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Bech MW, Staffe AT, Hougaard DD. A mechanical rotation chair provides superior diagnostics of benign paroxysmal positional vertigo. Front Neurol 2023; 14:1040701. [PMID: 36779048 PMCID: PMC9911680 DOI: 10.3389/fneur.2023.1040701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 01/09/2023] [Indexed: 01/28/2023] Open
Abstract
Background Benign paroxysmal positional vertigo (BPPV) is the most common vestibular disease. Both therapeutic and diagnostic benefits with mechanical rotation chairs (MRCs) for management of BPPV have been reported. No previous studies have compared diagnostics in MRCs to traditional diagnostics on an examination bed. Objective To investigate the agreement between BPPV diagnostics performed with an MRC and traditional diagnostics on an examination bed. Secondary objectives were to (1) examine if the two test modalities differ in diagnostic properties when diagnosing largely untreated patients referred from general practitioners (uncomplicated BPPV) compared to patients referred from private ENTs (complicated BPPV) and (2) examine whether impaired participant cooperation during Manual Diagnostics (MDs) alters agreement, sensitivity and specificity. Method Prospective randomized clinical trial in which patients with a case history of BPPV were recruited by referrals from general practitioners, otorhinolaryngologists and other hospital departments in the Northern Region of Denmark. Participants underwent diagnostic examinations twice: once by traditional MDs on an examination bed and once with an MRC. Initial examiner and order of test modality were randomized. Examiners were blinded to each other's findings. Results When testing the ability to diagnose BPPV, agreement between the two test modalities, was 0.83, Cohen's kappa 0.66. When comparing MD diagnostics to MRC diagnostics (set as gold standard diagnostics following test result interpretation), values for MDs were: sensitivity 71%, specificity 98%, Negative Predictive Value 73%, and Positive Predictive Value 97%. Agreement regarding BPPV subtype classification was found to be 0.71, and Cohen's kappa 0.58. Agreement when isolating the diagnosis to posterior canalolithiasis (p-CAN) was 0.89, Cohen's kappa 0.78. Conclusion Diagnostics, aided by an MRC, are more sensitive than traditional manual BPPV diagnostics. The overall agreement level between test modalities was found to be weak to moderate. When isolating diagnostics to p-CAN, the level of agreement increased to "moderate-strong." Results also showed higher agreement between test modalities and a significantly higher negative predictive value for MDs when examining patients referred directly from General Practitioners following no- or a single treatment attempt. The diagnostic properties of MDs improved in patients with a higher degree of cooperation.
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Affiliation(s)
- Mathias Winther Bech
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Balance and Dizziness Centre, Aalborg University Hospital, Aalborg, Denmark,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark,*Correspondence: Mathias Winther Bech ✉
| | - Alexander Torp Staffe
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Balance and Dizziness Centre, Aalborg University Hospital, Aalborg, Denmark,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Dan Dupont Hougaard
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Balance and Dizziness Centre, Aalborg University Hospital, Aalborg, Denmark,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Imai T, Inohara H. Benign paroxysmal positional vertigo. Auris Nasus Larynx 2022; 49:737-747. [DOI: 10.1016/j.anl.2022.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/11/2022] [Accepted: 03/04/2022] [Indexed: 10/18/2022]
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Imai T, Nishiike S, Okumura T, Takeda N, Sato T, Ohta Y, Kamakura T, Inohara H. Effect of Sitting Position vs. Supine Position With the Head Turned to the Affected Side on Benign Paroxysmal Positional Vertigo Fatigue. Front Neurol 2021; 12:705034. [PMID: 34220699 PMCID: PMC8247571 DOI: 10.3389/fneur.2021.705034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 05/21/2021] [Indexed: 11/20/2022] Open
Abstract
Objective: In benign paroxysmal positional vertigo (BPPV), positional nystagmus becomes generally weaker when the Dix–Hallpike test is repeated. This phenomenon is termed BPPV fatigue. We previously reported that the effect of BPPV fatigue deteriorates over time (i.e., the positional nystagmus is observed again after maintaining a sitting head position). The aim of this study was to investigate whether the effect of BPPV fatigue attenuates after maintaining a supine position with the head turned to the affected side. Methods: Twenty patients with posterior-canal-type BPPV were assigned to two groups. Group A received Dix–Hallpike test, were returned to the sitting position (reverse Dix–Hallpike test) with a sitting head position for 10 min, and then received a second Dix–Hallpike test. Group B received Dix–Hallpike test, were kept in the supine position with the head turned to the affected side for 10 min, and then received reverse Dix–Hallpike test followed by the second Dix–Hallpike test. The maximum slow phase eye velocity (MSPEV) of positional nystagmus induced by the first, reverse, and second Dix–Hallpike test were analyzed. Results: The ratio of MSPEV of the positional nystagmus induced by the second Dix–Hallpike test relative to the first Dix–Hallpike test was significantly smaller in group B than that in group A. There was no difference in the MSPEV of the positional nystagmus induced by the reverse Dix–Hallpike test between group A and B. Conclusions: The effect of BPPV fatigue is continued by maintaining a supine position with the head turned to the affected side, while the effect is weakened by maintaining a sitting head position. On the basis of the most widely accepted theory of the pathophysiology of BPPV fatigue, in which the particles become dispersed along the canal during head movement in the Dix–Hallpike test, we found an inconsistency whereby the dispersed otoconial debris return to a mass during the sitting position but do not return to a mass in the supine position with the head turned to the affected side. Future studies are required to determine the exact pathophysiology of BPPV fatigue. Classification of Evidence: 2b.
