Diagnostic value of repeated Dix-Hallpike and roll maneuvers in benign paroxysmal positional vertigo

Exploring the Association of Serum Uric Acid Levels with Benign Paroxysmal Positional Vertigo: A Systematic Review and Meta-Analysis

Objectives: The role of uric acid in pathogenesis of benign paroxysmal positional vertigo (BPPV) is not fully understood. It is aimed to assess the serum uric acid levels in BPPV patients compared to healthy controls. Study design: Systematic review and meta-analysis. Methods: Web of science, PubMed, Scopus, Google Scholar, Embase, Medline, and Cochrane library were systematically searched. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and Problem/Population, Intervention, Comparison, and Outcome (PICO) guidelines were used. Results: In total, 20 studies including 3967 participants met the inclusion criteria. Ten studies (50%) reported higher uric acid (UA) levels in BPPV patients, 4 studies (20%) indicated lower UA levels in BPPV patients, while 6 studies (30%) found no significant difference in UA levels between BPPV patients and healthy controls. The overall mean serum levels of UA (SMD: 0.265, [-0.163 to 0.693]) were higher in BPPV patients than control group. However, this difference was not statistically significant (P-value: .225). Conclusion: There is no significant difference in serum level of UA between BPPV patients and healthy controls. It means that serum level of UA (whether low or high) is not likely the underlying factor of development of BPPV.

Effects of noise on the vestibular system of normal-hearing workers

BACKGROUND: Studies in noise-exposed animals have shown changes in vestibular structures. Likewise, studies in humans have been suggesting that noise can damage the vestibular system, even with normal assessment results. OBJECTIVE: To assess the vestibular system of workers exposed to noise and to compare with individuals not exposed. METHODS: Twenty normal-hearing male adults were divided in the study group (SG), exposed to occupational noise, and control group (CG). We conducted the following procedures: medical history, Dizziness Handicap Inventory (DHI), Dix-Hallpike maneuver, and electronystagmography (eye and caloric tests). RESULTS: The DHI score did not differ between groups. The Dix-Hallpike maneuver was normal for both groups. All individuals had normal responses in the eye tests. 50% of the SG had hyperreflexia in the caloric tests, with a significant difference between the groups. There was a trend towards a statistical significance in the absolute values of angular speed of the slow component in the cold-air test, which were higher in the SG. There was a significant difference between the groups in the relative values of labyrinthine preponderance, which were higher in the SG. CONCLUSION: Our findings showed that 70% of the workers exposed to occupational noise had vestibular alterations identified with electronystagmography, whereas 100% of the individuals in the CG had normal results in the vestibular assessment. Moreover, only 20% of the sample in both groups had vestibular complaints, indicating the presence of subclinical vestibular changes in 50% of the individuals exposed to occupational noise.

The frequency and impact of undiagnosed benign paroxysmal positional vertigo in outpatients with high falls risk

BACKGROUND

The frequency and impact of undiagnosed benign paroxysmal positional vertigo (BPPV) in people identified with high falls risk has not been investigated.

OBJECTIVE

To determine the frequency and impact on key psychosocial measures of undiagnosed BPPV in adult community rehabilitation outpatients identified with a high falls risk.

DESIGN

A frequency study with cross-sectional design.

SETTING

A Community Rehabilitation Program in Melbourne, Australia.

SUBJECTS

Adult community rehabilitation outpatients with a Falls Risk for Older People in the Community Screen score of four or higher.

METHODS

BPPV was assessed in 34 consecutive high falls risk rehabilitation outpatients using the Dix-Hallpike test and supine roll test. Participants were assessed for anxiety, depression, fear of falls, social isolation and loneliness using the Hospital Anxiety and Depression Scale, Falls Efficacy Scale-International and De Jong Gierveld 6-Item Loneliness Scale.

RESULTS

A total of 18 (53%; 95% confidence interval: 36, 70) participants tested positive for BPPV. There was no significant difference between those who tested positive for BPPV and those who did not for Falls Risk for Older People in the Community Screen scores (P = 0.555), Hospital Anxiety and Depression Scale (Anxiety) scores (P = 0.627), Hospital Anxiety and Depression Scale (Depression) scores (P = 0.368) or Falls Efficacy Scale-International scores (P = 0.481). Higher scores for the De Jong Gierveld 6-Item Loneliness Scale in participants with BPPV did not reach significance (P = 0.056).

