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Kulthaveesup A, Bunnag K. Comparison of outcomes of the Epley and self-Epley maneuvers in PC-BPPV: A randomized controlled trial. Am J Otolaryngol 2023; 44:103995. [PMID: 37459743 DOI: 10.1016/j.amjoto.2023.103995] [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: 03/21/2023] [Accepted: 07/08/2023] [Indexed: 09/24/2023]
Abstract
OBJECTIVES This study aimed to compare the efficacy of the self-Epley and Epley maneuvers in treating posterior canal benign paroxysmal positional vertigo (PC-BPPV) in patients at the outpatient clinic at the Department of Otolaryngology, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand. METHODS In this prospective, randomized, comparative study, patients with PC-BPPV were randomized to receive the self-Epley or Epley maneuver. The self-Epley maneuver group received illustrated instructions and a video of how to perform the self-Epley maneuver. They then performed the first self-Epley maneuver under supervision in the clinic. The efficacy of the treatment was evaluated with the Dix-Hallpike test at the 1-week follow-up visit. RESULTS Sixty-four patients with PC-BPPV were enrolled, 32 patients were the self-Epley maneuver group and the other 32 patients were the Epley maneuver group. After 1 week, 29 of the 32 patients (90.62 %) in the self-Epley maneuver group were cured, while 28 of the 32 patients (87.5 %) in the Epley maneuver group were cured. The Kaplan-Meier survival estimates with a log-rank test for cumulative therapeutic effects at 1 week showed no statistically significant difference between the groups (P = 0.755). CONCLUSIONS The twice-a-day self-Epley maneuver had a high success rate and could be used for patients who cannot reach a hospital or needs quarantine due to covid-19. For the self-Epley maneuver, adequate instruction is important to obtain a good result. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Anan Kulthaveesup
- Department of Otolaryngology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand; Ear Nose Throat Department, BNH Hospital, Bangkok, Thailand
| | - Kanokrat Bunnag
- Department of Otolaryngology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.
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Erdur ZB, Evran N. Effect of betahistine treatment on dizziness and anxiety symptoms of BPPV patients. Niger J Clin Pract 2023; 26:1383-1387. [PMID: 37794554 DOI: 10.4103/njcp.njcp_305_23] [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] [Indexed: 10/06/2023]
Abstract
Background Patients with benign paroxysmal positional vertigo (BPPV) may experience significant deterioration in their quality of life due to dizziness and anxiety symptoms. Aim To evaluate the effect of betahistine add-on therapy on dizziness and anxiety symptoms of BPPV patients. Materials and Methods Eighty-four patients who were diagnosed as having posterior canal BPPV were included in the study. Patients were divided into two groups according to the treatment regimen: Group 1 included 42 subjects who were treated with the Epley maneuver alone and Group 2 included 42 subjects who received betahistine 48 mg/day for ten days with the Epley maneuver. Dizziness handicap inventory (DHI) and Beck anxiety inventory (BAI) were evaluated at the time of diagnosis and at the control examination on the tenth day. Results The mean before and after treatment DHI scores were 38.8 ± 14.6 and 5.47 ± 6.4 for Group 1 (P < 0.001), and 45.8 ± 21.1 and 10.3 ± 12.9 for Group 2 (P < 0.001). The mean before and after treatment BAI scores were 11.8 ± 6 and 1.33 ± 1.8 for Group 1 (P < 0.001), and 13.6 ± 8.3 and 2.9 ± 3.8 for Group 2 (P < 0.001). There was no significant difference between the before and after treatment DHI and BAI score differences of the two groups (P = 0.27, P = 0.43). Conclusion Canalith repositioning maneuvers (CRMs) should be the main treatment modality in the management of BPPV patients and adding on betahistine treatment to CRMs have no impact in the relieving of dizziness and anxiety symptoms.