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Affiliation(s)
- Takao Imai
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Suetaka Nishiike
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka Rosai Hospital, Sakai, Japan
| | - Tomoko Okumura
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Noriaki Takeda
- Department of Otorhinolaryngology - Head and Neck Surgery, Tokushima University Graduate School of Medicine, Tokushima, Japan
| | - Takashi Sato
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yumi Ohta
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takefumi Kamakura
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hidenori Inohara
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita, Japan
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Complex nystagmus in traumatic benign paroxysmal positional vertigo: A case study on the critical value of knowing semicircular canal excitation and inhibition patterns. J Otol 2021; 16:199-204. [PMID: 34220988 PMCID: PMC8241704 DOI: 10.1016/j.joto.2021.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/17/2021] [Accepted: 01/19/2021] [Indexed: 11/24/2022] Open
Abstract
A 73-year-old female presented to the emergency department with chief complaint of dizziness after sustaining a fall one month prior to dizziness onset. Although careful examination of eye movement patterns during positional testing was attempted at varying stages of her inpatient admission, her complex nystagmus patterns as a result of traumatic benign paroxysmal vertigo were difficult to manage. In particular, the nystagmus pattern from this case suggests the BPPV was variable and affecting either 1) left posterior semicircular canal (pSCC) exclusively 2) left pSCC and right anterior semicircular canal, 3) left and right pSCC canal. This case illustrates the importance of two critical details; positional testing should include observing nystagmus with fixation removed and an experienced clinician should be involved as early as possible.
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Di Cesare T, Tricarico L, Passali GC, Sergi B, Paludetti G, Galli J, Picciotti PM. Traumatic benign paroxysmal positional vertigo: personal experience and comparison with idiopathic BPPV. Int J Audiol 2020; 60:393-397. [PMID: 32959692 DOI: 10.1080/14992027.2020.1821253] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Benign paroxysmal positional vertigo (BPPV) is the most common cause of vestibular vertigo, with post-traumatic origin in about 15% of cases. Management and prognosis of traumatic BPPV (T-BPPV) are still debated, especially about recurrence. The aim was to compare T-BPPV to idiopathic (I-BPPV). DESIGN AND STUDY SAMPLE We analysed data about 795 BPPV patients: 716 idiopathic (90%) and 79 post-traumatic (10%), evaluating clinical history and bedside-examination, treating all patients with repositioning manoeuvres and reassessing them until the resolution of symptoms and nystagmus. RESULTS Persistence rate in T-BPPV and I-BPPV patients was significantly different (p = 0.0074, OR = 2.31), respectively 12.6% and 5%. Also the rate of bilateral disease (p = 0.0063, OR = 4.72) and multicanalar involvement (p = 0.0183; OR = 4.67) were significantly higher in T-BPPV patients . There were no significant differences in age and sex distribution, side and canal interested. In T-BPPV group, the resolution rate with one manoeuvre was lower than I-BPPV (p = 0.0132: OR: 0,56). Recurrence rate was 38% in the T-BPPV group and 30.6% in the I-BPPV group, without significant difference. CONCLUSIONS T-BPPV resulted different from I-BPPV in the resolution rate, bilateral or multiple canal involvement and persistence rate. T-BPPV and I-BPPV does not differ for recurrence rate, suggesting that, after resolution, the natural course of post-traumatic and idiopathic BPPV is similar.
