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Alashram AR. Effectiveness of brandt-daroff exercises in the treatment of benign paroxysmal positional vertigo: a systematic review of randomized controlled trials. Eur Arch Otorhinolaryngol 2024; 281:3371-3384. [PMID: 38341824 DOI: 10.1007/s00405-024-08502-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 01/23/2024] [Indexed: 02/13/2024]
Abstract
PURPOSE This review aims to examine the effects of Brandt-Daroff exercises (BDEs) on individuals with posterior canal Benign Paroxysmal Positional Vertigo (BPPV) and to provide recommendations for future research on this topic. METHODS PubMed, MEDLINE, PEDro, SCOPUS, REHABDATA, EMBASE, and Web of Science were searched from inception to November 2023. The Physiotherapy Evidence Database (PEDro) scale was used to assess the methodological quality of the included studies. RESULTS In total, ten randomized controlled trials met our eligibility criteria. A total of 880 individuals with BPPV (63.6% females) were included in this review. The included studies were ranked "good quality" on the PEDro scale. The available literature showed that BDEs do not significantly reduce symptoms or promote recovery in people with posterior canal BPPV compared to other interventions, such as Epley and Semont maneuvers. CONCLUSIONS The evidence for the effects of BDEs on patients with BPPV is limited. Further high-quality studies with long-term follow-ups are strongly required to investigate the long-term effects of BDEs in posterior canal BPPV, define the optimal application of BDEs, and identify the factors associated with treatment response and recovery.
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Affiliation(s)
- Anas R Alashram
- Department of Physiotherapy, Middle East University, Airport Road, Amman, Jordan.
- Applied Science Research Center, Applied Science Private University, Amman, Jordan.
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy.
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Alashram AR. Semont maneuver for posterior canal benign paroxysmal positional vertigo: a systematic review of randomized controlled trials. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08586-0. [PMID: 38530461 DOI: 10.1007/s00405-024-08586-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 02/27/2024] [Indexed: 03/28/2024]
Abstract
PURPOSE This review aimed to examine the effects of the Semont maneuver on posterior canal benign paroxysmal positional vertigo (BPPV). METHODS PubMed, PEDro, SCOPUS, REHABDATA, EMBASE, and Web of Science were searched comprehensively from inception to January 2024. The Physiotherapy Evidence Database (PEDro) scale was employed to evaluate the quality of the selected studies. RESULTS In total, 18 randomized controlled trials met the eligibility criteria. A total of 2237 participants with BPPV (mean age = 58.10 years) were included in this review. Among them, 37.5% were males, and 58% presented with right-sided BPPV. The included studies ranked from 5 to 9 out of 10 (Median = 7), suggesting good to excellent quality on the PEDro scale. The available literature revealed that the Semont maneuver is effective in improving posterior canal BPPV symptoms. CONCLUSION The Semont maneuver is considered a standard option for treating posterior canal BPPV, with a high success rate of around 80%. It is suggested as the primary option for managing posterior canal BPPV in individuals who complain of cervical or lumbar problems, severe cardiac or respiratory conditions. Further studies are strongly needed to understand the long-term effects of the Semont maneuver and to identify the recurrence rate.
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Affiliation(s)
- Anas R Alashram
- Department of Physiotherapy, Middle East University, Airport Road 1666, Amman, Jordan.
- Applied Science Research Center, Applied Science Private University, Amman, Jordan.
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy.
- Centre of SpaceBio-Medicine, Department of Systems Medicine, Faculty of Medicine and Surgery, University of Rome "Tor Vergata", 00133, Rome, Italy.
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Hu Y, Lu Y, Wang S, Quan X, Ren Y, Rong K, Pan S, Lu X, Chen L, Tian C, Lei J. Global research trends in benign paroxysmal positional vertigo: a bibliometric analysis. Front Neurol 2023; 14:1204038. [PMID: 37333008 PMCID: PMC10272773 DOI: 10.3389/fneur.2023.1204038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 05/09/2023] [Indexed: 06/20/2023] Open
Abstract
Background Benign paroxysmal positional vertigo is the most common disease in which vertigo is the main clinical manifestation, and it has become a global medical problem, affecting a wide range of areas and seriously affecting the quality of human life. Objective This article presents an analysis of the current characteristics of BPPV-related research and summarizes the current hot topics and trends, with the goal of inspiring future research into the prevention and treatment of BPPV, thereby improving the differential diagnosis and prevention of peripheral vertigo. Methods A bibliometric approach was used to collect 1,219 eligible studies on BPPV from four databases-PubMed, Embase, Scopus, and Web of Science-published between 1974 and 2022. The characteristics and status of the accumulated scientific output were processed using R and VOSviewer so that we could visualize any trends or hotspots. Results The results showed a significant increase in the annual number of publications, with an average annual growth rate of 21.58%. A possible reason for the especially pronounced peak in 2021 was an increase in the prevalence of BPPV as a result of COVID-19. The new coronavirus became a focus of research in 2021. A total of 3,876 authors (of whom 1,097 were first authors) published articles in 307 different journals; 15.7% of the articles were published in Acta Oto-Larygologica, Otology and Neurotology, and Frontiers in Neurology. Acta Oto-Laryngologica was well ahead of the other journals in terms of growth rate and number of articles published. American scholars generated the largest number of articles overall, and the USA was involved in the greatest number of international collaborations, followed by Italy and China. The themes of the research centered around three topics, namely the treatment of BPPV, its influencing factors, and diagnosis. Conclusions There has been a major increase in BPPV-related research over the last 50 years, leading to an increase in related articles and rapid development of the field. Key directions for future research include the improvement of individualized treatment for residual symptoms after initial treatment of BPPV among the elderly; effective control of comorbidities such as osteoporosis; and secondary inner ear disease, such as Ménière's disease.
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Affiliation(s)
- Yuanjia Hu
- School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yang Lu
- School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou, China
| | - Shengyue Wang
- School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou, China
| | - Xiyu Quan
- School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yijia Ren
- School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou, China
| | - Kaiyi Rong
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Sijia Pan
- School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou, China
| | - Xiaoyou Lu
- School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou, China
| | - Lei Chen
- School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou, China
| | - Chenghua Tian
- School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jianbo Lei
- Clinical Research Center, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- School of Medical Informatics and Engineering, Southwest Medical University, Luzhou, China
- Institute of Medical Technology, Peking University, Beijing, China
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Peña Navarro P, Pacheco López S, Almeida Ayerve CN, Marcos Alonso S, Serradilla López JM, Santa Cruz Ruiz S, Gómez Sánchez JC, Kaski D, Batuecas Caletrío Á. Early Diagnosis of Central Disorders Mimicking Horizontal Canal Cupulolithiasis. Brain Sci 2023; 13:brainsci13040562. [PMID: 37190527 DOI: 10.3390/brainsci13040562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/22/2023] [Accepted: 03/25/2023] [Indexed: 03/29/2023] Open
Abstract
Background: Horizontal Canal Cupulolithiasis (hc-BPPV-cu) can mimic a pathology of central origin, so a careful examination is essential to prevent misdiagnosis. Methods: Retrospective cross-sectional cohort study of 45 patients suffering from suspected hc-BPPV-cu. We recorded whether patients first presented through an ENT Emergency Department (ED) or through an Outpatient Otolaryngology Clinic (OC). Results: We found statistically significant differences (p < 0.05) between the OC versus the ED in relation to the time between symptom onset and first assessment (79.7 vs. 3.6 days, respectively), the number of therapeutic maneuvers (one maneuver in 62.5% vs. 75.9%, and more than one in 25.1% vs. 13.7%), and multi-canal BPPV rate (43.8% vs. 3.4%). hc-BPPV-cu did not resolve in 2 patients (12.5%) from the OC and in 3 (10.3%) from de ED, all of which showed central pathology. Discussion: There are no prior studies that analyze the approach to hc-BPPV-cu in the ED. The benefits of early specialist input are early identification of central positional nystagmus, a decrease in symptom duration, reduced number of therapeutic maneuvers required for symptom resolution, and lower rates of iatrogenic multi-canal BPPV. Conclusion: A comprehensive approach to hc-BPPV-cu in the ED allows both more effective treatment and early identification of central disorder mimics.
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Affiliation(s)
- Paula Peña Navarro
- Neurotology Unit, ENT Department, University Hospital of Salamanca, IBSAL, 37007 Salamanca, Spain
| | - Sofía Pacheco López
- Neurotology Unit, ENT Department, University Hospital of Salamanca, IBSAL, 37007 Salamanca, Spain
| | | | - Susana Marcos Alonso
- Neurotology Unit, ENT Department, University Hospital of Salamanca, IBSAL, 37007 Salamanca, Spain
| | | | - Santiago Santa Cruz Ruiz
- Neurotology Unit, ENT Department, University Hospital of Salamanca, IBSAL, 37007 Salamanca, Spain
| | - José Carlos Gómez Sánchez
- Neurotology Unit, Neurology Department, University Hospital of Salamanca, IBSAL, 37007 Salamanca, Spain
| | - Diego Kaski
- Department of Clinical and Movement Neurosciences, Institute of Neurology, UCL, London WC1N 3BG, UK
| | - Ángel Batuecas Caletrío
- Neurotology Unit, ENT Department, University Hospital of Salamanca, IBSAL, 37007 Salamanca, Spain
- ENT Department, Faculty of Medicine, University of Salamanca, 37007 Salamanca, Spain
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Strupp M, Mavrodiev V, Goldschagg N. Triple Benign Paroxysmal Positional Vertigo and the Strength of Remote Video-Based Management. JAMA Neurol 2023; 80:322. [PMID: 36622659 DOI: 10.1001/jamaneurol.2022.4861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
This case report describes remote video-based diagnosis and management of triple posttraumatic benign paroxysmal positional vertigo.
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Affiliation(s)
- Michael Strupp
- Department of Neurology and German Center for Vertigo and Balance Disorders, Hospital of the Ludwig Maximilians University, Munich, Germany
| | - Vergil Mavrodiev
- Department of Neurology and German Center for Vertigo and Balance Disorders, Hospital of the Ludwig Maximilians University, Munich, Germany
| | - Nicolina Goldschagg
- Department of Neurology and German Center for Vertigo and Balance Disorders, Hospital of the Ludwig Maximilians University, Munich, Germany
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Kim JM, Lee SH, Kim HJ, Kim JS. Less talked variants of benign paroxysmal positional vertigo. J Neurol Sci 2022; 442:120440. [PMID: 36244097 DOI: 10.1016/j.jns.2022.120440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/18/2022] [Accepted: 09/25/2022] [Indexed: 11/25/2022]
Abstract
The diagnostic criteria were established for benign paroxysmal positional vertigo (BPPV), the most common vestibular disorder worldwide, by the Barany Society in 2015. This marked an important milestone in the diagnosis and treatment of BPPV. However, there still remain uncertainties and ambiguities regarding the clinical features and pathophysiology of BPPV, and its clinical variants. In this manuscript, we will discuss 1) the emerging and controversial syndromes of BPPV (i.e., canalolithiasis of the anterior canal, cupulolthiasis of the posterior canal, and lithiasis of multiple canals) with updates, 2) atypical nystagmus according to the canal involved (e.g., nystagmus induced by head position changes in the pitch plane in horizontal canal BPPV, and positional downbeat nystagmus in posterior canal BPPV), 3) persistent geotropic positional nystagmus. Consideration of these uncommon types and manifestations of BPPV would broaden our understanding of BPPV pathomechanisms and allow differentiation from central vertigo and nystagmus.
