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Çelik EK, Öner F, Akay HG. Do single-session Epley maneuvers treat benign paroxysmal positional vertigo? Ann Saudi Med 2024; 44:161-166. [PMID: 38853479 PMCID: PMC11268478 DOI: 10.5144/0256-4947.2024.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 05/22/2024] [Indexed: 06/11/2024] Open
Abstract
BACKGROUND Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular condition characterized by short-term vertigo attacks that significantly affect quality of life. OBJECTIVES Examine how well a single Epley maneuver worked in an outpatient setting for people with posterior canal benign paroxysmal positional vertigo (PC-BPPV) and whether they needed a second Dix-Hallpike maneuver. DESIGN Prospective. SETTINGS Otorhinolaryngology department of a tertiary care center. PATIENTS AND METHODS Sociodemographic data, body mass index (BMI), and systemic disease history of 75 patients diagnosed with PC-BPPV were recorded, and their relationship with success rates after the modified Epley maneuver was analyzed. MAIN OUTCOME MEASURES Detect cases that could not be repositioned with the diagnostic control Dix-Hallpike test performed 20 minutes after the modified Epley reposition maneuver in the same session in PC-BPPV patients. SAMPLE SIZE 75. RESULTS Of the 75 patients, 31 were male (41.3%), 44 female (58.6%) with a mean (standard deviation) age of 58.6 (15.9) years age, 54.6% had one or more chronic diseases. BMI was 30 mg/kg2 and above in 31 patients (41.3%). The modified Epley maneuver was successful in 77.3%. No significant relationship was found between additional diseases or BMI in the patient group in whom the maneuver was unsuccessful. CONCLUSION The success rates of repositioning maneuvers in treating patients diagnosed with PC-BPPV are high. However, more than a single maneuver is required in some resistant patients. Second diagnostic and repositioning maneuvers performed in the same session will reduce multiple hospital admissions. While it is helpful to repeat the maneuver in the patient group where it was unsuccessful, other factors causing the failure should be investigated. LIMITATIONS Lack of follow-up results of patients after 7-10 days.
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Affiliation(s)
- Elif Kaya Çelik
- From the Otorhinolaryngology Head and Neck Surgery Department, Tokat Gaziosmanpasa Universitesi, Tokat, Turkey
| | - Fatih Öner
- From the Department of Otorhinolaryngology, Kastamonu University, Kastamonu, Turkey
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Zhang H, Zhu M. Mechanical rotational chair-assisted multiple canalith repositioning procedures for benign paroxysmal positional vertigo: enhanced vertigo relief, comparable adverse effects, and decreased incidence of residual dizziness. Front Neurol 2023; 14:1226138. [PMID: 37609657 PMCID: PMC10440428 DOI: 10.3389/fneur.2023.1226138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 07/13/2023] [Indexed: 08/24/2023] Open
Abstract
Objectives This retrospective study aimed to assess the effectiveness and adverse effects of mechanical rotational chair-assisted multiple canalith repositioning procedures (CRPs) to treat benign paroxysmal positional vertigo (BPPV). Materials and methods A retrospective analysis of 1,273 BPPV patients was conducted, with 241 patients included in the final study. The participants diagnosed with BPPV, unresolved by a single previous CRP, were categorized into either the single or multiple CRP groups. In both groups, on days 1, 4, and 7 after the initial treatment, the participants were re-evaluated after a single CRP; if positional vertigo was resolved, the treatment was regarded as successful. The remission rate, adverse effects (such as canal switch (CS), falls, and vomiting), residual dizziness (RD) rate, and RD duration were compared between the two groups. Results The resolution rates for the single and multiple CRP groups were significantly different on days 1 and 4 (55.7% vs. 85.1%, 75.5% vs. 91.9%; P < 0.05) but not on day 7 (93.3% vs. 94.8%; P > 0.05). There were no significant differences between the single and multiple CRP groups in terms of CS and falls (3.8% vs. 5.2%, 10.3% vs. 8.9%; P > 0.05). However, there was a significant difference in the incidence of vomiting (6.6% vs. 14.8%; P < 0.05). RD such as head heaviness, imbalance, and non-specific dizziness is more common in the single CRP group than in the multiple CRP group (34.9% vs. 20.7%, 42.5% vs. 26.7%, 47.2% vs. 32.6%; P < 0.05). The incidence and duration of RD were notably diminished in the group undergoing multiple CRPs compared to the single CRP group, with incidence rates of 41.5% and 57.5%, respectively (P < 0.05). Conclusion For patients with BPPV, multiple CRPs offer greater benefits than a single CRP.
