.0%) as low\u2011SPV dispersed type (vertical SPV &amp;lt;20\u00b0\/s). The rate of second repositioning was 14.3% (3\/21) in the high\u2011SPV aggregated type and 41.0% (16\/39) in the low\u2011SPV dispersed type (\n                      <jats:italic>\u03c7<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u202f=,\n                      <jats:italic>p<\/jats:italic>\n                      =0.041). Among patients with inhibitory nystagmus at step\u202f4, the low\u2011SPV dispersed type had a high second\u2011session rate of 84.6% (11\/13). Multivariate logistic regression showed that both the low\u2011SPV dispersed type (OR=4.7, 95% CI 1.2\u201319.3,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.031) and inhibitory nystagmus at step\u202f4 (OR=14.5, 95% CI 3.1\u201368.2,\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt; 0.001) were independent predictors of the need for a second repositioning. The events-per-variable ratio was approximately 9.5:1, which is acceptable but relatively modest; thus, the results warrant cautious interpretation. These findings are exploratory and require validation in independent external cohorts.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1881896","type":"journal-article","created":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T04:26:40Z","timestamp":1785212800000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Kinetic classification of posterior semicircular canal canalithiasis based on quantitative nystagmus parameters and its predictive value for the need of a second Epley maneuver: a retrospective quantitative analysis of 60 patients"],"prefix":"10.3389","volume":"17","author":[{"given":"Jing","family":"Chen","sequence":"first","affiliation":[{"name":"Zhengzhou Central Hospital Affiliated to Zhengzhou University","place":["Zhengzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuo","family":"Yang","sequence":"additional","affiliation":[{"name":"Zhengzhou Central Hospital Affiliated to Zhengzhou University","place":["Zhengzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,28]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"710","DOI":"10.1136\/jnnp.2006.100420","article-title":"Epidemiology of benign paroxysmal positional vertigo: a population based study","volume":"78","author":"von Brevern","year":"2007","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.1177\/0194599816689667","article-title":"Clinical practice guideline: benign paroxysmal positional vertigo (update)","volume":"156","author":"Bhattacharyya","year":"2017","journal-title":"Otolaryngol Head Neck Surg"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1143","DOI":"10.1097\/00005537-200407000-00002","article-title":"The canalith repositioning procedure for benign positional vertigo: a meta-analysis","volume":"114","author":"Woodworth","year":"2004","journal-title":"Laryngoscope"},{"key":"ref4","first-page":"151","article-title":"The mechanics of benign paroxysmal vertigo","volume":"8","author":"Hall","year":"1979","journal-title":"J Otolaryngol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"3567","DOI":"10.1007\/s00405-017-4674-9","article-title":"Analysis of risk factors influencing the outcome of the Epley maneuver","volume":"274","author":"Dom\u00ednguez-Dur\u00e1n","year":"2017","journal-title":"Eur Arch Otorrinolaringol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"102472","DOI":"10.1016\/j.amjoto.2020.102472","article-title":"Orthotropic nystagmus in predicting the efficacy of treatment in posterior canal benign paroxysmal positional vertigo","volume":"41","author":"Lou","year":"2020","journal-title":"Am J Otolaryngol"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"107","DOI":"10.3988\/jcn.2008.4.3.107","article-title":"Residual dizziness after successful repositioning treatment in patients with benign paroxysmal positional vertigo","volume":"4","author":"Seok","year":"2008","journal-title":"J Clin Neurol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"341","DOI":"10.1177\/003591575204500604","article-title":"The pathology symptomatology and diagnosis of certain common disorders of the vestibular system","volume":"45","author":"Dix","year":"1952","journal-title":"Proc R Soc Med"}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1881896\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T13:30:41Z","timestamp":1786627841000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1881896\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,28]]},"references-count":8,"alternative-id":["10.3389\/fneur.2026.1881896"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2026.1881896","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,28]]},"article-number":"1881896"}}