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Affiliation(s)
- Z B Erdur
- Department of Otolaryngology Head and Neck Surgery, Kirklareli Training and Research Hospital, Kirklareli, Türkiye
| | - N Evran
- Department of Audiology, Kirklareli Training and Research Hospital, Kirklareli, Türkiye
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Kalmanson OA, Aasen DM, Gubbels SP, Foster CA. Reversible Canalith Jam of the Horizontal Semicircular Canal Mimicking Cupulolithiasis. Ann Otol Rhinol Laryngol 2021; 130:1213-1219. [PMID: 33813907 DOI: 10.1177/00034894211007245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe a case of benign paroxysmal positional vertigo (BPPV) resulting in reversible horizontal semicircular canalith jam successfully treated with horizontal canal occlusion. A brief literature review of similar cases was performed. METHODS Case report and literature review. RESULTS A 68-year-old female presented with apogeotropic positional nystagmus, attributed to reversible horizontal canalith jam mimicking cupulolithiasis that was refractory to tailored repositioning maneuvers across months. She was unable to work due to the severity of her symptoms. She underwent surgical occlusion of the affected canal with immediate resolution of her symptoms. A literature review revealed similar cases of canalith jam mimicking cupulolithiasis. CONCLUSIONS Reversible canalith jam, in which particles moving with horizontal head position alternate between obstructing the semicircular canal and resting on the cupula, can mimic signs of cupulolithiasis. This variant of BPPV can be effectively managed with surgical canal occlusion should symptoms fail to resolve after tailored repositioning maneuvers.
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Affiliation(s)
- Olivia A Kalmanson
- Department of Otolaryngology, The University of Colorado School of Medicine, Aurora, CO, USA
| | - Davis M Aasen
- Department of Otolaryngology, The University of Colorado School of Medicine, Aurora, CO, USA
| | - Samuel P Gubbels
- Department of Otolaryngology, The University of Colorado School of Medicine, Aurora, CO, USA
| | - Carol A Foster
- Department of Otolaryngology, The University of Colorado School of Medicine, Aurora, CO, USA
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Gulen M, Satar S, Acehan S, Avci A, Kaya A, Sener K, Isikber C. Benign paroxysmal positional vertigo in emergency department: How to treat? HONG KONG J EMERG ME 2020. [DOI: 10.1177/1024907920972283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: The treatment of benign paroxysmal positional vertigo (BPPV) has not been well studied. Many clinicians are indifferent about canalith reposition maneuvers and frequently prefer medical treatments. Objectives: We aimed to detect efficacy of Epley maneuver in relieving symptoms of benign paroxysmal positional vertigo patients diagnosed in emergency department and if medical treatments are useful in patients whose symptoms were not relieved. Methods: The study was conducted as a prospective cohort study in the emergency department of a tertiary hospital. Patients who were over 18 years of age and presented to emergency department with complaints of vertigo symptoms and nausea and had a positive Dix–Hallpike test were included in the study. Patients’ demographic data, possible etiological factors, affected ear, and benign paroxysmal positional vertigo diagnosis in the history were recorded on the study data form. The European Evaluation of Vertigo scale and the Visual Analogue Scale (VAS) score of nausea and vertigo symptoms were graded and recorded for each patient before and after treatment. Results: Ninety patients were included in the study in total. Epley maneuver was carried out to all patients. Vertigo symptoms VAS (VASd) score (p < 0.001), nausea and vomiting VAS (VASnv) score (p < 0.001), and European Evaluation of Vertigo scale score (p < 0.001) of all patients showed a statistically significant decrease after Epley maneuver. A combination of dimenhydrinate and metoclopramide helped to reduce VASd (p = 0.048), VASnv (p = 0.031), and European Evaluation of Vertigo scale scores (p = 0.001) at a statistically significant level more than dimenhydrinate treatment alone. Conclusions: Epley maneuver may be applied to every patient with benign paroxysmal positional vertigo. Dimenhydrinate and/or metoclopramide helps to control patients’ symptoms whose symptoms remain despite Epley maneuver.
