Treatment of anterior semi-circular canalithiasis by a sedimentation procedure in a vertical rotatory chair

Treatment of Patients With Benign Paroxysmal Positional Vertigo and Severe Immobility Using the Particle Repositioning Chair: A Retrospective Cohort Study

OBJECTIVE

To report treatment of benign paroxysmal positional vertigo (BPPV) in patients unable to undergo traditional canalith repositioning maneuvers (CRMs) using a particle repositioning chair (PRC).

METHODS

A retrospective chart review was conducted at a single high-volume otology practice of patients diagnosed with BPPV from 2007 to 2017 with immobility prohibiting use of traditional CRMs. Patients were diagnosed and treated using a PRC, and outcome measures including resolution, recurrence, and number of treatment visits were recorded.

RESULTS

A total of 34 patients meeting criteria were identified, 24 of whom had cervical spine disease and 10 of whom had other prohibitive immobility. Symptoms were present for between 5 days and 11 years at presentation, with mean and median of 552 and 90 days, respectively. Symptoms resolved in 68% of patients and recurred in 13% of those patients. Most patients required 1 treatment visit.

CONCLUSIONS

Successful treatment of patients with BPPV and concomitant immobility prohibiting traditional CRMs is reported using the PRC. Benign paroxysmal positional vertigo in the setting of immobility is an indication for treatment with a PRC if available.

Analysis of non-posterior canal benign paroxysmal positional vertigo in patients treated using the particle repositioning chair: A large, single-institution series

PURPOSE

Benign paroxysmal positional vertigo (BPPV) involving the horizontal and superior semicircular canals is difficult to study due to variability in diagnosis. We aim to compare disease, treatment, and outcome characteristics between patients with BPPV of non-posterior semicircular canals (NP-BPPV) and BPPV involving the posterior canal only (P-BPPV) using the particle repositioning chair as a diagnostic and therapeutic tool.

METHODS

Retrospective review of patients diagnosed with and treated for BPPV at a high volume otology institution using the particle repositioning chair.

RESULTS

A total of 610 patients with BPPV were identified, 19.0% of whom had NP-BPPV. Patients with NP-BPPV were more likely to have bilateral BPPV (52.6% vs. 27.6%, p < 0.0005) and Meniere's disease (12.1% vs. 5.9%, p = 0.02) and were more likely to have caloric weakness (40.3% vs. 24.3%, p = 0.01). Patients with NP-BPPV required more treatments for BPPV (average 3.4 vs. 2.4, p = 0.01) but did not have a significantly different rate of resolution, rate of recurrence, or time to resolution or recurrence than patients with posterior canal BPPV.

CONCLUSIONS

Comparison of NP-BPPV and P-BPPV is presented with reliable diagnosis by the particle repositioning chair. NP-BPPV affects 19% of patients with BPPV, and these patients are more likely to have bilateral BPPV and to require more treatment visits but have similar outcomes to those with P-BPPV. NP-BPPV is common and should be part of the differential diagnosis for patients presenting with positional vertigo.

Diagnosis and Treatment of Anterior-Canal Benign Paroxysmal Positional Vertigo: A Systematic Review

Background and Purpose

In contrast to the posterior- and horizontal-canal variants, data on the frequency and therapeutic management of anterior-canal benign paroxysmal positional vertigo (AC-BPPV) are sparse. To synthesize the existing body of evidence into a systematic review regarding the incidence and treatment of AC-BPPV.

Methods

Systematic search of medical databases employing predefined criteria, using the term "anterior canal benign paroxysmal positional vertigo."

Results

The electronic search retrieved 178 unique citations, 31 of which were considered eligible for further analysis. Analysis of the collected data revealed an estimated occurrence of AC-BPPV among benign paroxysmal positional vertigo patients of 3% (range 1-17.1%). No controlled therapeutic trials could be identified, and so the analysis was focused on uncontrolled case series. Treatment was categorized into three groups: Epley maneuver, Yacovino maneuver, and specific, nonstandard maneuvers described in individual articles. All three categories demonstrated success rates of over 75%, and the overall sample-size-weighted mean was 85.6%.

Conclusions

The present analysis demonstrated that AC-BPPV comprises about 3% of all BPPV cases. It can be treated safely using the Epley, Yacovino, and other maneuvers with rates of symptom resolution lying in the range of that reported for the other, more frequent canal variants. Multicenter controlled trials are needed in order to develop evidence-based guidelines for the treatment of AC-BPPV.

Anterior semicircular canal benign paroxysmal positional vertigo: a series of 20 patients

OBJECTIVES

The purpose of this study is to define the diagnostic criteria for anterior semicircular canal benign paroxysmal positional vertigo (BPPV) based on clinical data and the available anatomical and pathophysiological data.

MATERIAL AND METHOD

Between July 2006 and June 2007, 4320 patients consulting for otoneurological disease were investigated by otological examination, videonystagmography and neurological examination.

RESULTS

BPPV was diagnosed in 1430 patients, involving the posterior semicircular canal in 1325 patients, the horizontal semicircular canal in 85 patients, the posterior semicircular canal and ipsilateral anterior (superior) semicircular canal in 19 patients and the anterior semicircular canal only in one patient. In the 20 patients with anterior semicircular canal BPPV, the Dix-Hallpike (DH) test induced ageotropic horizontal torsional nystagmus beating towards the uppermost ear in the lateral supine position with reversal on standing. The modified Epley manoeuvre was effective in 94.1% of cases on the 8th day and in 97.5% of cases at 1 month.

DISCUSSION/CONCLUSION

Nystagmus beating towards the uppermost ear on the DH test is consistent with BPPV involving the anterior semicircular canal of the uppermost ear. The torsional component of nystagmus and not just the vertical component must be taken into account to facilitate the diagnosis with videonystagmoscopy glasses and identify the affected side. The anterior semicircular canal is rarely affected due to its anatomical position. Settling of otoconia in this canal requires hyperextension of the head. Treatment is simple, consisting of the modified Epley particle repositioning manoeuvre.

Why Treat Apogeotropic BPPVs of the Horizontal Canal? About 30 Observations

Benign paroxysmal positional vertigo (BPPV), of the horizontal canal, in the apogeotropic form (AHBPPV) was described in 1995. Based on 30 observations of typical AHBPPVs of the horizontal canal, we endeavor to discuss the relevance of physiotherapy. Material and Method. Thirty observations of typical apogeotropic BPPVs of the horizontal canal treated with a 360° barbeque rotation on the BPPV side, reviewed in consultation at 1 and 3 weeks and reevaluated the following year. Results. Our cohort of 30 patients had an average age of 58.6 years. The apogeotropic BPPVs of the horizontal canal, which can be transformed into BPPVs of the posterior canal or into geotropic-type BPPVs of the horizontal canal do not recover more quickly. Patients who follow the positional advice do not recover more quickly than those who do not (P = 0.152). The 15 patients treated on average 13.73 days after the onset of the disease did not recover more quickly after the start of therapeutic treatment than those treated later (P = 0.032). Conclusion. Here, we demonstrate that the direction of rotation during the maneuvers is of no importance for the results. We show that transformability is not a guarantee of rapid recovery and that the therapist's effectiveness is limited when it comes to the short-term results.