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Affiliation(s)
- Hao Zhang
- Department of Neurology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong, China
- Department of Neurology, The People's Hospital of Rizhao City, Rizhao, Shandong, China
| | - Meijia Zhu
- Department of Neurology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, Shandong, China
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Zhang X, Deng Q, Liu Q, Wen C, Wang W, Chen T. The horizontal and vertical components of nystagmus evoked by the supine roll test in horizontal semicircular canal canalolithiasis. Front Neurosci 2022; 16:957617. [PMID: 36090273 PMCID: PMC9448955 DOI: 10.3389/fnins.2022.957617] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/01/2022] [Indexed: 12/03/2022] Open
Abstract
Objective The characteristics of horizontal and vertical components of nystagmus evoked by the supine roll test in patients with horizontal semicircular canal canalolithiasis (HSC-Can) were analyzed, according to Ewald’s first law. It provided a basis for the study of human horizontal semicircular canal function and structure, objective diagnosis, and treatment of benign paroxysmal positional vertigo (BPPV). Materials and methods The records of patients that had been tested with 2-dimensional videonystagmography (2D-VNG) were reviewed between June 2019 and June 2021. The intensity and direction of horizontal and vertical nystagmus elicited by the supine roll test were analyzed in 189 patients with idiopathic HSC-Can. Results All the 189 patients with HSC-Can were induced horizontal nystagmus with the same direction as head-turning (geotropic) in the supine roll test, of which 119 patients (63.96%) had a weak vertical upward component of nystagmus on the affected and unaffected sides, 57 patients (30.16%) had a vertical downward component of nystagmus on the affected side and/or the unaffected side, and 13 patients (6.88%) had no vertical component of nystagmus on both the sides. The intensity values of the horizontal component on the affected and unaffected sides were 42.14 ± 24.78 (range: 6.26–138.00°/s) and 17.48 ± 10.91°/s (range: 2.40–53.83°/s), with a ratio of 2.96 ± 2.17:1, representing a significant difference (p < 0.001). We analyzed the characteristics of horizontal and vertical components in 119 patients with HSC-Can (57 L-HSC-Can and 62 R-HSC-Can) on the supine roll test. The intensity values of the horizontal component on the affected and unaffected sides were 43.17 ± 23.76 (range: 8.60–124.51°/s) and 17.98 ± 10.99°/s (range: 2.40–53.83°/s), and the intensity values of the vertical component on the affected and unaffected sides were 10.65 ± 8.46 (range: 1.90–50.83°/s) and 4.81 ± 3.45°/s (range: 0.30–20.43°/s), representing a significant difference between groups (p < 0.001). Among 119 patients with HSC-Can who had a vertical upward component on both the affected and unaffected sides in the supine roll test, unilateral weakness (UW) was normal in 53 cases and abnormal in 51 cases, and 15 cases did not undergo the caloric test. We compared the horizontal and vertical components of nystagmus induced on the affected and unaffected sides in the supine roll test in 53 patients with normal UW and 51 patients with abnormal UW, and the difference was not statistically significant. Conclusion There is mostly a vertical upward component based on the horizontal component in HSC-Can, and the direction and intensity characteristics of nystagmus accord with Ewald’s first law, which can provide a basis for the study of human HSC function and structure, objective diagnosis, and treatment of BPPV.