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Affiliation(s)
- Muge Gulen
- Department of Emergency Medicine, Adana City Training and Research Hospital, Adana, Turkey
| | - Salim Satar
- Department of Emergency Medicine, Adana City Training and Research Hospital, Adana, Turkey
| | - Selen Acehan
- Department of Emergency Medicine, Adana City Training and Research Hospital, Adana, Turkey
| | - Akkan Avci
- Department of Emergency Medicine, Adana City Training and Research Hospital, Adana, Turkey
| | - Adem Kaya
- Department of Emergency Medicine, Adana City Training and Research Hospital, Adana, Turkey
| | - Kemal Sener
- Department of Emergency Medicine, Istanbul Basaksehir City Hospital, Istanbul, Turkey
| | - Cem Isikber
- Department of Emergency Medicine, Adana City Training and Research Hospital, Adana, Turkey
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Sayin I, Koç RH, Temirbekov D, Gunes S, Cirak M, Yazici ZM. Betahistine add-on therapy for treatment of subjects with posterior benign paroxysmal positional vertigo: a randomized controlled trial. Braz J Otorhinolaryngol 2020; 88:421-426. [PMID: 32978116 PMCID: PMC9422698 DOI: 10.1016/j.bjorl.2020.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/22/2020] [Accepted: 07/23/2020] [Indexed: 11/30/2022] Open
Abstract
Introduction Benign paroxysmal positional vertigo is a common vestibular disorder that accounts for one fifth of hospital admissions due to vertigo, although it is commonly undiagnosed. Objective To evaluate the effects of betahistine add-on therapy in the treatment of subjects with posterior benign paroxysmal positional vertigo. Methods This randomized controlled study was conducted in a population of 100 subjects with posterior benign paroxysmal positional vertigo. Subjects were divided into the Epley maneuver + betahistine group (group A) and Epley maneuver only (group B) group. Subjects were evaluated before and 1-week after the maneuver using a visual analog scale and dizziness handicap inventory Results One hundred subjects completed the study protocol. The Epley maneuver had an overall success rate of 95% (96% in group A; 94% in group B, p = 0.024). Groups A and B had similar baseline visual analog scale scores (6.98 ± 2.133 and 6.27 ± 2.148, respectively, p = 0.100). After treatment, the visual analog scale score was significantly lower in both groups, and was significantly lower in group A than group B (0.74 ± 0.853 vs. 1.92 ± 1.288, respectively, p = 0.000). The change in visual analog scale score after treatment compared to baseline was also significantly greater in group A than group B (6.24 ± 2.01 vs. 4.34 ± 2.32, respectively, p = 0.000). The baseline dizziness handicap inventory values were also similar in groups A and B (55.60 ± 22.732 vs. 45.59 ± 17.049, respectively, p = 0.028). After treatment, they were significantly lower in both groups. The change in score after treatment compared to baseline was also significantly greater in group A than group B (52.44 ± 21.42 vs. 35.71 ± 13.51, respectively, p = 0.000). Conclusion The Epley maneuver is effective for treatment of benign paroxysmal positional vertigo. Betahistine add-on treatment in posterior benign paroxysmal positional vertigo resulted in improvements in both visual analog scale score and dizziness handicap inventory.
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Carnevale C, Arancibia-Tagle DJ, Rizzo-Riera E, Til-Perez G, Sarría-Echegaray PL, Rama-Lopez JJ, Quer-Canut S, Fermin-Gamero G, Tomas-Barberan MD. Efficacy of Particle Repositioning Manoeuvres in Benign Positional Paroxysmal Vertigo: A Revision of 176 Cases Treated in a Tertiary Care Centre. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2018. [DOI: 10.1016/j.otoeng.2017.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Carnevale C, Arancibia-Tagle DJ, Rizzo-Riera E, Til-Perez G, Sarría-Echegaray PL, Rama-Lopez JJ, Quer-Canut S, Fermin-Gamero G, Tomas-Barberan MD. Eficacia de las maniobras de reposicionamiento canalicular en el vértigo posicional paroxístico benigno: revisión de 176 casos tratados en un centro hospitalario de tercer nivel. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2018; 69:201-207. [DOI: 10.1016/j.otorri.2017.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 06/20/2017] [Accepted: 06/23/2017] [Indexed: 10/18/2022]