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Affiliation(s)
- Jae-Myung Kim
- Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Seung-Han Lee
- Department of Neurology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Hyo-Jung Kim
- Research Administration Team, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Ji-Soo Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Wu Y, Song N, Ling X, Li X, Feng Y, Xing Y, Gu P, Yang X. Canal switch in benign paroxysmal positional vertigo: Clinical characteristics and possible mechanisms. Front Neurol 2022; 13:1049828. [PMID: 36452167 PMCID: PMC9702335 DOI: 10.3389/fneur.2022.1049828] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 10/31/2022] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Canal switch-benign paroxysmal positional vertigo (CS-BPPV) refers to the phenomenon in which otolith particles move from one canal to another (on the ipsilateral side) during or after canalith repositioning procedure (CRP). However, the clinical characteristics of CS-BPPV and the underlying pathological mechanisms remain unclear. In this study, we investigated the incidence of canal switch (CS) for the different semicircular canals in benign paroxysmal positional vertigo (BPPV), examined nystagmus characteristics, and explored the underlying mechanisms. METHODS Clinical data for 1,099 patients with single-canal BPPV were collected and retrospectively analyzed. The incidences of CS in the different types of BPPV were analyzed. Patients were divided into CS-BPPV and non-CS (NCS)-BPPV groups according to whether they exhibited CS after CRP. The baseline characteristics and nystagmus characteristics of patients were compared between the two groups. RESULTS Patients with BPPV who developed or did not develop CS accounted for 4.6% (51/1,099) and 95.4% (1,048/1,099), respectively, of the patients included in the study. There were no statistically significant differences between the two groups in terms of sex, age, side of the canals involved, hypertension, or diabetes. CS was observed in 3.7% (25/677) of patients with PC-BPPV, including conversion between posterior canal (PC) and horizontal canal (HC) (1.6%, 11/677), and between PC and anterior canal (AC) (2.1%, 14/677). CS was observed in 5.2% (17/327) of patients with HC-BPPV, including from HC to PC (4.3%, 14/327), and from HC to AC (0.9%, 3/327). CS was found in 9.5% (9/95) of patients with AC-BPPV, including from AC to PC (8.4%, 8/95), and from AC to HC (1.1%, 1/95). The intensity of nystagmus was significantly greater in the CS-BPPV group compared with that in the NCS-BPPV group [24.00 (11-39) vs. 12.00 (7-24), P < 0.001]. Furthermore, the incidence of direction-reversing nystagmus was significantly higher in the CS-BPPV group than in the NCS-BPPV group [31.4% (16/51) vs. 4.3% (45/1,048), P < 0.001]. CONCLUSIONS CS in BPPV is uncommon. Patients with AC-BPPV are more likely to develop CS, followed by patients with HC-BPPV and PC-BPPV. The occurrence of CS-BPPV may be related to the anatomical structure of the semicircular canals. When the canals contain large/heavy accumulations of otolith particles, CS may be more common during re-examination after CRP.
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Affiliation(s)
- Yuexia Wu
- Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China
- Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ning Song
- Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Xia Ling
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Xiang Li
- Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Yufei Feng
- Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Yue Xing
- Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Ping Gu
- Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xu Yang
- Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China
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Krieger J, Frackowiak M, Berger M, Heneka MT, Jacobs AH. Falls at advanced age - The importance to search for benign paroxysmal positional vertigo (BPPV). Exp Gerontol 2022; 165:111868. [PMID: 35700849 DOI: 10.1016/j.exger.2022.111868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/20/2022] [Accepted: 06/07/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION One of the most important geriatric syndromes is dizziness in conjunction with gait disorder and consequent falls. There are various differential diagnoses for dizziness, one of them is benign paroxysmal positional vertigo (BPPV). OBJECTIVES A targeted diagnostic work-up and treatment of BPPV can prevent subsequent falls and a decline in the patients' quality of life, prolonged hospitalization with unnecessary examinations and medication. DESIGN Prospective examination of patients with a positive medical history of BPPV. SETTING AND PARTICIPANTS All patients treated within the Department of Geriatrics between 05/2015 and 03/2018 were included. A total of n = 5166 patients were screened (n = 2651 geriatrics; n = 2515 controls). METHODS All patients from other wards subjected to a neurological examination due to vertigo served as controls. Patients with typical hints in the medical history for a BPPV were subjected to the diagnostic Dix-Hallpike maneuver and, if positive, subsequent canalith repositioning maneuvers. The percentage of successful positional treatments was determined in both groups. RESULTS N = 254 patients (4.9 %) had indications in the medical history for a BPPV. For 71 of n = 254 patients (28 %; in total 1.4 %; mean age: 78.4 ± 12.3 years) the diagnosis of BPPV was proven by a positive Dix-Hallpike maneuver. N = 39 (54.9 %) patients belong to the geriatric group (mean age 82 years) and n = 32 (45.1 %) to the control group (mean age 73.9 years). The frequency of BPPV was similar in both groups (1.3-1.5 %). In 91.9 % of patients the BPPV was localized in the posterior semicircular canal. Up to 93 % were asymptomatic after one or repeated canalith repositioning maneuvers. CONCLUSIONS AND IMPLICATIONS The BPPV should be considered as an important differential diagnosis for geriatric patients with dizziness and falls. After therapeutic repositioning maneuvers most of the patients are asymptomatic. Therefore, targeted screening and therapy ("theragnostic") of BPPV at an advanced age increases diagnostic accuracy and prevents unnecessary examinations, medications and future falls.
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Affiliation(s)
- Jasmin Krieger
- Department of Geriatrics and Neurology, and Centres for Aging Medicine (AMZ) and Orthogeriatrics (ATZ) of the Johanniter Hospital, Bonn, Germany; Department of Neurodegenerative Diseases, and Centre for Integrated Oncology (CIO) of the University Hospital, Bonn, Germany
| | - Monika Frackowiak
- Department of Geriatrics and Neurology, and Centres for Aging Medicine (AMZ) and Orthogeriatrics (ATZ) of the Johanniter Hospital, Bonn, Germany; Department of Neurodegenerative Diseases, and Centre for Integrated Oncology (CIO) of the University Hospital, Bonn, Germany
| | - Moritz Berger
- Department of Geriatrics and Neurology, and Centres for Aging Medicine (AMZ) and Orthogeriatrics (ATZ) of the Johanniter Hospital, Bonn, Germany; Department of Neurodegenerative Diseases, and Centre for Integrated Oncology (CIO) of the University Hospital, Bonn, Germany
| | - Michael T Heneka
- Department of Geriatrics and Neurology, and Centres for Aging Medicine (AMZ) and Orthogeriatrics (ATZ) of the Johanniter Hospital, Bonn, Germany; Department of Neurodegenerative Diseases, and Centre for Integrated Oncology (CIO) of the University Hospital, Bonn, Germany
| | - Andreas H Jacobs
- Department of Geriatrics and Neurology, and Centres for Aging Medicine (AMZ) and Orthogeriatrics (ATZ) of the Johanniter Hospital, Bonn, Germany; Department of Neurodegenerative Diseases, and Centre for Integrated Oncology (CIO) of the University Hospital, Bonn, Germany.
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Vadlamani S, Dorasala S, Dutt SN. Diagnostic Positional Tests and Therapeutic Maneuvers in the Management of Benign Paroxysmal Positional Vertigo. Indian J Otolaryngol Head Neck Surg 2022; 74:475-487. [PMID: 36032928 PMCID: PMC9411440 DOI: 10.1007/s12070-020-02292-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 11/24/2020] [Indexed: 11/24/2022] Open
Abstract
Benign Paroxysmal Positional Vertigo (BPPV), the most common vestibular disorder characterized by recurrent, brief episodes of vertigo, is attributed to the presence of otoconia in the semicircular canals. Two mechanisms contribute to its cause-canalolithiasis (otoconia freely mobile in the semicircular canal) and cupulolithiasis (otoconia adherent to the cupula). Posterior semicircular canal is the most common canal involved. Although the occurrence of BPPV in lateral and superior semicircular canal is rare, with the advancement in diagnostic techniques, their incidence is being reported in the past few years. Various diagnostic tests and therapeutic maneuvers have been described in the management of BPPV. The present report is a comprehensive review of the tests and maneuvers for BPPV written as a guide intended to help the clinicians in the accurate diagnosis and application of a canal-specific treatment maneuver for BPPV. A simplified algorithmic approach ("The Bangalore BPPV Algorithm") for the management of BPPV is described.
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The Role of Video Head Impulse Test (Vhit) in Diagnosing Benign Paroxysmal Positional Vertigo (BPPV). Indian J Otolaryngol Head Neck Surg 2022; 74:506-510. [PMID: 36032822 PMCID: PMC9411412 DOI: 10.1007/s12070-020-02351-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 12/23/2020] [Indexed: 10/22/2022] Open
Abstract
Benign paroxysmal positional vertigo (BPPV) is a common clinical disorder characterized by brief recurrent spells of vertigo often brought about by certain head position changes. General treatment for BPPV is by clinical examination by Dix-Hallpike maneuver, Video head impulse test (VHIT) is a novel test that enhances diagnostic opportunities and enables a clinician to precisely localize the site of vestibular disorders. This interested us to investigate its potential in diagnosis of BPPV.The aim of the present study is to assess the role of Video head impulse test (VHIT) in confirming the clinically diagnosed case of BPPV.All patients above the age of 18 years who were clinically diagnosed with BPPV underwent VHIT and results were correlated with clinical findings. Total 60 patients were studied in the period of 2016-2018.Among the 60 patients clinically diagnosed with BPPV, 41 were males and 19 were females. Majority of patients were in the age group of 51-60 years. Posterior canal is most commonly affected (97%) than anterior and lateral canals in BPPV. In unilateral posterior canal BPPV and bilateral posterior canal BPPV VOR (Vestibulo- ocular reflex) gains was reduced but were not statistically significant. Saccades were present only in 17 cases. There is no relationship between the presence of saccades, the canal involved and the side of the lesion.From the present study we conclude that the currently available equipment for VHIT is not useful in diagnosing BPPV. Also, strongly recommends advanced research on this to record minute changes in VOR gain.
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Yacovino DA, Zanotti E, Cherchi M. AUTHOR RESPONSE: RE: BENIGN PAROXYSMAL POSITIONAL VERTIGO: CANAL SWITCHING AFFECTING ALL CANALS DURING A SINGLE SESSION. Otol Neurotol 2022; 43:e695-e696. [PMID: 35761468 DOI: 10.1097/mao.0000000000003543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Seyed Resuli A, Bedir A, Özgür A. The Relationship Between Benign Paroxysmal Positional Vertigo and Vitamin D. Cureus 2022; 14:e26068. [PMID: 35747111 PMCID: PMC9209340 DOI: 10.7759/cureus.26068] [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] [Accepted: 06/18/2022] [Indexed: 12/01/2022] Open
Abstract
Introduction Benign paroxysmal positional vertigo (BPPV) is a type of vertigo and its signs are short-time, severe attacks that occur in certain head and body positions. Recent studies have revealed that vitamin D deficiency correlates with BPPV and this is explained by cupulolithiasis and canalithiasis theories. Method In the present study, levels of serum vitamin D in the patients who were diagnosed as BPPV and those in the control group consisting of healthy individuals were investigated. In addition, it was examined whether vitamin D is influential on the rates of BPPV types. In our study, 258 patients who were diagnosed with BPPV after detailed ear-nose-throat and neurology examinations were examined. We compared the control group according to their ages, genders, and levels of vitamin D. In addition, we divided the BPPV group into two sub-groups according to their vitamin D levels (20-30 ng/ml and 20 g/ml lower), and each was compared by calculating vertigo types and ratios. Results The BPPV group included 187 females and 71 males, and their mean age was 43.70 ± 15.44. The control group consisted of 65 females and 35 males, and the mean age of this group was 44.63 ± 15.42. The mean vitamin D levels of the females and males were 18.42 ± 5.07 and 19.82 ± 5.11, respectively, in this study. On the other hand, the mean vitamin D levels of healthy females and males were found to be 30.88 ± 10.74. Conclusion Our study found that the vitamin D levels of the individuals in the BPPV group were statistically significantly lower than those of the individuals who were in the control group. However, it was observed that vitamin D did not affect the rate of vertigo subtypes.