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Affiliation(s)
- Xueqing Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, Tianjin First Central Hospital, Tianjin, China
- Institute of Otolaryngology of Tianjin, Tianjin, China
- Key Laboratory of Auditory Speech and Balance Medicine, Tianjin, China
- Key Medical Discipline of Tianjin (Otolaryngology), Tianjin, China
- Quality Control Centre of Otolaryngology, Tianjin, China
| | - Qiaomei Deng
- Department of Otorhinolaryngology Head and Neck Surgery, Tianjin First Central Hospital, Tianjin, China
- Institute of Otolaryngology of Tianjin, Tianjin, China
- Key Laboratory of Auditory Speech and Balance Medicine, Tianjin, China
- Key Medical Discipline of Tianjin (Otolaryngology), Tianjin, China
- Quality Control Centre of Otolaryngology, Tianjin, China
| | - Qiang Liu
- Department of Otorhinolaryngology Head and Neck Surgery, Tianjin First Central Hospital, Tianjin, China
- Institute of Otolaryngology of Tianjin, Tianjin, China
- Key Laboratory of Auditory Speech and Balance Medicine, Tianjin, China
- Key Medical Discipline of Tianjin (Otolaryngology), Tianjin, China
- Quality Control Centre of Otolaryngology, Tianjin, China
| | - Chao Wen
- Department of Otorhinolaryngology Head and Neck Surgery, Tianjin First Central Hospital, Tianjin, China
- Institute of Otolaryngology of Tianjin, Tianjin, China
- Key Laboratory of Auditory Speech and Balance Medicine, Tianjin, China
- Key Medical Discipline of Tianjin (Otolaryngology), Tianjin, China
- Quality Control Centre of Otolaryngology, Tianjin, China
| | - Wei Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Tianjin First Central Hospital, Tianjin, China
- Institute of Otolaryngology of Tianjin, Tianjin, China
- Key Laboratory of Auditory Speech and Balance Medicine, Tianjin, China
- Key Medical Discipline of Tianjin (Otolaryngology), Tianjin, China
- Quality Control Centre of Otolaryngology, Tianjin, China
- Wei Wang,
| | - Taisheng Chen
- Department of Otorhinolaryngology Head and Neck Surgery, Tianjin First Central Hospital, Tianjin, China
- Institute of Otolaryngology of Tianjin, Tianjin, China
- Key Laboratory of Auditory Speech and Balance Medicine, Tianjin, China
- Key Medical Discipline of Tianjin (Otolaryngology), Tianjin, China
- Quality Control Centre of Otolaryngology, Tianjin, China
- *Correspondence: Taisheng Chen,
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Craniocerebral Magnetic Resonance Imaging Features of Benign Paroxysmal Positional Vertigo under Artificial Intelligence Algorithm and the Correlation with Cerebrovascular Disease. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:8952355. [PMID: 35582236 PMCID: PMC9071938 DOI: 10.1155/2022/8952355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 03/25/2022] [Accepted: 04/04/2022] [Indexed: 11/17/2022]
Abstract
This research aimed to discuss the characteristics of benign paroxysmal positional vertigo (BPPV) and the correlation with cerebrovascular disease. An artificial intelligence algorithm under a parallel dual-domain concatenated convolutional neural network (PDDC-CNN) was proposed to process the images of magnetic resonance imaging (MRI). MRI, magnetic resonance angiography (MRA), and susceptibility weighted imaging (SWI) were performed on all 60 research objects with a 3.0 MRI scanner. The number of cases with cerebral microbleeds (CMBs), SWI image display of small veins, the number of lacunar infarctions, vertebral artery dominance, and vertebrobasilar morphology were observed in the two groups. The number of lacunar infarctions was 2.400 ± 3.358 and 0.672 ± 0.251, respectively, in the BBPV group with 30 cases and the control group with the other 30 cases. The positive rates of CMBs on SWI images were 48% and 27% in the BBPV group and the control group, respectively, and the average CMBs were counted as 1.670 ± 2.326 and 0.487 ± 0.865. CMBs were shown as round or oval lesions of conventional sequence deletion in the images with a diameter of less than 1.5 cm. SWI images of the BBPV group showed a significant increase in intracerebral small veins compared to those of the control group. The curvature of the vertebrobasilar artery in the BBPV group was significantly higher than that in the control group, and the curvature of the basilar artery was slightly higher than that in the control group. In conclusion, the MRI features of BPPV patients were related to their own microvascular lesions closely, and it was speculated that the cerebrovascular factors might play a dominant role in the early onset of BPPV.