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Bhattacharyya N, Gubbels SP, Schwartz SR, Edlow JA, El-Kashlan H, Fife T, Holmberg JM, Mahoney K, Hollingsworth DB, Roberts R, Seidman MD, Steiner RWP, Do BT, Voelker CCJ, Waguespack RW, Corrigan MD. Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update). Otolaryngol Head Neck Surg 2017; 156:S1-S47. [DOI: 10.1177/0194599816689667] [Citation(s) in RCA: 363] [Impact Index Per Article: 51.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Objective This update of a 2008 guideline from the American Academy of Otolaryngology—Head and Neck Surgery Foundation provides evidence-based recommendations to benign paroxysmal positional vertigo (BPPV), defined as a disorder of the inner ear characterized by repeated episodes of positional vertigo. Changes from the prior guideline include a consumer advocate added to the update group; new evidence from 2 clinical practice guidelines, 20 systematic reviews, and 27 randomized controlled trials; enhanced emphasis on patient education and shared decision making; a new algorithm to clarify action statement relationships; and new and expanded recommendations for the diagnosis and management of BPPV. Purpose The primary purposes of this guideline are to improve the quality of care and outcomes for BPPV by improving the accurate and efficient diagnosis of BPPV, reducing the inappropriate use of vestibular suppressant medications, decreasing the inappropriate use of ancillary testing such as radiographic imaging, and increasing the use of appropriate therapeutic repositioning maneuvers. The guideline is intended for all clinicians who are likely to diagnose and manage patients with BPPV, and it applies to any setting in which BPPV would be identified, monitored, or managed. The target patient for the guideline is aged ≥18 years with a suspected or potential diagnosis of BPPV. The primary outcome considered in this guideline is the resolution of the symptoms associated with BPPV. Secondary outcomes considered include an increased rate of accurate diagnoses of BPPV, a more efficient return to regular activities and work, decreased use of inappropriate medications and unnecessary diagnostic tests, reduction in recurrence of BPPV, and reduction in adverse events associated with undiagnosed or untreated BPPV. Other outcomes considered include minimizing costs in the diagnosis and treatment of BPPV, minimizing potentially unnecessary return physician visits, and maximizing the health-related quality of life of individuals afflicted with BPPV. Action Statements The update group made strong recommendations that clinicians should (1) diagnose posterior semicircular canal BPPV when vertigo associated with torsional, upbeating nystagmus is provoked by the Dix-Hallpike maneuver, performed by bringing the patient from an upright to supine position with the head turned 45° to one side and neck extended 20° with the affected ear down, and (2) treat, or refer to a clinician who can treat, patients with posterior canal BPPV with a canalith repositioning procedure. The update group made a strong recommendation against postprocedural postural restrictions after canalith repositioning procedure for posterior canal BPPV. The update group made recommendations that the clinician should (1) perform, or refer to a clinician who can perform, a supine roll test to assess for lateral semicircular canal BPPV if the patient has a history compatible with BPPV and the Dix-Hallpike test exhibits horizontal or no nystagmus; (2) differentiate, or refer to a clinician who can differentiate, BPPV from other causes of imbalance, dizziness, and vertigo; (3) assess patients with BPPV for factors that modify management, including impaired mobility or balance, central nervous system disorders, a lack of home support, and/or increased risk for falling; (4) reassess patients within 1 month after an initial period of observation or treatment to document resolution or persistence of symptoms; (5) evaluate, or refer to a clinician who can evaluate, patients with persistent symptoms for unresolved BPPV and/or underlying peripheral vestibular or central nervous system disorders; and (6) educate patients regarding the impact of BPPV on their safety, the potential for disease recurrence, and the importance of follow-up. The update group made recommendations against (1) radiographic imaging for a patient who meets diagnostic criteria for BPPV in the absence of additional signs and/or symptoms inconsistent with BPPV that warrant imaging, (2) vestibular testing for a patient who meets diagnostic criteria for BPPV in the absence of additional vestibular signs and/or symptoms inconsistent with BPPV that warrant testing, and (3) routinely treating BPPV with vestibular suppressant medications such as antihistamines and/or benzodiazepines. The guideline update group provided the options that clinicians may offer (1) observation with follow-up as initial management for patients with BPPV and (2) vestibular rehabilitation, either self-administered or with a clinician, in the treatment of BPPV.