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骆 志, 刘 秀, 石 林, 王 路, 韩 威, 田 丽, 邓 万. [A prospective randomized controlled study of the difference between BPPV manual reduction and automatic device reduction]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2022; 36:285-288. [PMID: 35511621 PMCID: PMC10128185 DOI: 10.13201/j.issn.2096-7993.2022.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Indexed: 06/14/2023]
Abstract
Objective:To investigate the difference between manual reduction and automatic device reduction in the treatment of benign paroxysmal positional vertigo(BPPV), and to provide evidence-based medicine for the clinical choice of BPPV treatment. Methods:Two hundred and two BPPV patients who came to the hospital for diagnosis and treatment were collected and divided into two groups by random number table method. Group A had 102 cases for manual reduction, and group B had 100 cases for automatic device reduction. Both groups were given the same medicine-assisted treatment. All patients were followed up 7 to 10 days after reduction treatment. To evaluate the differences in the overall effective rate of treatment, visual analog scale(VAS), incidence of adverse reactions, treatment time were compared between the two groups. Results:The overall effective rate was 98.03% and 91.00% in group A and group B, respectively, group A was slightly higher than group B(P=0.027); the difference in VAS scores before and after treatment: group A was 6(4) points, group B was 5(3) , group A is greater than group B(P=0.002); adverse reaction rates in groups A and B were 4.90% and 8.00%, respectively, group B was slightly higher than group A(P=0.37); treatment time: group A 6.0(1.0) min in group A and 8.0(2.0) min in group B, group A was significantly shorter than group B(P<0.01). Conclusion:Both manual and fully automatic device reduction can effectively improve the clinical symptoms of BPPV patients, but for physicians with extensive clinical experience it is recommended to choose manual reduction.
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Affiliation(s)
- 志雅 骆
- 大连医科大学附属第一医院耳鼻咽喉科(辽宁大连, 116000)Department of Otolaryngology, Vertigo Clinic Treatment Center, the First Affiliated Hospital of Dalian Medical University, Dalian, 116000, China
| | - 秀丽 刘
- 大连医科大学附属第一医院耳鼻咽喉科(辽宁大连, 116000)Department of Otolaryngology, Vertigo Clinic Treatment Center, the First Affiliated Hospital of Dalian Medical University, Dalian, 116000, China
| | - 林 石
- 大连医科大学附属第一医院耳鼻咽喉科(辽宁大连, 116000)Department of Otolaryngology, Vertigo Clinic Treatment Center, the First Affiliated Hospital of Dalian Medical University, Dalian, 116000, China
| | - 路阳 王
- 大连医科大学附属第一医院耳鼻咽喉科(辽宁大连, 116000)Department of Otolaryngology, Vertigo Clinic Treatment Center, the First Affiliated Hospital of Dalian Medical University, Dalian, 116000, China
| | - 威 韩
- 大连医科大学附属第一医院耳鼻咽喉科(辽宁大连, 116000)Department of Otolaryngology, Vertigo Clinic Treatment Center, the First Affiliated Hospital of Dalian Medical University, Dalian, 116000, China
| | - 丽娟 田
- 大连医科大学附属第一医院耳鼻咽喉科(辽宁大连, 116000)Department of Otolaryngology, Vertigo Clinic Treatment Center, the First Affiliated Hospital of Dalian Medical University, Dalian, 116000, China
| | - 万锦 邓
- 大连医科大学附属第一医院耳鼻咽喉科(辽宁大连, 116000)Department of Otolaryngology, Vertigo Clinic Treatment Center, the First Affiliated Hospital of Dalian Medical University, Dalian, 116000, China
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14
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Libonati GA, Martellucci S, Castellucci A, Malara P. Minimum Stimulus Strategy: A step-by-step diagnostic approach to BPPV. J Neurol Sci 2022; 434:120158. [DOI: 10.1016/j.jns.2022.120158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/15/2021] [Accepted: 01/13/2022] [Indexed: 11/29/2022]
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15
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Liu X. Sudden-Onset Vertigo Associated with Persistent Spontaneous Torsional Nystagmus and Imbalance: A Unique Clinical Manifestation of Benign Paroxysmal Positional Vertigo But Not Acute Unilateral Peripheral Vestibulopathy (Vestibular Neuritis). SSRN ELECTRONIC JOURNAL 2022. [DOI: 10.2139/ssrn.4141358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
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16
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Vats A, Kothari S, Sharma J, Ramchandani G. Side lying test for anterior semicircular canal benign paroxysmal positional vertigo. Ann Indian Acad Neurol 2022; 25:148-151. [PMID: 35342236 PMCID: PMC8954310 DOI: 10.4103/aian.aian_176_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/21/2021] [Accepted: 03/23/2021] [Indexed: 11/14/2022] Open
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17
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Correia F, Castelhano L, Cavilhas P, Escada P. Lateral semicircular canal-BPPV: Prospective randomized study on the efficacy of four repositioning maneuvers. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2022; 73:27-34. [DOI: 10.1016/j.otoeng.2020.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/01/2020] [Indexed: 10/19/2022]
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18
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Thomas RJ, Goutham MK, Bhat VS, Kamath SD, Aroor R, Bhandary SK. Association of Serum Calcium and Vitamin D with Benign Paroxysmal Positional Vertigo. Int Arch Otorhinolaryngol 2021; 26:e365-e369. [PMID: 35846804 PMCID: PMC9282954 DOI: 10.1055/s-0041-1724093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 11/21/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction
Benign paroxysmal positional vertigo (BPPV) is one of the common disorders of the peripheral vestibular system. The prevalence of BPPV is found to be higher among middle-aged women.
Objectives
To estimate the serum levels of calcium and vitamin D in patients with BPPV, and to study their association.
Methods
The present is a hospital-based prospective case-control study. Venous blood samples of the 49 patients with BPPV and an equal number of age- and gender-matched individuals were recruited and submitted to an analysis of the serum levels of calcium and vitamin D.
Results
Among the cases, 67.3% were found to be females, and 32.7% were males. Most of the 30 cases (61.3%) were aged > 40 years. The mean age of the cases was 44.39 years. The mean serum level of vitamin D in the cases was of 21.26 ng/ml compared with 17.59 ng/ml in the controls. The mean serum level of calcium was of 9.33 mg/dl in the cases, compared with 8.95 mg/dl in the controls. There was no significant difference in the serum levels of vitamin D and calcium between cases and controls.
Conclusion
We could not establish any correlation between the serum levels of calcium and vitamin D with BPPV. However, a negative relationship was found between the serum levels of vitamin D and the number of episodes of BPPV (
p
= 0.012).
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Affiliation(s)
- Ron Jacob Thomas
- Department of Otorhinolaryngology, K S Hegde Medical Academy, Nitte (Deemed to be University), Mangalore, Karnataka, India
| | - M. K. Goutham
- Department of Otorhinolaryngology, K S Hegde Medical Academy, Nitte (Deemed to be University), Mangalore, Karnataka, India
| | - Vadisha Srinivas Bhat
- Department of Otorhinolaryngology, K S Hegde Medical Academy, Nitte (Deemed to be University), Mangalore, Karnataka, India
| | - Shrinath D. Kamath
- Department of Otorhinolaryngology, K S Hegde Medical Academy, Nitte (Deemed to be University), Mangalore, Karnataka, India
| | - Rajeshwary Aroor
- Department of Otorhinolaryngology, K S Hegde Medical Academy, Nitte (Deemed to be University), Mangalore, Karnataka, India
| | - Satheesh Kumar Bhandary
- Department of Otorhinolaryngology, K S Hegde Medical Academy, Nitte (Deemed to be University), Mangalore, Karnataka, India
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19
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Bhandari A, Bhandari R, Kingma H, Strupp M. Diagnostic and Therapeutic Maneuvers for Anterior Canal BPPV Canalithiasis: Three-Dimensional Simulations. Front Neurol 2021; 12:740599. [PMID: 34630309 PMCID: PMC8497794 DOI: 10.3389/fneur.2021.740599] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 08/16/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Objectives: Anterior canal BPPV is a rare BPPV variant. Various diagnostic and therapeutic maneuvers have been described for its management. The aim of this study was to use three-dimensional simulation models to visualize otoconial debris movement within the anterior canal during diagnostic tests and different liberatory maneuvers. This can help to optimize existing treatment maneuvers and help in the development of better management protocols. Methods: Based on reconstructed MRI images and fluid dynamics, a 3D dynamic simulation model (as a function of time) was developed and applied. Simulations of the supine head-hanging test for diagnosis of ac-BPPV were studied. Three repositioning maneuvers were simulated: 1) the Yacovino maneuver and its modifications, 2) the reverse Epley maneuver and 3) the short canal repositioning (CRP) maneuver. Results: The simulation showed that the supine head-hanging test is a good test for diagnosis of ac-BPPV affecting both labyrinths and demonstrated why there is no inversion of nystagmus on sitting up. The Yacovino maneuver was seen to be an effective treatment option for ac-BPPV without having to determine the side involved. However, simulations showed that the classical Yacovino maneuver carried a risk of canal switch to the posterior canal. To overcome this risk, a modified Yacovino maneuver is suggested. The reverse Epley maneuver was not an effective treatment. Short CRP is useful in ac-BPPV treatment; however, it requires determination of side of involvement. Conclusion: The 3D simulator of the movement of the otoconial debris presented here can be used to test the mechanism of action and the theoretical efficacy of existing diagnostic tests and maneuvers as well as to develop new treatment maneuvers to optimize BPPV treatment.
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Affiliation(s)
| | | | - Herman Kingma
- Department of Otorhinolaryngology, Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, Netherlands.,Faculty of Physics, Tomsk State University, Tomsk, Russia.,Department of ENT, Aalborg University, Aalborg, Denmark
| | - Michael Strupp
- Department of Neurology and German Center for Vertigo and Balance Disorders, Ludwig Maximilian University of Munich, Munich, Germany
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20
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Ling X, Kim HJ, Lee JH, Choi JY, Yang X, Kim JS. Diagnostic Value of Straight Head Hanging in Posterior Canal Benign Paroxysmal Positional Vertigo. J Clin Neurol 2021; 17:558-562. [PMID: 34595864 PMCID: PMC8490902 DOI: 10.3988/jcn.2021.17.4.558] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/26/2021] [Accepted: 05/26/2021] [Indexed: 11/29/2022] Open
Abstract
Background and Purpose To determine the diagnostic value of straight head hanging (SHH) in benign paroxysmal positional vertigo involving the posterior semicircular canal (PC-BPPV). Methods We retrospectively included 62 patients (age=56.2±15.0 years, 47 female) with unilateral PC-BPPV who underwent both the Dix-Hallpike maneuver and SHH before receiving canalith repositioning therapy (CRT) between September 2017 and July 2020 at the Dizziness Center of Seoul National University Bundang Hospital in South Korea (16 patients, 25.8%) or the Neurology Outpatient Clinic of Aerospace Central Hospital in China (46 patients, 74.2%). SHH was performed before (n=29, group A) or after (n=33, group B) the Dix-Hallpike maneuver. Results Torsional upbeat nystagmus typical of PC-BPPV was induced during SHH in 52 (83.9%) patients, and the incidence of this type of positional nystagmus did not differ between the groups A and B (79.3% vs. 87.9%, p=0.569). The maximum slow-phase velocity of the induced upbeat nystagmus was higher during SHH than during the Dix-Hallpike maneuver toward the lesion side [range=2.0–60.0°/s (median=18.5°/s) vs. range=2.7–40.0°/s (median=13.4°/s), p<0.001]. Reversal of the positional nystagmus was observed upon resuming the sitting position after SHH in 47 (75.8%) patients and after the Dix-Hallpike maneuver in 54 (87.7%) patients, with no significant difference between the groups (p=0.082). Conclusions SHH is effective for diagnosing PC-BPPV. Given its simplicity, SHH may be performed before the Dix-Hallpike maneuver, and CRT may be attempted thereafter when the typical positional nystagmus for unilateral PC-BPPV is induced during SHH.
