Developing a Diagnostic Decision Support System for Benign Paroxysmal Positional Vertigo Using a Deep-Learning Model

Background: Diagnosis of benign paroxysmal positional vertigo (BPPV) depends on the accurate interpretation of nystagmus induced by positional tests. However, difficulties in interpreting eye-movement often can arise in primary care practice or emergency room. We hypothesized that the use of machine learning would be helpful for the interpretation. Methods: From our clinical data warehouse, 91,778 nystagmus videos from 3467 patients with dizziness were obtained, in which the three-dimensional movement of nystagmus was annotated by four otologic experts. From each labeled video, 30 features changed into 255 grid images fed into the input layer of the neural network for the training dataset. For the model validation, video dataset of 3566 horizontal, 2068 vertical, and 720 torsional movements from 1005 patients with BPPV were collected. Results: The model had a sensitivity and specificity of 0.910 ± 0.036 and 0.919 ± 0.032 for horizontal nystagmus; of 0.879 ± 0.029 and 0.894 ± 0.025 for vertical nystagmus; and of 0.783 ± 0.040 and 0.799 ± 0.038 for torsional nystagmus, respectively. The affected canal was predicted with a sensitivity of 0.806 ± 0.010 and a specificity of 0.971 ± 0.003. Conclusions: As our deep-learning model had high sensitivity and specificity for the classification of nystagmus and localization of affected canal in patients with BPPV, it may have wide clinical applicability.