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Affiliation(s)
- Neil Bhattacharyya
- Department of Otolaryngology, Harvard Medical School, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Samuel P. Gubbels
- Department of Otolaryngology, School of Medicine and Public Health, University of Colorado, Aurora, Colorado, USA
| | - Seth R. Schwartz
- Department of Otolaryngology, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Jonathan A. Edlow
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Hussam El-Kashlan
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Terry Fife
- Barrow Neurological Institute and College of Medicine, University of Arizona, Phoenix, Arizona, USA
| | | | | | | | - Richard Roberts
- Alabama Hearing and Balance Associates, Inc, Birmingham, Alabama, USA
| | - Michael D. Seidman
- Department of Otolaryngology–Head and Neck Surgery, College of Medicine, University of Central Florida, Orlando, Florida, USA
| | - Robert W. Prasaad Steiner
- Department of Health Management and Systems Science and Department of Family and Geriatric Medicine, School of Public Health and Information Science, University of Louisville, Louisville, Kentucky, USA
| | - Betty Tsai Do
- Department of Otorhinolaryngology, Health Sciences Center, University of Oklahoma, Oklahoma City, Oklahoma, USA
| | - Courtney C. J. Voelker
- Department of Otolaryngology–Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Richard W. Waguespack
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Maureen D. Corrigan
- American Academy of Otolaryngology–Head and Neck Surgery Foundation, Alexandria, Virginia, USA
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Efficacy of Epley's Maneuver in Treating BPPV Patients: A Prospective Observational Study. Int J Otolaryngol 2015; 2015:487160. [PMID: 26495002 PMCID: PMC4606415 DOI: 10.1155/2015/487160] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 09/15/2015] [Indexed: 11/18/2022] Open
Abstract
Vertigo and balance disorders are among the most common symptoms encountered in patients who visit ENT outpatient department. This is associated with risk of falling and is compounded in elderly persons with other neurologic deficits and chronic medical problems. BPPV is the most common cause of peripheral vertigo. BPPV is a common vestibular disorder leading to significant morbidity, psychosocial impact, and medical costs. The objective of Epley's maneuver, which is noninvasive, inexpensive, and easily administered, is to move the canaliths out of the canal to the utricle where they no longer affect the canal dynamics. Our study aims to analyze the response to Epley's maneuver in a series of patients with posterior canal BPPV and compares the results with those treated exclusively by medical management alone. Even though many studies have been conducted to prove the efficacy of this maneuver, this study reinforces the validity of Epley's maneuver by comparison with the medical management.
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Ballve Moreno JL, Carrillo Muñoz R, Villar Balboa I, Rando Matos Y, Arias Agudelo OL, Vasudeva A, Bigas Aguilera O, Almeda Ortega J, Capella Guillén A, Buitrago Olaya CJ, Monteverde Curto X, Rodero Perez E, Rubio Ripollès C, Sepulveda Palacios PC, Moreno Farres N, Hernández Sánchez AM, Martin Cantera C, Azagra Ledesma R. Effectiveness of the Epley's maneuver performed in primary care to treat posterior canal benign paroxysmal positional vertigo: study protocol for a randomized controlled trial. Trials 2014; 15:179. [PMID: 24886338 PMCID: PMC4043960 DOI: 10.1186/1745-6215-15-179] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 05/13/2014] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Vertigo is a common medical condition with a broad spectrum of diagnoses which requires an integrated approach to patients through a structured clinical interview and physical examination. The main cause of vertigo in primary care is benign paroxysmal positional vertigo (BPPV), which should be confirmed by a positive D-H positional test and treated with repositioning maneuvers. The objective of this study is to evaluate the effectiveness of Epley's maneuver performed by general practitioners (GPs) in the treatment of BPPV. METHODS/DESIGN This study is a randomized clinical trial conducted in the primary care setting. The study's scope will include two urban primary care centers which provide care for approximately 49,400 patients. All patients attending these two primary care centers, who are newly diagnosed with benign paroxysmal positional vertigo, will be invited to participate in the study and will be randomly assigned either to the treatment group (Epley's maneuver) or to the control group (a sham maneuver). Both groups will receive betahistine. Outcome variables will be: response to the D-H test, patients' report on presence or absence of vertigo during the previous week (dichotomous variable: yes/no), intensity of vertigo symptoms on a Likert-type scale in the previous week, total score on the Dizziness Handicap Inventory (DHI) and quantity of betahistine taken. DISCUSSION Positive results from our study will highlight that treatment of benign paroxysmal positional vertigo can be performed by trained general practitioners (GPs) and, therefore, its widespread practice may contribute to improve the quality of life of BPPV patients. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01969513.