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Affiliation(s)
- Xia Ling
- Department of Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hyo Jung Kim
- Research Administration Team, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jong Hee Lee
- Dizziness Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jeong Yoon Choi
- Dizziness Center, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
| | - Xu Yang
- Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Ji Soo Kim
- Dizziness Center, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Neurology, Seoul National University College of Medicine, Seoul, Korea.
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21
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Li Maneuver for geotropic horizontal canal benign paroxysmal positional vertigo (HC-BPPV) -A better choice. Am J Otolaryngol 2021; 42:103132. [PMID: 34216878 DOI: 10.1016/j.amjoto.2021.103132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/16/2021] [Accepted: 06/13/2021] [Indexed: 11/23/2022]
Abstract
PURPOSE This study aimed to retrospectively evaluate the efficacy of Li Maneuver as a repositioning maneuver for geotropic HC-BPPV, compared with Gufon Maneuver. METHODS Data of geotropic HC-BPPV patients treated at our department between January 2009 and January 2020 was retrospectively collected and analyzed. Enrolled cases were divided into Gufoni Group and Li Group. Follow-up results were recorded on the first, third, and seventh day after the first therapeutic maneuver. RESULTS A total of 254 cases were enrolled, with 87 cases in Gufoni Group, and 167 cases in Li Group. The cure rate at the first, third, and seventh days of follow-up was 62.22%, 77.01%, and 90.80% respectively for Gufoni Group, while for Li Group the number was 60.48%, 72.46%, and 89.22% respectively. Statistical analysis showed no significant difference. CONCLUSIONS Li Maneuver for geotropic HC-BPPV was as effective as Gufoni Maneuver but much simpler and faster. By introducing Li Maneuver, we may help physicians to treat geotropic HC-BPPV patients more willingly, which would decrease the chance of delayed treatment and ease the burden of the health-care system.
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22
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Péus D, Straumann D, Huber A, Bockisch CJ, Wettstein V. Therapy-Resistant Atypical Downbeat Nystagmus with Vertigo Confined to Specific Head-Hanging Positions: Mapping to the Gravity Vector on a Multi-Axis Turntable. Case Rep Neurol 2021; 13:464-469. [PMID: 34413748 PMCID: PMC8339484 DOI: 10.1159/000517840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/03/2021] [Indexed: 12/21/2022] Open
Abstract
Downbeat nystagmus (DBN) observed in head-hanging positions, may be of central or peripheral origin. Central DBN in head-hanging positions is mostly due to a disorder of the vestibulo-cerebellum, whereas peripheral DBN is usually attributed to canalolithiasis of an anterior semicircular canal. Here, we describe an atypical case of a patient who, after head trauma, experienced severe and stereotypic vertigo attacks after being placed in various head-hanging positions. Vertigo lasted 10–15 s and was always associated with a robust DBN. The provocation of transient vertigo and DBN, which both showed no decrease upon repetition of maneuvers, depended on the yaw orientation relative to the trunk and the angle of backward pitch. On a motorized, multi-axis turntable, we identified the two-dimensional Helmholtz coordinates of head positions at which vertigo and DBN occurred (y-axis: horizontal, space-fixed; z-axis: vertical, and head-fixed; x-axis: torsional, head-fixed, and unchanged). This two-dimensional area of DBN-associated head positions did not change when whole-body rotations took different paths (e.g., by forwarding pitch) or were executed with different velocities. Moreover, the intensity of DBN was also independent of whole-body rotation paths and velocities. So far, therapeutic approaches with repeated liberation maneuvers and cranial vibrations were not successful. We speculate that vertigo and DBN in this patient are due to macular damage, possibly an unstable otolithic membrane that, in specific orientations relative to gravity, slips into a position causing paroxysmal stimulation or inhibition of macular hair cells.
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Affiliation(s)
- Dominik Péus
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Zurich and University Hospital Zurich, Zurich, Switzerland.,Department of Neurology, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Dominik Straumann
- Department of Ophthalmology, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Alexander Huber
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Christopher J Bockisch
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Zurich and University Hospital Zurich, Zurich, Switzerland.,Department of Ophthalmology, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Vincent Wettstein
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Zurich and University Hospital Zurich, Zurich, Switzerland.,Rautipraxis AG, Zurich, Switzerland
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23
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Bhandari A, Bhandari R, Kingma H, Zuma E Maia F, Strupp M. Three-dimensional simulations of six treatment maneuvers for horizontal canal benign paroxysmal positional vertigo canalithiasis. Eur J Neurol 2021; 28:4178-4183. [PMID: 34339551 DOI: 10.1111/ene.15044] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Horizontal canal benign paroxysmal positional vertigo (BPPV) is the second most common variant of BPPV after posterior canal BPPV. Various liberatory maneuvers are recommended for the treatment of horizontal canal BPPV canalithiasis (hc-BPPV-ca). The aim of this study was to show how three-dimensional (3D) dynamic simulation models visualize the movement of the clot of otoconia within the canal for a better understanding of the theoretical efficacy. METHODS Based on reconstructed magnetic resonance imaging and fluid dynamics, a 3D dynamic simulation model (as a function of time) was developed and applied. Thereby, six treatment maneuvers for hc-BPPV-ca were simulated: two types of the roll maneuver (the original 270° and the modified 360°) as well as two Gufoni and Zuma maneuvers (for geotropic and apogeotropic nystagmus). RESULTS The simulations showed that the 360° roll maneuver and Zuma maneuver are effective treatment options for hc-BPPV-ca for debris in all locations within the canal. However, the original 270° roll maneuver will not be effective if the clot is in the ampullary arm of the horizontal canal. The Gufoni maneuver for geotropic hc-BPPV-ca is effective, whereas for apogeotropic hc-BPPV-ca there is a risk of treatment failure due to insufficient repositioning of the debris. CONCLUSIONS The 3D simulations for movement of the otoconia clots can be used to test the mechanism of action and the theoretical efficacy of existing maneuvers for the different BPPV variants. For hc-BPPV-ca, the modified 360° roll maneuver and Zuma maneuver are theoretically efficient for all subtypes, whereas Gufoni maneuver is effective for geotropic nystagmus only.
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Affiliation(s)
| | | | - Herman Kingma
- Department of Ear Nose Throat, Maastricht University, Maastricht, Netherlands.,Faculty of Physics, Tomsk State National Research University, Tomsk, Russia.,Department of Ear Nose Throat, Aalborg University, Aalborg, Denmark
| | - Francisco Zuma E Maia
- Department of Otorhinolaryngology and Instituto de Cerebro, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Michael Strupp
- Department of Neurology and German Center for Vertigo and Balance Disorders, Hospital of Ludwig Maximilian University of Munich, Munich, Germany
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24
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Lee HJ, Ahn SK, Yim CD, Kim SD, Hur DG. Prolonged Positional Downbeat Nystagmus in Benign Paroxysmal Positional Vertigo: A Case Report and Literature Review. Am J Audiol 2021; 30:235-240. [PMID: 33784182 DOI: 10.1044/2020_aja-20-00187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose This study aimed to report an unusual case of benign paroxysmal positional vertigo (BPPV), who showed prolonged positional downbeat nystagmus without latency and was diagnosed with cupulolithiasis of the anterior canal (AC). We compared this case with one of typical AC-BPPV, and possible mechanisms underlying the atypical characteristics were discussed. Method Two patients diagnosed with AC-BPPV were reported. Positional testing using video-oculography goggles was performed, and outcomes were measured via medical records and analysis of videos of the nystagmus. Results Downbeat nystagmus was observed in the contralateral Dix-Hallpike test in both cases. The torsional component was subtle or absent, but motion was induced toward the affected ear. The two cases differed in latency and duration of vertigo, as well as habituation. The patient with atypical nystagmus showed little or no latency and longer duration. Moreover, there was no habituation on repeated tests. The nystagmus showed several differences from that of typical AC-BPPV. Conclusions Based on our case, AC-BPPV may induce various unusual clinical manifestations of nystagmus. Accurate diagnosis requires careful consideration of the patient's symptoms and the characteristics of the nystagmus. Supplemental Material https://doi.org/10.23641/asha.14265356.
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Affiliation(s)
- Hyun-Jin Lee
- Department of Otorhinolaryngology, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, South Korea
| | - Seong Ki Ahn
- Department of Otorhinolaryngology, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, South Korea
- Institute of Health Sciences, Gyeongsang National University, Jinju, South Korea
| | - Chae Dong Yim
- Department of Otorhinolaryngology, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, South Korea
| | - Seong Dong Kim
- Department of Otorhinolaryngology, National Medical Center, Seoul, South Korea
| | - Dong Gu Hur
- Department of Otorhinolaryngology, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, South Korea
- Institute of Health Sciences, Gyeongsang National University, Jinju, South Korea
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25
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Grzesiak M, Carender W, Basura GJ. Posttraumatic Dizziness: Navigating the Maze Towards Accurate Vestibular Diagnosis and Treatment. Otol Neurotol 2021; 42:e573-e578. [PMID: 33967250 DOI: 10.1097/mao.0000000000003035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Highlight the importance of establishing a differential diagnosis to identify and treat multiple origins of dizziness in a patient following traumatic brain injury (TBI). PATIENT 73-year-old man with TBI and temporal bone fracture developed posttraumatic bilateral multiple canal benign paroxysmal positional vertigo (BPPV). INTERVENTION Multi-disciplinary diagnostic evaluation and vestibular rehabilitation (VR) treatment focused on canalith repositioning maneuvers (CRMs) and central adaptation. MAIN OUTCOME MEASURES Diagnostic imaging, audiometric testing, clinical evaluation including video recordings of patterns of nystagmus, Dizziness Handicap Inventory (DHI). RESULTS Systematic clinical examination identified multiple semicircular canal BPPV in addition to a suspected underlying unilateral hypofunction. Treatment focused on the appropriate CRMs and adaptation exercises. DHI scores improved significantly and patient returned to work and recreational activities. CONCLUSION This Clinical Capsule Report highlights the importance of a comprehensive clinical evaluation of the TBI patient with dizziness when making an accurate diagnosis and treatment plan. Due to the complexity of differentiating between multiple canal BPPV in addition to other central and vestibular disorders, it is imperative for the clinician to have a clear understanding of nystagmus patterns for multicanal BPPV as well as other vestibular pathology.