CONCLUSIONS

Undiagnosed BPPV is very common and associated with a trend towards increased loneliness in adult rehabilitation outpatients identified as having a high falls risk.

Optimizing Testing for BPPV - The Loaded Dix-Hallpike

OBJECTIVES

Although the Dix-Hallpike testing is generally considered as the gold standard for the identification of the posterior canal benign paroxysmal positional vertigo (BPPV), we investigated a modification of the maneuver termed the "loaded Dix-Hallpike."

STUDY DESIGN

Prospective randomized controlled trial.

MATERIALS AND METHODS

Twenty-eight patients participated in this prospective study comparing the standard Dix-Hallpike (S-DH) to the loaded Dix-Hallpike (L-DH) test. Each patient underwent repeated testing with the S-DH and the L-DH. The patients were placed into two groups. Fourteen patients underwent 3 rounds of S-DH testing followed by 3 rounds of L-DH testing. The other fourteen patients underwent 3 rounds of L-DH testing followed by 3 rounds of S-DH testing. The duration of nystagmus and the latency prior to the onset of nystagmus were measured for each test. Additionally, the patients were asked to rate the severity of their symptoms following each test.

RESULTS

The duration of nystagmus of the L-DH was significantly longer than that of the S-DH (p<0.0001). The patients reported a higher severity score with L-DH as compared to with S-DH (p<0.001). The L-DH was found to be more sensitive than the S-DH (p=0.0131).

CONCLUSION

The L-DH produces significantly longer duration of nystagmus, stronger symptoms, and improved sensitivity when compared to the S-DH.

The Clinical Response Time of Epley Maneuvers for Treatment of BPPV: A Hospital Based Study

The Epley maneuver is one of the most effective canalith repositioning procedures for treatment of posterior canal benign paroxysmal positional vertigo. It was found that response to BPPV varies with various factors such as types, single versus multiple canals BPPV, single or repeated cycles of head maneuvers in each session and duration of follow up of patient. Furthermore, less uniform result exists after treatment of BPPV among studies. Hence, the present study was taken with aim to investigate "The clinical response time of Epley maneuvers in treatment of BPPV: A Hospital Based Study. A total of 132 patients were included in study with age ranging from 30 to 50 years These patient visited department of ENT from 2019 to 2020 with complaint of vertigo. The subjective balancing assessments along with Dix-Hallpike maneuver were done and dizziness handicap inventory were administrated for screening of BPPV. The patients, who were diagnosed as posterior canal BPPV, were treated with Canal repositioning procedure i.e. Epley's Maneuvers during the initial visit. In addition, the same maneuvers were repeated after 1 week of sequential sessions if the patient reported no benefit or partial benefit from first session until the patient became asymptomatic and Dix-Hallpike maneuver were negative. The total number of sessions of Epley maneuver required by each patient was recorded. The findings of present study suggested that 37.69% of cases with posterior canal BPPV were asymptomatic after first CRP session of Epleys maneuver whereas repeated sessions were required in 61.52% of cases of BPPV and 0.76% of cases showed no response to repeated CRP up to 6 months. BPPV involving posterior canals may be easily detected by position test with good response to Epley maneuver. Short-term and long term control of symptoms of unilateral posterior SCC through this easy and simple procedure can be achieved. This cost effective approach requires proper trained and committed professionals. The repeated session may be required as complete recovery may not be immediate. Sometimes partial response can be due to canal switching during BPPV Hence, it is necessary to counsel the patient regarding the importance of follow-up.

Pseudo-Benign Paroxysmal Positional Vertigo: A Retrospective Study and Case Report

Pseudo-benign paroxysmal positional vertigo (pseudo-BPPV) is a specific type of vestibular migraine disguised as benign paroxysmal positional vertigo, which is characterized by recurrent different types of positional and atypical positional vertigo with migraine features. It is easy to be misdiagnosed with BPPV at the first visit, which means that the ideal therapeutic effects are not achieved. Twenty-five cases of pseudo-BPPV with frequent changing positional vertigo were retrospected and the following key features help to identify the disease: recurrent positional and atypical positional vertigo, migrainous accompanying symptoms or migraine history, mild or indistinctive headaches, with or without impaired vestibular function, ineffective for simply reposition. And we found that vertigo in pseudo-BPPV can be preferable controlled by valproic acid combined with canalith repositioning procedure.