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Affiliation(s)
- José Luis Ballve Moreno
- Centre d’Atenció Primària (CAP) Florida Nord, Institut Català de la Salut, Hospitalet de Llobregat, de Llobregat, Spain
| | - Ricard Carrillo Muñoz
- Centre d’Atenció Primària (CAP) Florida Sud, Institut Català de la Salut, Hospitalet de Llobregat, de Llobregat, Spain
| | - Iván Villar Balboa
- Centre d’Atenció Primària (CAP) Florida Sud, Institut Català de la Salut, Hospitalet de Llobregat, de Llobregat, Spain
| | - Yolanda Rando Matos
- Centre d’Atenció Primària (CAP) Florida Nord, Institut Català de la Salut, Hospitalet de Llobregat, de Llobregat, Spain
| | - Olga Lucia Arias Agudelo
- Centre d’Atenció Primària (CAP) Florida Nord, Institut Català de la Salut, Hospitalet de Llobregat, de Llobregat, Spain
| | - Asha Vasudeva
- Centre d’Atenció Primària (CAP) Florida Nord, Institut Català de la Salut, Hospitalet de Llobregat, de Llobregat, Spain
| | - Olga Bigas Aguilera
- Centre d’Atenció Primària (CAP) Florida Sud, Institut Català de la Salut, Hospitalet de Llobregat, de Llobregat, Spain
| | - Jesús Almeda Ortega
- Técnico de Salud de Soporte a la Investigación. Unitat de Suport a la Recerca. Direcció d’Atenció Primaria de Costa de Ponent. Gerencia Territorial Metropolitana Sud, Institut Català de la Salut (ICS), Barcelona, Spain
| | - Alicia Capella Guillén
- Centre d’Atenció Primària (CAP) Florida Nord, Institut Català de la Salut, Hospitalet de Llobregat, de Llobregat, Spain
| | - Clara Johanna Buitrago Olaya
- Centre d’Atenció Primària (CAP) Florida Nord, Institut Català de la Salut, Hospitalet de Llobregat, de Llobregat, Spain
| | - Xavier Monteverde Curto
- Centre d’Atenció Primària (CAP) Florida Nord, Institut Català de la Salut, Hospitalet de Llobregat, de Llobregat, Spain
| | - Estrella Rodero Perez
- Centre d’Atenció Primària (CAP) Florida Nord, Institut Català de la Salut, Hospitalet de Llobregat, de Llobregat, Spain
| | - Carles Rubio Ripollès
- Centre d’Atenció Primària (CAP) Florida Nord, Institut Català de la Salut, Hospitalet de Llobregat, de Llobregat, Spain
| | | | - Noemí Moreno Farres
- Centre d’Atenció Primària (CAP) Florida Nord, Institut Català de la Salut, Hospitalet de Llobregat, de Llobregat, Spain
| | | | - Carlos Martin Cantera
- Departament de Medicina, Equip d’Atenció Primària Barcelona, Universitat Autònoma de Barcelona, Passeig Sant Joan, Barcelona, Spain
| | - Rafael Azagra Ledesma
- Equip d’Atenció Primària Badia del Valles. Servei d’Atenció Primària Vallés Occidental. USR IDIAP Jordi Gol. Direcció d’Atenció Primària Metropolitana Nord, Institut Català de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain
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Abstract
The article focuses on the evidence basis for the management of benign paroxysmal positional vertigo, the most common diagnosis of vertigo in both primary care and subspecialty settings. An overview is presented, along with evidence-based clinical assessment, diagnosis, and management. Summaries of differential diagnosis of vertigo and outcomes are presented.
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Affiliation(s)
- Anh T Nguyen-Huynh
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, 3181 Sam Jackson Park Road PV01, Portland, OR 97239, USA.
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