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Affiliation(s)
- Melissa Grzesiak
- Department of Otolaryngology/Head and Neck Surgery, Michigan Balance-Vestibular Testing and Rehabilitation
- Division of Otology/Neurotology-Skull Base Surgery, Department of Otolaryngology/Head and Neck Surgery, Michigan Medicine, The University of Michigan, Ann Arbor, Michigan
| | - Wendy Carender
- Department of Otolaryngology/Head and Neck Surgery, Michigan Balance-Vestibular Testing and Rehabilitation
- Division of Otology/Neurotology-Skull Base Surgery, Department of Otolaryngology/Head and Neck Surgery, Michigan Medicine, The University of Michigan, Ann Arbor, Michigan
| | - Gregory J Basura
- Division of Otology/Neurotology-Skull Base Surgery, Department of Otolaryngology/Head and Neck Surgery, Michigan Medicine, The University of Michigan, Ann Arbor, Michigan
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26
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Yacovino DA, Zanotti E, Roman K, Hain TC. Square wave manoeuvre for apogeotropic variant of horizontal canal benign paroxysmal positional vertigo in neck restricted patients. J Otol 2021; 16:65-70. [PMID: 33777117 PMCID: PMC7985006 DOI: 10.1016/j.joto.2020.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/08/2020] [Accepted: 10/27/2020] [Indexed: 11/15/2022] Open
Abstract
Objective We aimed to describe the clinical features of the apogeotropic variant of horizontal canal benign paroxysmal positional vertigo (HC BPPV-AG) in a cluster of patients with restrictive neck movement disorders and a new therapeutic manoeuvre for its management. Methods In a retrospective review of cases from an ambulatory tertiary referral center, patients with HC BPPV-AG in combination with neck movement restriction that prevented any classical manual repositioning procedure or who were refractory to canalith repositioning manoeuvres, were treated with a new manoeuvre comprised of sequential square-wave pattern of head and body supine rotations while nystagmus was being monitored, until either an apogeotropic to geotropic conversion or resolution of the nystagmus was observed. Results Fifteen patients were studied. All but one [14/15 cases] showed a positive therapeutic response to the repositioning procedure in a single session. In two cases, a direct relief of vertigo and elimination of nystagmus was observed without an intermediate geotropic phase. Although in three patients the affected ear was not initially identified, it was ultimately identified and successfully treated by the square wave manoeuvre in all of them. Conclusions The square-wave manoeuvre is an alternative for HC BPPV-AG treatment in either cases with neck restriction, where the affected side is not well identified at the bedside or when other manoeuvres fail to resolve the HC BPPV-AG.
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Affiliation(s)
- Dario A Yacovino
- Department of Neurology, Dr. Cesar Milstein Hospital, Buenos Aires, Argentina.,Memory and Balance Clinic, Buenos Aires, Argentina
| | - Estefania Zanotti
- Department of Neurology, Dr. Cesar Milstein Hospital, Buenos Aires, Argentina
| | - Karen Roman
- Department of Neurology, Dr. Cesar Milstein Hospital, Buenos Aires, Argentina
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Bhandari A, Kingma H, Bhandari R. BPPV Simulation: A Powerful Tool to Understand and Optimize the Diagnostics and Treatment of all Possible Variants of BPPV. Front Neurol 2021; 12:632286. [PMID: 33841305 PMCID: PMC8032929 DOI: 10.3389/fneur.2021.632286] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 03/03/2021] [Indexed: 11/13/2022] Open
Abstract
BPPV is a mechanical disorder caused by the displacement of otolith debris into the semicircular canals. The treatment involves different repositioning maneuvers to bring the debris back into the utricle. This study aims to show how dynamic simulation models based on fluid dynamics and MRI, can help to visualize and understand the movement of the debris within the canals during head movement in 3D as a function of time. The user can define the rotation angle and plane at each step of the maneuver and then the model visualizes the canal and the otoconial movement in 3D. The simulation developed also allows alteration of various parameters like the rotational head acceleration, the duration of each step of the maneuver, the initial position of the otoconial debris in the canal, the size and the number of the particles and fluid dynamics of endolymph. The clod movement is visualized in such a way that it allows a better understanding of the impact and efficacy of various liberation maneuvers and why certain maneuvers might fail when not applied properly in the clinic. The model allows simulation of multi-canal BPPV. In this paper we demonstrate the power of the model applied on the maneuvers of Semont and Yacovino when executed in different ways. The model aims to provide a visual explanation for the need of specific maneuvers for each type of BPPV. The simulator presented here can be used to test the efficacy of existing maneuvers and help in the development of new maneuvers to treat different BPPV variants.
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Affiliation(s)
| | - Herman Kingma
- Department of Ear Nose Throat, Maastricht University, Maastricht, Netherlands.,Faculty of Physics, Tomsk State National Research University, Tomsk, Russia.,Department of Ear Nose Throat, Aalborg University, Aalborg, Denmark
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Porwal P, V R A, Pawar V, Dorasala S, Bijlani A, Nair P, Nayar R. Clinical and VNG Features in Anterior Canal BPPV-An Analysis of 13 Cases. Front Neurol 2021; 12:618269. [PMID: 33776883 PMCID: PMC7988206 DOI: 10.3389/fneur.2021.618269] [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: 10/16/2020] [Accepted: 02/08/2021] [Indexed: 11/25/2022] Open
Abstract
Objective: To define diagnostic VNG features in anterior canal BPPV during positional testing (Dix-Hallpike, supine head hanging, and McClure Pagnini tests). Study Design: A retrospective study of patients diagnosed with anterior canal BPPV across four referral centers in New Delhi, Kochi, Bangalore, and Dubai. Subjects and Methods: Clinical records of 13 patients with AC BPPV out of 1,350 cases, during a 3-years period, were reviewed and analyzed by four specialists. Results: Four patients had positional down beating nystagmus with symptoms of vertigo during the bilateral DHP maneuver. Seven cases had positional down beating nystagmus only on one side of DHP. Typical down beating nystagmus was seen in 10 out of 13 cases during the straight head hanging maneuver. Down beating torsional nystagmus was seen in 6 out of 13 cases. Down beating with horizontal nystagmus was seen in three cases (in DHP and MCP mainly) while pure down beating nystagmus during SHH was only seen in four cases. Conclusion: We conclude that anterior canal BPPV is a rare but definite entity. It may not be apparent on positional testing the first time, so repeated testing may be needed. The most consistent diagnostic maneuver is SHH though there were patients in which findings could only be elicited using DHP testing. We recommend a testing protocol that includes DHP testing on both sides and SHH. MCP testing may also evoke DBN with or without the torsional component. Reversal of nystagmus on reversal of testing position is unusual but can occur. The Yacovino maneuver is effective in resolving AC BPPV. We also propose a hypothesis that explains why DHP testing is sensitive to AC BPPV on either side, whereas MCP lateral position on one side is only sensitive to AC BPPV on one side. We have explained a possible role for the McClure Pagnini test in side determination and therapeutic implications.
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Affiliation(s)
| | - Ananthu V R
- Vertigo and Balance Clinic, Bangalore, India
| | - Vishal Pawar
- Aster Clinic, Zen Cluster, Discovery Gardens, Dubai, United Arab Emirates
| | - Srinivas Dorasala
- Ear, Nose and Throat (ENT) Department, Jawaharlal Nehru Medical College (JNMC), Belagavi, India
| | | | - Prem Nair
- Department of Speech Pathology and Audiology, Amrita Institute of Medical Sciences, Kochi, India
| | - Ravi Nayar
- Centre of Academics Research, HCG, Bangalore, India
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Barreto RG, Yacovino DA, Teixeira LJ, Freitas MM. Teleconsultation and Teletreatment Protocol to Diagnose and Manage Patients with Benign Paroxysmal Positional Vertigo (BPPV) during the COVID-19 Pandemic. Int Arch Otorhinolaryngol 2021; 25:e141-e149. [PMID: 33542764 PMCID: PMC7851369 DOI: 10.1055/s-0040-1722252] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 11/10/2020] [Indexed: 02/08/2023] Open
Abstract
Introduction
Telehealth consists in the application of technology to provide remote health service. This resource is considered safe and effective and has attracted an exponential interest in the context of the COVID pandemic. Expanded to dizzy patients, it would be able to provide diagnosis and treatment, minimizing the risk of disease transmission. Benign paroxysmal positional vertigo (BPPV) is the most common vestibular disorder. The diagnosis typically rests on the description of the symptoms along with the nystagmus observed at a well-established positional testing.
Objectives
The aim of the present study was to propose a teleconsultation and teletreatment protocol to manage patients with BPPV during the COVID-19 pandemic.
Methods
Specialists in the vestibular field met through remote access technologies to discuss the best strategy to manage BPPV patients by teleconsultation and teletreatment system. Additionally, several scientific sources were consulted. Technical issues, patient safety, and clinical assessment were independently analyzed. All relevant information was considered in order to design a clinical protocol to manage BPPV patients in the pandemic context.
Results
Teleconsultation for BPPV patients requires a double way (video and audio) digital system. An adapted informed consent to follow good clinical practice statements must be considered. The time, trigger and target eye bedside examination (TiTRaTe) protocol has proven to be a valuable first approach. The bow and lean test is the most rational screening maneuver for patients with suspected positional vertigo, followed by most specific maneuvers to diagnostic the sub-variants of BPPV.
Conclusion
Although with limited evidence, teleconsultation and teletreatment are both reasonable and feasible strategies for the management of patients with BPPV in adverse situations for face-to-face consultation.
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Affiliation(s)
- Renato Gonzaga Barreto
- Clínica Otorrino Premier, Ilhéus, Bahia, Brazil.,Faculdade Madre Thaís, Ilhéus, Bahia, Brazil
| | - Darío Andrés Yacovino
- Otovestibular Section, Neurology department, Dr. Cesar Milstein Hospital, Buenos Aires, Argentina.,Memory and Balance Clinic, Buenos Aires, Argentina
| | - Lázaro Juliano Teixeira
- Prefeitura Municipal, Balneário Camboriú, SC, Brazil.,Consultório Particular, Balneário Camboriú, SC, Brazil
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Correia F, Castelhano L, Cavilhas P, Escada P. Lateral semicircular canal-BPPV: Prospective randomized study on the efficacy of four repositioning maneuvers. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2021; 73:S0001-6519(20)30198-9. [PMID: 33494876 DOI: 10.1016/j.otorri.2020.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/14/2020] [Accepted: 11/01/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Multiple repositioning maneuvers have been described to treat lateral semi-circular canal Benign Paroxysmal Positional Vertigo (LC-BPPV) patients. In this study, we compare efficacy of four therapeutic repositioning maneuvers for LC-BPPV patients and aim to identify clinical variables associated with persistent disease. MATERIAL AND METHODS A prospective study was conducted at a tertiary center, between January 2017 and September 2019. Patients diagnosed with LC-BPPV were randomly treated with Gufoni or barbecue-roll maneuvers (for the geotropic variant) and Gufoni-Appiani, barbecue-roll or Zuma-e-Maia maneuvers (for the apogeotropic form). Efficacy was compared and statistical analysis was performed to find clinical factors associated with no response. RESULTS Forty-eight patients and 82 maneuvers were included. Female patients and right side were more commonly affected. The mean age was 67 years. Seven cases (14.6%) resulted from a canal-switch. One single maneuver resolved 23 cases (47.9%) and the success rate rose to 75% at the end of the first visit (after up to 4 maneuvers) and to 93.8% after a-week of follow-up. Success rates were significantly better with Gufoni (68%) than with barbecue roll (34.8%; p=0.021) in geotropic LC-BPPV and better with Gufoni-Appiani (71.4%) than barbecue roll and Zuma-e-Maia maneuvers (33.3%; p=0.239) in apogeotropic LC-BPPV. Higher rates of persistent disease after first visit were found with older patients, left side and apogeotropic LC-BPPV and with longer latency and duration diagnostic nystagmus. CONCLUSION Our study suggests that Gufoni and Gufoni-Appiani maneuvers may be the most efficacious treatment for geotropic and apogeotropic LC-BPPV, respectively, compared to barbecue-roll and Zuma-e-Maia maneuvers.
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Affiliation(s)
- Filipe Correia
- Serviço de Otorrinolaringologia, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal; Nova Medical School, Universidade Nova de Lisboa, Lisboa, Portugal.
| | - Luís Castelhano
- Serviço de Otorrinolaringologia, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal; Nova Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Pedro Cavilhas
- Serviço de Otorrinolaringologia, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal; Nova Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Pedro Escada
- Serviço de Otorrinolaringologia, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal; Nova Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
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Kim HJ, Park J, Kim JS. Update on benign paroxysmal positional vertigo. J Neurol 2020; 268:1995-2000. [PMID: 33231724 PMCID: PMC7684151 DOI: 10.1007/s00415-020-10314-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/04/2020] [Accepted: 11/08/2020] [Indexed: 12/11/2022]
Abstract
Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo worldwide. This review considers recent advances in the diagnosis and management of BPPV including the use of web-based technology and artificial intelligence as well as the evidence supporting the use of vitamin D supplements for patients with BPPV and subnormal serum vitamin D.