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Affiliation(s)
- Tiziana Di Cesare
- ENT and Head Neck Surgery Department, Catholic University, Rome, Italy
| | - Laura Tricarico
- ENT and Head Neck Surgery Department, Catholic University, Rome, Italy
| | | | - Bruno Sergi
- Otolaryngology, Catholic University, Rome, Italy
| | - Gaetano Paludetti
- ENT and Head Neck Surgery Department, Catholic University, Rome, Italy.,Otolaryngology, Catholic University, Rome, Italy
| | - Jacopo Galli
- ENT and Head Neck Surgery Department, Catholic University, Rome, Italy.,Otolaryngology, Catholic University, Rome, Italy
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Ichijo H. A new treatment (the affected-ear-up 90° maneuver) for benign paroxysmal positional vertigo of the lateral semicircular canal. Acta Otolaryngol 2019; 139:588-592. [PMID: 31066612 DOI: 10.1080/00016489.2019.1609700] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Although several researchers have tried various kinds of canalith repositioning procedures for lateral canalolithiasis, a standard treatment has not been established. We have adopted 90° rotation, which is anatomically appropriate. Objective: To clarify the efficacy of the affected-ear-up 90° maneuver. Materials and methods: The subjects were 23 consecutive patients (15 females, 8 males) who revealed transient direction-changing geotropic positional nystagmus. After determining the affected side, we immediately performed the canalith repositioning procedure. To perform this maneuver: (1) Place the patient in the supine position. (2) Rotate the head toward the healthy side until 90° from the supine. (3) Sit up. (4) Ask the patient to remain upright with the chin down until going to bed. Results: Nineteen patients (83%) became symptom-free by only one maneuver. However, three patients converted to ipsilateral cupulolithiasis of the lateral canal, and one patient required a second maneuver. Conclusion: The affected-ear-up 90° maneuver is effective against lateral canalolithiasis.
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Imai T, Okumura T, Sato T, Takeda N, Ohta Y, Okazaki S, Inohara H. Effects of Interval Time of the Epley Maneuver on Immediate Reduction of Positional Nystagmus: A Randomized, Controlled, Non-blinded Clinical Trial. Front Neurol 2019; 10:304. [PMID: 31019486 PMCID: PMC6459130 DOI: 10.3389/fneur.2019.00304] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 03/11/2019] [Indexed: 11/27/2022] Open
Abstract
Objective: The Epley maneuver (EM) has an immediate effect: rapid reduction of positional nystagmus. Benign paroxysmal positional vertigo (BPPV) causes BPPV fatigue, which constitutes fatigability of positional nystagmus and vertigo with repeated performance of the Dix-Hallpike test; notably, BPPV fatigability becomes ineffective over time. We hypothesized that the immediate effect of the EM is caused by BPPV fatigue. Therefore, we suspected that performance of the EM with intervals between head positions would worsen the immediate reduction of positional nystagmus in patients with BPPV, because BPPV fatigability would become ineffective during performance of this therapy. Methods: Forty patients with newly diagnosed BPPV were randomly assigned to the following two groups; one group performed the EM without intervals between positions (group A), and the other group performed the EM with 3 min intervals between positions (group B). The primary outcome measure was the ratio of maximum slow-phase eye velocity (MSPEV) of positional nystagmus soon after the EM, compared with that measured before the EM. Secondary outcome included whether a 30 min interval after the EM enabled recovery of MSPEV of positional nystagmus to the original value. This study followed the CONSORT 2010 reporting standards. Results: In both groups A and B, the immediate effect of the EM could be observed, because MSPEV during the second Dix-Hallpike test was significantly smaller than MSPEV during the first Dix-Hallpike test (p < 0.0001 in group A, p < 0.0001 in group B). The primary outcome measure was larger in group B than in group A (p = 0.0029). The immediate effect faded 30 min later (secondary outcome). Conclusions: This study showed that the EM had an immediate effect both with and without interval time in each head position of the EM. Because setting interval time in each head position of the EM reduced the immediate effect of the EM, interval time during the EM adds less benefit. This finding can reduce the effort exerted by doctors, as well as the discomfort experienced by patients with pc-BPPV, during EM. However, this immediate effect may be caused by BPPV fatigue, and may fade rapidly. Classification of Evidence: 1b
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Affiliation(s)
- Takao Imai
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tomoko Okumura
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takashi Sato
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Noriaki Takeda
- Department of Otorhinolaryngology - Head and Neck Surgery, Tokushima University Graduate School of Medicine, Tokushima, Japan
| | - Yumi Ohta
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Suzuyo Okazaki
- Department of Otolaryngology, Osaka City General Hospital, Osaka, Japan
| | - Hidenori Inohara
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka University Graduate School of Medicine, Suita, Japan
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