Author response: Questionnaire-based diagnosis of benign paroxysmal positional vertigo

We thank Dr. Lanska for the interest in our article¹ that introduced a questionnaire comprising 6 questions to diagnose benign paroxysmal positional vertigo (BPPV) and its subtypes. Dr. Lanska instead proposed a rather simple 4-question approach. This proposition is based on the assumption that BPPV preferentially involves the posterior semicircular canal (PC-BPPV). Indeed, the posterior semicircular canal is more commonly involved (60%–90%) than other canals in BPPV.² The proportion of BPPV involving the horizontal canal (HC-BPPV), however, should not be underestimated. According to the prior studies, HC-BPPV comprises 20%–35% of idiopathic BPPV.^3,4 Given the similar proportion of HC-BPPV among the centers in South Korea³ and a lower incidence of HC-BPPV in patients with a lesser interval from symptom onset to diagnosis,⁵ this seemingly higher proportion of HC-BPPV in our studies may not be ascribed to a referral-bias, and the proportion of HC-BPPV seems higher than is believed in the real world.

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