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Affiliation(s)
- Hyo-Jung Kim
- Research Administration Team, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - JaeHan Park
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Ji-Soo Kim
- Department of Neurology, Seoul National University College of Medicine, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea. .,Dizziness Center, Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam, South Korea.
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Garaycochea O, Pérez-Fernández N, Manrique-Huarte R. A novel maneuver for diagnosis and treatment of torsional-vertical down beating positioning nystagmus: anterior canal and apogeotropic posterior canal BPPV. Braz J Otorhinolaryngol 2020; 88:708-716. [PMID: 33176986 PMCID: PMC9483926 DOI: 10.1016/j.bjorl.2020.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/15/2020] [Accepted: 09/22/2020] [Indexed: 11/24/2022] Open
Abstract
Introduction In patients with benign paroxysmal positional vertigo, BPPV; a torsional-vertical down beating positioning nystagmus can be elicited in the supine straight head-hanging position test or in the Dix-Hallpike test to either side. This type of nystagmus can be explained by either an anterior canal BPPV or by an apogeotropic variant of the contralateral posterior canal BPPV Until now all the therapeutic maneuvers that have been proposed address only one possibility, and without first performing a clear differential diagnosis between them. Objective To propose a new maneuver for torsional-vertical down beating positioning nystagmus with a clear lateralization that takes into account both possible diagnoses (anterior canal-BPPV and posterior canal-BPPV). Methods A prospective cohort study was conducted on 157 consecutive patients with BPPV. The new maneuver was performed only in those with torsional-vertical down beating positioning nystagmus with clear lateralization. Results Twenty patients (12.7%) were diagnosed with a torsional-vertical down beating positioning nystagmus. The maneuver was performed in 10 (6.35%) patients, in whom the affected side was clearly determined. Seven (4.45%) patients were diagnosed with an anterior canal-BPPV and successfully treated. Two (1.25%) patients were diagnosed with a posterior canal-BPPV and successfully treated with an Epley maneuver after its conversion into a geotropic posterior BPPV. Conclusion This new maneuver was found to be effective in resolving all the cases of torsional-vertical down beating positioning nystagmus-BPPV caused by an anterior canal-BPPV, and in shifting in a controlled way the posterior canal-BPPV cases of the contralateral side into a geotropic-posterior-BPPV successfully treated during the followup visit. Moreover, this new maneuver helped in the differential diagnosis between anterior canal-BPPV and a contralateral posterior canal-BPPV.
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Affiliation(s)
- Octavio Garaycochea
- University of Navarra, Clinica Universitaria de Navarra, Department of Otorhinolaryngology, Pamplona, Spain.
| | - Nicolás Pérez-Fernández
- University of Navarra, Clinica Universitaria de Navarra, Department of Otorhinolaryngology, Pamplona, Spain
| | - Raquel Manrique-Huarte
- University of Navarra, Clinica Universitaria de Navarra, Department of Otorhinolaryngology, Pamplona, Spain
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Benign Paroxysmal Positional Vertigo: Canal Switching Affecting All Canals During a Single Session. Otol Neurotol 2020; 42:e110. [PMID: 33073972 DOI: 10.1097/mao.0000000000002853] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
: SDC Video Link:http://links.lww.com/MAO/B86.
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Castellucci A, Malara P, Martellucci S, Botti C, Delmonte S, Quaglieri S, Rebecchi E, Armato E, Ralli M, Manfrin ML, Ghidini A, Asprella Libonati G. Feasibility of Using the Video-Head Impulse Test to Detect the Involved Canal in Benign Paroxysmal Positional Vertigo Presenting With Positional Downbeat Nystagmus. Front Neurol 2020; 11:578588. [PMID: 33178119 PMCID: PMC7593380 DOI: 10.3389/fneur.2020.578588] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/07/2020] [Indexed: 12/19/2022] Open
Abstract
Positional downbeat nystagmus (pDBN) represents a relatively frequent finding. Its possible peripheral origin has been widely ascertained. Nevertheless, distinguishing features of peripheral positional nystagmus, including latency, paroxysm and torsional components, may be missing, resulting in challenging differential diagnosis with central pDBN. Moreover, in case of benign paroxysmal positional vertigo (BPPV), detection of the affected canal may be challenging as involvement of the non-ampullary arm of posterior semicircular canal (PSC) results in the same oculomotor responses generated by contralateral anterior canal (ASC)-canalolithiasis. Recent acquisitions suggest that patients with persistent pDBN due to vertical canal-BPPV may exhibit impaired vestibulo-ocular reflex (VOR) for the involved canal on video-head impulse test (vHIT). Since canal hypofunction normalizes following proper canalith repositioning procedures (CRP), an incomplete canalith jam acting as a "low-pass filter" for the affected ampullary receptor has been hypothesized. This study aims to determine the sensitivity of vHIT in detecting canal involvement in patients presenting with pDBN due to vertical canal-BPPV. We retrospectively reviewed the clinical records of 59 consecutive subjects presenting with peripheral pDBN. All patients were tested with video-Frenzel examination and vHIT at presentation and after resolution of symptoms or transformation in typical BPPV-variant. BPPV involving non-ampullary tract of PSC was diagnosed in 78%, ASC-BPPV in 11.9% whereas in 6 cases the involved canal remained unidentified. Presenting VOR-gain values for the affected canal were greatly impaired in cases with persistent pDBN compared to subjects with paroxysmal/transitory nystagmus (p < 0.001). Each patient received CRP for BPPV involving the hypoactive canal or, in case of normal VOR-gain, the assumed affected canal. Each subject exhibiting VOR-gain reduction for the involved canal developed normalization of vHIT data after proper repositioning (p < 0.001), proving a close relationship with otoliths altering high-frequency cupular responses. According to our results, overall vHIT sensitivity in detecting the affected SC was 72.9%, increasing up to 88.6% when considering only cases with persistent pDBN where an incomplete canal plug is more likely to occur. vHIT should be routinely used in patients with pDBN as it may enable to localize otoconia within the labyrinth, providing further insights to the pathophysiology of peripheral pDBN.
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Affiliation(s)
- Andrea Castellucci
- ENT Unit, Department of Surgery, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Pasquale Malara
- Audiology and Vestibology Service, "Centromedico Bellinzona", Bellinzona, Switzerland
| | | | - Cecilia Botti
- ENT Unit, Department of Surgery, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy.,PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Silvia Delmonte
- ENT Unit, Department of Surgery, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Silvia Quaglieri
- ENT Unit, Policlinico San Matteo Fondazione (IRCCS), Pavia, Italy
| | | | - Enrico Armato
- ENT Unit, "SS Giovanni e Paolo" Hospital, Venice, Italy
| | - Massimo Ralli
- Head and Neck Department, ENT Clinic, Policlinico Umberto I, Rome, Italy.,Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | | | - Angelo Ghidini
- ENT Unit, Department of Surgery, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
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D'Albora Rivas R, Teixido M, Casserly RM, Mónaco MJ. Short CRP for Anterior Canalithiasis: A New Maneuver Based on Simulation With a Biomechanical Model. Front Neurol 2020; 11:857. [PMID: 32903468 PMCID: PMC7438444 DOI: 10.3389/fneur.2020.00857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 07/07/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction/Objective: Anterior canalithiasis is an uncommon and challenging diagnosis. This is due in part to the difficulty of defining the affected side, the extreme positioning required to carry out described therapeutic maneuvers, and the infrequent use of specific maneuvers. Our objective is to present a new treatment alternative for anterior canalithiasis which is based on the well-known canalith repositioning procedure (CRP) described by Epley and which is used routinely in the treatment of both posterior and anterior canalithiasis. Analysis of the standard CRP for anterior canalithiasis with a biomechanical model validates that this new maneuver is an enhanced treatment option for anterior canalithiasis. We call the new maneuver the “short CRP.” Methods: A previously published 3D biomechanical model of the human labyrinths for the study of BPPV was used to analyze the conventional CRP in the treatment of anterior canalithiasis. The expected position of free otoliths near the anterior ampulla of the anterior semicircular duct was followed while recreating the sequential positions of the CRP. Although the standard CRP was possibly effective, certain enhancements were evident that could increase successful repositioning. These enhancements were incorporated into the modification of the CRP presented here as the “short CRP” for anterior canalithiasis. Results: The traditional CRP used for posterior canalithiasis can also be used for anterior canalithiasis. Although in the traditional CRP the head hangs 30° below horizontal, our simulation shows that a 40° head-hang below horizontal is an enhancement and may ensure progression of anterior otolith debris. Elimination of Position 4 of the classic CRP, in which the face is turned 45° toward the floor, was also seen as an enhancement as this position is predicted to cause retrograde movement of otoliths back into the anterior canal if the patient tucks the chin in position 4 or when sitting up. Conclusion: A modification of the CRP called the “short CRP” can be used to treat anterior canalithiasis. Model analysis predicts possible increased efficacy over the standard CRP. Model analysis of existing BPPV treatments is a valuable exercise for examination and can lead to realistic enhancements in patient care.
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Affiliation(s)
- Ricardo D'Albora Rivas
- Department of ENT, Hospital de Clínicas, University of the Republic, Montevideo, Uruguay
| | - Michael Teixido
- Christiana Care Health Systems, Newark, DE, United States.,Department of Otolaryngology, University of Pennsylvania, Philadelphia, PA, United States.,Department of Otolaryngology, Thomas Jefferson University, Philadelphia, PA, United States
| | | | - María Julia Mónaco
- Audiology Department Arauz Otorhinolaryngology Institute (IORL Arauz), Buenos Aires, Argentina
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Pedersen MF, Eriksen HH, Kjaersgaard JB, Abrahamsen ER, Hougaard DD. Treatment of Benign Paroxysmal Positional Vertigo with the TRV Reposition Chair. J Int Adv Otol 2020; 16:176-182. [PMID: 32784154 PMCID: PMC7419101 DOI: 10.5152/iao.2020.6320] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 05/27/2020] [Accepted: 05/31/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES The primary objective of this study was to evaluate how successful the reposition of retractable benign paroxysmal positional vertigo (BPPV) was when treating patients with the Thomas Richard Vitton (TRV) reposition chair. MATERIALS AND METHODS This is a prospective clinical trial. A total of 81 BPPV patients who were referred to the tertiary Balance - Dizziness Centre at the Department of Otolaryngology, Head - Neck Surgery and Audiology, Aalborg University Hospital, Denmark were included and analyzed. All the patients were diagnosed and treated with the TRV reposition chair. RESULTS The patients were successfully treated after an average of 2.23 (± 1.66 SD) treatments with the TRV reposition chair. There was a significant difference between the number of treatments needed in the single semicircular canal group and the multicanal group. Seventeen (22.6%) of the patients experienced either dislocation of otoconia, relapse, or new onset of BPPV during the trial period. The number of patients with BPPV located to the anterior, lateral, and multiple semicircular canals in this study was significantly higher than that in similar studies. Six patients (7.4%) were classified as treatment failures. CONCLUSION We found the TRV reposition chair to be very successful in the diagnostics and treatment of patients with retractable and atypical BPPV. However, 7.4% experienced treatment failure.