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Hui J, Lei Q, Ji Z, Zi D. Betahistine alleviates benign paroxysmal positional vertigo (BPPV) through inducing production of multiple CTRP family members and activating the ERK1/2-AKT/PPARy pathway. Biol Res 2022; 55:16. [PMID: 35379352 PMCID: PMC8981858 DOI: 10.1186/s40659-022-00385-3] [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: 08/06/2020] [Accepted: 03/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Betahistine is a clinical medication for the treatment of benign paroxysmal positional vertigo (BPPV). Otolin, a secreted glycoprotein with a C-terminal globular domain homologous to the immune complement C1q, has been identified as a biomarker for BPPV. However, the role of complement C1q/TNF-related proteins (CTRPs) with a C-terminal globular domain in BPPV is unclear, so we explored the change of CTRPs in betahistine treated BPPV. METHODS We treated BPPV patients with Betahistine (12 mg/time, 3 times/day) for 4 weeks and observed the clinical efficacy and the expression of CTRP family members in BPPV patients. Then, we constructed a vertigo mice model of vestibular dysfunction with gentamicin (150 mg/Kg) and a BPPV model of Slc26a4loop/loop mutant mice. Adenoviral vectors for CTRP expression vector and small interfering RNA were injected via the intratympanic injection into mice and detected the expression of CTRP family members, phosphorylation levels of ERK and AKT and the expression of PPARγ. In addition, we treated mice of vestibular dysfunction with Betahistine (10 mg/Kg) and/or ERK inhibitor of SCH772984 (12 mg/Kg) and/or and PPARγ antagonist GW9662 (1 mg/Kg) for 15 days, and evaluated the accuracy of air righting reflex, the time of contact righting reflex and the scores of head tilt and swimming behavior. RESULTS After treatment with Betahistine, the residual dizziness duration and the score of the evaluation were reduced, and the expression of CTRP1, 3, 6, 9 and 12 were significantly increased in BPPV patients. We also found that Betahistine improved the accuracy of air righting reflex, reduced the time of contact righting reflex and the scores of head tilt and swimming behavior in gentamicin-treated mice and Slc26a4loop/loop mutant mice. The expression levels of CTRP1, 3, 6, 9 and 12, phosphorylation levels of ERK and AKT, and PPARγ expression were significantly increased, and the scores of head tilt and swimming behavior were decreased in vestibular dysfunction mice with overexpression of CTRPs. Silencing CTRPs has the opposite effect. SCH772984 reversed the effect of Betahistine in mice with vestibular dysfunction. CONCLUSION Betahistine alleviates BPPV through inducing production of multiple CTRP family members and activating the ERK1/2-AKT/PPARy pathway.
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Affiliation(s)
- Jing Hui
- Department of Neurology, The Second Affiliated Hospital of Xi'an Medical College, Xi'an, 710038, China
| | - Qi Lei
- Shaanxi Normal University Hospital, Xi'an, 710119, China
| | - Zhi Ji
- Department of Neurology, The Second Affiliated Hospital of Xi'an Medical College, Xi'an, 710038, China
| | - Dingjing Zi
- Department of Otolaryngology, The Second Affiliated Hospital of Air Force Medical University, No. 1 Xinsi Road, Xi'an , 710038, China.
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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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Bashir K, Bashir MT, Elmoheen A. Curing Benign Paroxysmal Positional Vertigo in Patients With Brain Tumor: Case Series and Literature Review. Cureus 2021; 13:e13873. [PMID: 33868837 PMCID: PMC8043051 DOI: 10.7759/cureus.13873] [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] [Accepted: 03/12/2021] [Indexed: 11/09/2022] Open
Abstract
Benign paroxysmal positional vertigo (BPPV) is a common vestibular disorder. It accounts for a third of all vestibular disorders diagnosed in the general population and is usually diagnosed and treated successfully. This article presents two cases of BPPV in a 52-year-old man and a 45-year-old patient, respectively. Both patients presented with recurrent episodes of vertigo associated with certain head movements. Medical history for the first patient included surgery for acoustic neuroma 12 months before developing the vertigo episodes. The second patient underwent a neurosurgical operation for glioblastoma multiforme (GBM) followed by radiotherapy three months before this presentation. Both patients were diagnosed with right-sided posterior canal BPPV after the Dix-Hallpike test. Their symptoms completely resolved within few minutes of the Epley maneuver. These cases highlight the importance of diagnosing and treating a potentially curable condition that can coexist in some patients with brain tumors.
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Affiliation(s)
- Khalid Bashir
- Emergency Medicine, Qatar University College of Medicine, Doha, QAT
- Emergency Medicine, Hamad Medical Corporation, Doha, QAT
- Emergency Medicine, Weill Cornell Medical College Qatar, Doha, QAT
| | - Mohammed T Bashir
- School of Medicine and Dentistry, University of Aberdeen, Scotland, GBR
| | - Amr Elmoheen
- Emergency Medicine, Hamad Medical Corporation, Doha, QAT
- Emergency Medicine, Qatar University College of Medicine, Doha, QAT
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