Asking about dizziness when turning in bed predicts examination findings for benign paroxysmal positional vertigo

BACKGROUND

Benign paroxysmal positional vertigo (BPPV) is the single most common cause of vestibular vertigo and is characterised by short episodes of rotational vertigo precipitated by changes in head positions like lying down or turning in bed.

OBJECTIVE

This study aims to assess useful questions when suspecting benign paroxysmal positional vertigo (BPPV) caused dizziness as well as identifying if a single question can be useful in identify or distinguish patients with BPPV from other dizziness aetiology.

METHOD

A total of 149 patients admitted due to dizziness were included. Patients answered a questionnaire and were investigated for BPPV with diagnostic manoeuvres.

RESULT

Two of the 15 questions were of diagnostic importance. Dizziness when laying down or turning in bed, increased likelihood of BPPV by an odds ratio (95% confidence interval) of 60 (7.47-481.70). Continuous dizziness duration as opposed to lasting seconds decreased likelihood of BPPV with an odds ratio of 0.06 (0.01-0.27).

CONCLUSION

Vertiginous attacks by turning or laying down in bed together with dizziness <1 minute, are important questions and strongly related to BPPV. Such questions are important when taking a medical history and may help to early identify BPPV, also for non-medical staff, as well as reduce the need of further investigations.

Investigation of self-reported dizziness in the elderly when lying down or turning over in bed, and possible benign paroxysmal positional vertigo

OBJECTIVES

This study aimed to investigate the rate of dizziness and occurrence of benign paroxysmal positional vertigo in the elderly by physical examination in those reporting dizziness symptoms when lying down or turning over in bed.

METHODS

A total of 498 people, aged 70-85 years, were asked to complete a questionnaire regarding dizziness symptoms. Subjects answering that they became dizzy in bed were asked to participate in a physical examination and diagnostic manoeuvres investigating benign paroxysmal positional vertigo.

RESULTS

A total of 324 participants (65 per cent) completed the questionnaire. More than one-quarter (29 per cent) reported dizziness and 32 (10 per cent) reported dizziness when turning in bed. Of these 32 persons, 22 (69 per cent) underwent a physical examination. Six participants tested positive for benign paroxysmal positional vertigo.

CONCLUSION

Ten per cent of the elderly participants reported positional symptoms, and 6 out of 22 fulfilled diagnostic criteria for benign paroxysmal positional vertigo. Furthermore, benign paroxysmal positional vertigo was established despite a delay between questionnaire completion and investigation, emphasising that this type of dizziness may not be a self-limiting disorder.

Theoretical observation on diagnosis maneuver for benign paroxysmal positional vertigo

CONCLUSION

To make a comprehensive analysis with a variety of diagnostic maneuvers is conducive to the correct diagnosis and classification of BPPV.

OBJECTIVE

Based on the standard spatial coordinate-based semicircular canal model for theoretical observation on diagnostic maneuvers for benign paroxysmal positional vertigo (BPPV) to analyze the meaning and key point of each step of the maneuver.

MATERIALS AND METHODS

This study started by building a standard model of semicircular canal with space orientation by segmentation of the inner ear done with the 3D Slicer software based on MRI scans, then gives a demonstration and observation of BPPV diagnostic maneuvers by using the model.

RESULTS

The supine roll maneuver is mainly for diagnosis of lateral semicircular canal BPPV. The Modified Dix-Hallpike maneuver is more specific for the diagnosis of posterior semicircular canal BPPV. The side-lying bow maneuver designed here is theoretically suitable for diagnosis of anterior semicircular canal BPPV.

A Return to Work Program for an Employee With Resolving Vertigo

Vertigo is a disorder that affects equilibrium. Symptoms include a loss of balance with nausea and vomiting. Employees diagnosed with vertigo can return to work safely; however, they may need workplace restrictions and accommodation as symptoms may persist for months. This article reviews the evaluation and treatment of vertigo with back-to-work recommendations.