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Affiliation(s)
- Morten Falshoj Pedersen
- Department of Otolaryngology, Head - Neck Surgery and Audiology, Aalborg University Hospital, Denmark;Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Helle Hojmark Eriksen
- Unit of Clinical Biostatistics and Bioinformatics, Aalborg University Hospital, Aalborg, Denmark
| | - Jonas Bruun Kjaersgaard
- Department of Otolaryngology, Head - Neck Surgery and Audiology, Aalborg University Hospital, Denmark;Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Emil Riis Abrahamsen
- Department of Otolaryngology, Head - Neck Surgery and Audiology, Aalborg University Hospital, Denmark;Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Dan Dupont Hougaard
- Department of Otolaryngology, Head - Neck Surgery and Audiology, Aalborg University Hospital, Denmark;Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Peripheral Downbeat Positional Nystagmus: Apogeotropic Posterior Canal or Anterior Canal BPPV. J Neurol Phys Ther 2020; 43 Suppl 2:S8-S13. [PMID: 30883487 DOI: 10.1097/npt.0000000000000267] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Downbeat nystagmus (DBN) during the Dix-Hallpike test (DHT) suggests excitation of the anterior canal (AC) or inhibition of the posterior canal (PC) underlying benign paroxysmal positional vertigo (BPPV). This case series describes 2 individuals presenting with DBN in positional testing suggestive of a PC BPPV variant termed apogeotropic PC-BPPV and due to inhibition of the PC. CASE DESCRIPTIONS Case 1 illustrates a DBN during positional testing (PC inhibition) that changes to an upbeating nystagmus (PC excitation) representing the otoconial material changing location and direction of movement within the PC. Case 2 describes a canal jam in the nonampullary segment of the PC. DIFFERENTIAL DIAGNOSIS Apogeotropic PC-BPPV can cause DBN due to inhibition of the vestibular afferent. Apogeotropic PC-BPPV may be due to a canal jam of debris within the nonampullary segment or cupulolithiasis with debris attached to the inferior-most aspect of the cupula within the PC. It can be difficult to differentiate AC-BPPV from the apogeotropic PC-BPPV variant. In both forms, the affected canal may be provoked in 1 or both positions of the DHT and straight head hanging position. However, in AC-BPPV there may only be a slight or absent torsional component toward the involved ear. In apogeotropic PC-BPPV, a strong torsion away from the involved ear is typically observed. The straight head hanging position may resolve AC-BPPV or convert apogeotropic PC-BPPV to typical PC-BPPV. SUMMARY These 2 cases illustrate atypical variants of BPPV that clinicians must consider in their interpretation of DBN during positional testing, particularly in the absence of other neurological signs.
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Si L, Ling X, Li Z, Li K, Shen B, Yang X. Clinical characteristics of patients with multi-canal benign paroxysmal positional vertigo. Braz J Otorhinolaryngol 2020; 88:89-100. [PMID: 32595078 PMCID: PMC9422682 DOI: 10.1016/j.bjorl.2020.05.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 04/10/2020] [Accepted: 05/06/2020] [Indexed: 11/30/2022] Open
Abstract
Introduction Multi-canal benign paroxysmal positional vertigo is considered to be a rare and controversial type in the new diagnostic guidelines of Bárány because the nystagmus is more complicated or atypical, which is worthy of further study. Objective Based on the diagnostic criteria for multi-canal benign paroxysmal positional vertigo proposed by International Bárány Society, the study aimed to investigate the clinical characteristics, diagnosis and treatment of multi-canal benign paroxysmal positional vertigo. Methods A total of 41 patients with multi-canal benign paroxysmal positional vertigo were included and diagnosed by Roll, Dix-Hallpike and straight head hanging tests. Manual reduction was performed according to the involvement of semicircular canals. Results Among the 41 cases, 19 (46.3%) patients showed vertical up-beating nystagmus with or without torsional component and geotropic, apogeotropic horizontal nystagmus, and were diagnosed with posterior-horizontal canal. 11 (26.8%) patients showed vertical up-beating nystagmus with torsional component on one side and vertical down-beating nystagmus with or without torsional component on the other side during Dix-Hallpike test or straight head hanging test and were diagnosed with posterior-anterior canal benign paroxysmal positional vertigo 9 (26.8%) patients showed vertical down-beating nystagmus with or without torsional component and geotropic, apogeotropic horizontal nystagmus, and were diagnosed with anterior-horizontal canal 2 (4.9%) patients showed vertical geotropic torsional up-beating nystagmus on both sides and were diagnosed with bilateral posterior canal benign paroxysmal positional vertigo. High correlation between the sides with reduced vestibular function or hearing loss and the side affected by Multi-canal benign paroxysmal positional vertigo was revealed (contingency coefficient = 0.602, p = 0.010). During one-week follow up, nystagmus/vertigo has been significantly alleviated or disappeared in 87.8% (36/41) patients. Conclusion Posterior-horizontal canal benign paroxysmal positional vertigo was the most common type. Multi-canal benign paroxysmal positional vertigo involving anterior canal was also not uncommon. Caloric tests and pure tone audiometry may help in the determination of the affected side. Manual reduction was effective in most of Multi-canal benign paroxysmal positional vertigo patients.
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Affiliation(s)
- Lihong Si
- Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing 100049, P.R. China
| | - Xia Ling
- Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing 100049, P.R. China
| | - Zheyuan Li
- Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing 100049, P.R. China
| | - Kangzhi Li
- Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing 100049, P.R. China
| | - Bo Shen
- Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing 100049, P.R. China
| | - Xu Yang
- Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing 100049, P.R. China.
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Dispenza F, Mazzucco W, Mazzola S, Martines F. Observational study on risk factors determining residual dizziness after successful benign paroxysmal positional vertigo treatment: the role of subclinical BPPV. ACTA ACUST UNITED AC 2020; 39:347-352. [PMID: 31708581 PMCID: PMC6843589 DOI: 10.14639/0392-100x-2247] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 12/20/2018] [Indexed: 11/23/2022]
Abstract
After successful treatment for benign paroxysmal positional vertigo, many patients may complain of residual dizziness. Possible explanations may be the persistence of otolith into canal insufficient to provoke noticeable nystagmus, utricular dysfunction and undiagnosed coexisting vestibular disorder. We conducted a prospective observational case-control study, focusing on the role of risk factors in determining residual dizziness after BPPV treatment. In the present study, 148 patients were recruited and residual dizziness was documented in the 57.5% of the cohort. Among patients with residual dizziness 36 had subclinical BPPV and after retreatment, although nystagmus was not clinically evident, there was resolution of dizziness. We conclude that residual otoliths may play a role in determining post-maneuver residual dizziness that is often linked to subclinical BPPV; this conclusion is also supported by the high prevalence of BPPV recurrence in patients with residual dizziness, as confirmed by our analysis. The main cause appears to be linked with dispersed otolith in semicircular canals.
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Affiliation(s)
- F Dispenza
- UOC Otorinolaringoiatria, AOU Policlinico P. Giaccone, Palermo, Italy, Istituto Euro-Mediterraneo di Scienza e Tecnologia - IEMEST, Palermo, Italy
| | - W Mazzucco
- Department of Science for Health Promotion and Mother and Child Care G. D'Alessandro; University of Palermo, Italy
| | - S Mazzola
- Clinical Epidemiology and Cancer Registry Operative Unit, University Hospital Policlinico "Paolo Giaccone", Palermo, Italy
| | - F Martines
- Dipartimento Biomedicina e Neuroscienze Cliniche, Università degli Studi di Palermo, Italy
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A Possible Role of Video-Head Impulse Test in Detecting Canal Involvement in Benign Paroxysmal Positional Vertigo Presenting With Positional Downbeat Nystagmus. Otol Neurotol 2020; 41:386-391. [DOI: 10.1097/mao.0000000000002500] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
PURPOSE OF THE REVIEW To define the best up-to-date practical approach to treat benign paroxysmal positional vertigo (BPPV). RECENT FINDINGS Both posterior and horizontal canal BPPV canalith repositioning maneuvers (Semont, Epley, and Gufoni's maneuvers) are level 1 evidence treatment for evidence-based medicine. The choice of maneuver (since their efficacy is comparable) is up to the clinician's preferences, failure of the previous maneuver, or movement restrictions of the patient. Maneuvers for controversial variants, such as anterior canal and apogeotropic posterior canal BPPV, have weaker evidence of efficacy. Despite this, these variants are increasingly diagnosed and treated. Maneuvers also play a role in the differential diagnosis with central vestibular disorders. Chair-assisted treatment may be of help if available while surgical canal plugging should be indicated in selected same-canal, same-side intractable severe BPPV. The primary evidence-based treatment strategy for BPPV should be physical therapy through maneuvers. Despite the high success rate of liberatory maneuvers, there is a low percentage of subjects who have unsatisfactory outcomes. These patients need to be investigated to identify recurrences, multiple canal involvement, associated comorbidities (migraine, persistent postural perceptual dizziness), or risk factors for recurrences (low vitamin D serum level). Future research should also identify the optimum maneuvers for variants whose diagnosis and treatment are still a matter of some debate.
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Vlastarakos PV, Plioutas J, Tsilis NS, Nikolopoulos TP. Management of Benign Paroxysmal Positional Vertigo Not Attributed to the Posterior Semicircular Canal: A Case Series. Ann Indian Acad Neurol 2019; 22:533-535. [PMID: 31736599 PMCID: PMC6839287 DOI: 10.4103/aian.aian_437_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 10/30/2018] [Accepted: 10/31/2018] [Indexed: 11/20/2022] Open
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Lin Y, Xue J, Lee SJ, Wu X, Shan H, Ma X, Yu L, Lai JT. Value of clinical data and positional testing in patients with positional vertigo. Clin Otolaryngol 2019; 44:1181-1185. [PMID: 31559691 DOI: 10.1111/coa.13442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 09/17/2019] [Accepted: 09/23/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Yunjuan Lin
- Department of Otolaryngology, Peking University International Hospital, Beijing, China
| | - Junfang Xue
- Department of Otolaryngology, Peking University International Hospital, Beijing, China
| | - Su-Jeong Lee
- Department of Otolaryngology, Peking University International Hospital, Beijing, China
| | - Xiaoqin Wu
- Department of Otolaryngology, Peking University International Hospital, Beijing, China
| | - Haijun Shan
- Department of Otolaryngology, Peking University International Hospital, Beijing, China
| | - Xin Ma
- Department of Otolaryngology, Peking University People's Hospital, Beijing, China
| | - Lisheng Yu
- Department of Otolaryngology, Peking University People's Hospital, Beijing, China
| | - Jen-Tsung Lai
- Department of Otolaryngology, Kuang-Tien General Hospital, Taichung, Taiwan
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Song MH, Kong TH, Shim DB. Optimal reassessment time for treatment response in posterior canal benign paroxysmal positional vertigo. Laryngoscope 2019; 130:496-499. [PMID: 30982972 DOI: 10.1002/lary.28005] [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] [Received: 11/06/2018] [Revised: 03/20/2019] [Accepted: 03/28/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS The present study aimed to evaluate the optimal reassessment time for treatment response in posterior canal benign paroxysmal positional vertigo (PC-BPPV) following the initial Epley maneuver. STUDY DESIGN Prospective, single-blinded, randomized study. METHODS One hundred eight patients with PC-BPPV agreed to participate. These patients received a single modified Epley maneuver (recommended by the 2008 American Academy of Otolaryngology-Head and Neck Surgery guidelines) daily until positional nystagmus disappeared during the Dix-Hallpike maneuver 24 hours after the treatment. Repeated Dix-Hallpike testing to reassess the treatment response was performed at 1 hour (post-1 hour), every 24 hours (post-24 hours) until the positional nystagmus resolved, 1 week (post-1 week), and 1 month (post-1 month) following the therapeutic maneuver. The difference in the resolution rates at post-1 hour and post-24 hours reassessment was analyzed, and the recurrence rates at post-1 week and post-1 month were evaluated. RESULTS The resolution rate was 67.6% at post-1 hour, which increased to 79.6% at post-24 hours reassessment. There was a statistically significant difference in the results of the Dix-Hallpike test between post-1 hour and post-24 hours follow-up. After complete resolution, nine out of 108 patients (8.3%) demonstrated recurrence within 1 month. CONCLUSIONS Reassessment after 24 hours following the initial Epley maneuver is more advantageous than a 1-hour follow-up in patients with PC-BPPV. This information may be helpful for clinicians in deciding the appropriate follow-up period after treatment for PC-BPPV. LEVEL OF EVIDENCE 1b Laryngoscope, 130:496-499, 2020.
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Affiliation(s)
- Mee Hyun Song
- Department of Otorhinolaryngology, Myongji Hospital, Hanyang University College of Medicine, Goyang, South Korea
| | - Tae Hoon Kong
- Department of Otorhinolaryngology-Head and Neck Surgery, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Dae Bo Shim
- Department of Otorhinolaryngology, Myongji Hospital, Hanyang University College of Medicine, Goyang, South Korea
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Yang X, Ling X, Shen B, Hong Y, Li K, Si L, Kim JS. Diagnosis strategy and Yacovino maneuver for anterior canal-benign paroxysmal positional vertigo. J Neurol 2019; 266:1674-1684. [PMID: 30963252 DOI: 10.1007/s00415-019-09312-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 04/02/2019] [Accepted: 04/03/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To investigate the diagnosis strategy of anterior canal-benign paroxysmal positional vertigo (AC-BPPV) and the therapeutic effects of the Yacovino maneuver. METHODS The clinical data of 40 AC-BPPV patients were collected. The nystagmus characteristics induced by the Dix-Hallpike (D-H) and straight head-hanging (SHH) tests, the diagnostic methods used, and the effectiveness of the Yacovino maneuver for the treatment of AC-BPPV were all retrospectively analyzed. RESULTS Among the 40 cases analyzed, 19 patients had simple AC-BPPV, 11 patients had AC-posterior canal BPPV, and 10 patients had AC-horizontal canal BPPV. D-H and SHH tests showed down-beating nystagmus in 26 and 33 patients, respectively, and showed down-beating and torsional nystagmus in 14 and 7 patients, respectively. AC-BPPV was diagnosed in 15 patients based on the presence of typical BPPV in other canals, in 9 patients based on typical disease history and the results of position tests, in 6 patients based on effectiveness of the treatment with the Yacovino maneuver, in 4 patients based on the treatment effectiveness and the presence of typical BPPV in other canals, in 3 patients based on the treatment effectiveness and the follow-up outcome, in 2 patients based on the typical BPPV in other canals and occurrence of canal conversion, and in 1 patient based on the treatment effectiveness and occurrence of canal conversion. Thirteen patients with canalolithiasis and four patients with cupulolithiasis were cured after the initial Yacovino maneuver treatment. Twenty-one patients with canalolithiasis and seven patients with cupulolithiasis were cured following 1 week of treatment. CONCLUSIONS The effectiveness of the Yacovino maneuver, the follow-up outcome, the presence of typical BPPV in other canals, and the occurrence of canal conversions contribute to AC-BPPV diagnosis. The Yacovino maneuver was found to be more effective in AC-BPPV patients with canalolithiasis than in those with cupulolithiasis.
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Affiliation(s)
- Xu Yang
- Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, 100049, People's Republic of China.
| | - Xia Ling
- Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, 100049, People's Republic of China
| | - Bo Shen
- Department of Neurology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, 121001, People's Republic of China
| | - Yuan Hong
- Department of Neurology, Peking University Shougang Hospital, Beijing, 100144, People's Republic of China
| | - Kangzhi Li
- Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, 100049, People's Republic of China
| | - Lihong Si
- Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, 100049, People's Republic of China
| | - Ji-Soo Kim
- Department of Neurology, College of Medicine, Seoul National University, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam, Gyeonggi-do, 463-707, South Korea
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Argaet E, Bradshaw A, Welgampola M. Benign positional vertigo, its diagnosis, treatment and mimics. Clin Neurophysiol Pract 2019; 4:97-111. [PMID: 31193795 PMCID: PMC6542326 DOI: 10.1016/j.cnp.2019.03.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 03/20/2019] [Accepted: 03/22/2019] [Indexed: 11/18/2022] Open
Abstract
The diagnosis of benign positional vertigo (BPV) relies on a history of episodic positional vertigo and a distinctive pattern of nystagmus during provocative positional testing. The direction of the induced nystagmus is specific to the affected canal and the velocity profile reflects the underlying mechanism of canalithiasis (free-floating otoconia within the canal duct) or cupulolithiasis (otoconia adherent to the cupula). We review current theories on the pathophysiology of BPV, the clinical history and examination underlying its diagnosis, and recommended repositioning manoeuvres for each of the BPV subtypes. Disorders other than BPV which may present with a similar history and/or positional nystagmus are discussed.
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Affiliation(s)
- E.C. Argaet
- Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Central Clinical School, University of Sydney, Sydney, Australia
- The Balance Clinic and Laboratory, 155 Missenden Rd Camperdown, Sydney, Australia
| | - A.P. Bradshaw
- Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Central Clinical School, University of Sydney, Sydney, Australia
- The Balance Clinic and Laboratory, 155 Missenden Rd Camperdown, Sydney, Australia
| | - M.S. Welgampola
- Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Central Clinical School, University of Sydney, Sydney, Australia
- The Balance Clinic and Laboratory, 155 Missenden Rd Camperdown, Sydney, Australia
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Pérez-Vázquez P, Franco-Gutiérrez V, Soto-Varela A, Amor-Dorado JC, Martín-Sanz E, Oliva-Domínguez M, Lopez-Escamez JA. Practice Guidelines for the Diagnosis and Management of Benign Paroxysmal Positional Vertigo Otoneurology Committee of Spanish Otorhinolaryngology and Head and Neck Surgery Consensus Document. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.otoeng.2018.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Roberts RA, Rivas A, Makowiec KF. Anterior Canal benign paroxysmal positional Vertigo following surgical Management of superior canal dehiscence. Am J Otolaryngol 2018; 39:796-799. [PMID: 30224218 DOI: 10.1016/j.amjoto.2018.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 09/11/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Benign paroxysmal positional vertigo (BPPV) is a common post-surgical finding in patients managed for superior semicircular canal dehiscence (SSCD). The posterior semicircular canal has been reported as the involved canal in the majority of cases of post-surgical BPPV, with only two cases reported of lateral canal involvement. The objective of this report is to present a case in which an anterior semicircular canal BPPV response was identified in a patient following surgical management for SSCD. METHOD This case report presents an adult with residual dizziness following surgical management of SSCD and vestibular rehabilitation therapy (VRT). During subsequent evaluation of vestibular function, a transient and torsional, down-beating nystagmus was provoked along with vertigo during Dix-Hallpike positioning to the right. This was consistent with BPPV affecting the left superior (anterior) semicircular canal. RESULTS The patient was treated with a repositioning maneuver to manage anterior semicircular canal BPPV and no nystagmus response was recorded with post-repositioning Dix-Hallpike test. Review of radiographic images, obtained prior to vestibular function testing, showed a hyperintensity in the area of the left anterior semicircular canal ampulla. It was felt this was likely a bone chip from the SSCD repair that was pushing against the ampulla with further mobile debris within the canal. CONCLUSION It is reported that BPPV is a common complication in patients surgically managed for SSCD. Posterior semicircular canal BPPV is reported most often, with a couple of cases of lateral semicircular canal BPPV also reported. As far as we are aware, the current case represents the first report of anterior semicircular canal BPPV in this type of patient.
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Ling X, Li KZ, Shen B, Si LH, Hong Y, Yang X. Diagnosis and treatment of anterior canal benign paroxysmal positional vertigo. Int J Audiol 2018; 57:673-680. [PMID: 30318958 DOI: 10.1080/14992027.2018.1472397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To investigate the diagnosis and treatment of anterior canal benign paroxysmal positional vertigo (AC-BPPV). DESIGN Retrospective analysis of clinical data regarding the diagnosis and treatment of patients with AC-BPPV. STUDY SAMPLE Six patients with AC-BPPV. RESULTS All patients underwent the Dix-Hallpike test and/or the straight head-hanging test to induce vertigo and down-beating nystagmus with or without torsional components. Down-beating nystagmus in patients 1, 3 and 6 lasted <1 min and was successfully treated with the Yacovino manoeuvre. Down-beating nystagmus in patients 2, 4 and 5 lasted >1 min. The Yacovino manoeuvre was not effective in patient 4, whereas it was effective in patient 2 but with frequently recurring symptoms. Patients 3, 4 and 6 also had other types of typical BPPV. Canal conversion appeared in patients 4 and 5 during the follow-up period. CONCLUSION Typical BPPV, canal conversion, a therapeutic diagnosis after applying the Yacovino manoeuvre, and the follow-up outcome contribute to AC-BPPV diagnosis in patients with dizziness and vertigo presenting with down-beating positional nystagmus. Yacovino manoeuvre was more effective in AC-BPPV patients with down-beating positional nystagmus lasted <1 min than in those in whom it lasted >1 min.
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Affiliation(s)
- Xia Ling
- a Peking University Aerospace School of Clinical Medicine , Beijing , PR China
| | - Kang-Zhi Li
- a Peking University Aerospace School of Clinical Medicine , Beijing , PR China
| | - Bo Shen
- b Department of Neurology , The First Affiliated Hospital of Jinzhou Medical University , Jinzhou , PR China
| | - Li-Hong Si
- a Peking University Aerospace School of Clinical Medicine , Beijing , PR China
| | - Yuan Hong
- c Department of Neurology , Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine , Beijing , PR China
| | - Xu Yang
- a Peking University Aerospace School of Clinical Medicine , Beijing , PR China
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Chen CC, Cho HS, Lee HH, Hu CJ. Efficacy of Repositioning Therapy in Patients With Benign Paroxysmal Positional Vertigo and Preexisting Central Neurologic Disorders. Front Neurol 2018; 9:486. [PMID: 30013505 PMCID: PMC6037198 DOI: 10.3389/fneur.2018.00486] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 06/04/2018] [Indexed: 11/17/2022] Open
Abstract
With the exception of migraines, benign paroxysmal positional vertigo (BPPV) in patients with preexisting central neurologic disorders (CND) is rarely discussed in the literature. Demographic features of this patient group and the efficacy of repositioning therapy are still unknown. We hypothesized that a CND may alter the function of the central vestibular pathway, thus changing the pattern of BPPV and outcomes of repositioning. In this study, we enrolled 93 consecutive idiopathic BPPV patients and categorized them into two groups according to the presence or absence of a CND. In our series, 31.2% of BPPV cases had a CND. The most common associated CNDs were cerebrovascular disease and migraines. The two groups showed similar age distributions, canal involvement, success rates of repositioning, and cycles of treatment used to achieve complete resolution. The major differences were the proportion of females (89.7%) and a right-side predominance (75.9%) in the CND group. There was a trend of more residual dizziness (RD) after successful repositioning in the CND group, but the difference was not significant. The reason for the female and right-side predominance in the CND group is unclear. We concluded that the efficacy of repositioning therapy was excellent (with a success rate of 80.6% with one cycle and 93.5% within two cycles of treatment) for BPPV with or without a preexisting CND. Clinicians are encouraged to diagnose and treat BPPV in patients with a preexisting CND as early as possible to improve patients' quality of life, avoid complications, and reduce medical costs.
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Affiliation(s)
- Chih-Chung Chen
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Neurology, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan.,Dizziness and Balance Disorder Center, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan
| | - Hsiao-Shan Cho
- Department of Neurology, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan
| | - Hsun-Hua Lee
- Department of Neurology, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan.,Dizziness and Balance Disorder Center, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan.,Graduate Institute of Clinical Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chaur-Jong Hu
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Neurology, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan
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