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Kwok BYC, Young AS, Kong JHK, Birman CS, Flanagan S, Greenberg SL, Gibson WP, Argaet EC, Fratturo L, Pogson JM, Taylor RL, Rosengren SM, Halmagyi GM, Welgampola MS. Post Cochlear Implantation Vertigo: Ictal Nystagmus and Audiovestibular Test Characteristics. Otol Neurotol 2024; 45:65-74. [PMID: 37853785 DOI: 10.1097/mao.0000000000004037] [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: 10/20/2023]
Abstract
OBJECTIVE To investigate ictal nystagmus and audiovestibular characteristics in episodic spontaneous vertigo after cochlear implantation (CI). STUDY DESIGN Retrospective and prospective case series. PATIENTS Twenty-one CI patients with episodic spontaneous vertigo after implantation were recruited. INTERVENTIONS Patient-initiated home video-oculography recordings were performed during one or more attacks of vertigo, using miniature portable home video-glasses. To assess canal and otolith function, video head-impulse tests (vHITs) and vestibular-evoked myogenic potential tests were conducted. MAIN OUTCOME MEASURES Nystagmus slow-phase velocities (SPVs), the presence of horizontal direction-changing nystagmus, and post-CI audiovestibular tests. RESULTS Main final diagnoses were post-CI secondary endolymphatic hydrops (48%) and exacerbation of existing Ménière's disease (29%). Symptomatic patients demonstrated high-velocity horizontal ictal-nystagmus (SPV, 44.2°/s and 68.2°/s in post-CI secondary endolymphatic hydrop and Ménière's disease). Direction-changing nystagmus was observed in 80 and 75%. Two were diagnosed with presumed autoimmune inner ear disease (SPV, 6.6°/s and 172.9°/s). One patient was diagnosed with probable vestibular migraine (15.1°/s).VHIT gains were 0.80 ± 0.20 (lateral), 0.70 ± 0.17 (anterior), and 0.62 ± 0.27 (posterior) in the implanted ear, with abnormal values in 33, 35, and 35% of each canal. Bone-conducted cervical and ocular vestibular-evoked myogenic potentials were asymmetric in 52 and 29% of patients (all lateralized to the implanted ear) with mean asymmetry ratios of 51.2 and 35.7%. Reversible reduction in vHIT gain was recorded in three acutely symptomatic patients. CONCLUSION High-velocity, direction-changing nystagmus time-locked with vertigo attacks may be observed in post-CI implant vertigo and may indicate endolymphatic hydrops. Fluctuating vHIT gain may be an additional marker of a recurrent peripheral vestibulopathy.
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Affiliation(s)
| | | | | | | | - Sean Flanagan
- Department of Otolaryngology, Head and Neck, and Skull Base Surgery, St Vincent's Public Hospital, Sydney
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Hougaard DD, Duch K, Bech MW. Treatment of posterior Benign Paroxysmal Positional Vertigo is efficient and safe with a new Mechanical Rotational Chair. Front Neurol 2023; 14:1239959. [PMID: 37662040 PMCID: PMC10469607 DOI: 10.3389/fneur.2023.1239959] [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: 06/14/2023] [Accepted: 08/07/2023] [Indexed: 09/05/2023] Open
Abstract
Background Benign paroxysmal positional vertigo (BPPV) is the most predominant vestibular disease. Previously, in the management of BPPV, both therapeutic and diagnostic benefits with mechanical rotation chairs (MRCs) have been reported. However, no previous studies have examined the efficacy of MRC treatment with a fairly new MRC. Methods Randomized three-armed parallel open-labeled prospective clinical trial. One hundred and five patients diagnosed with posterior BPPV underwent diagnostics and treatment with an MRC. Patients were randomized to either a Semont maneuver, an Epley maneuver or a 360-degree backwards somersault maneuver. Primary endpoint was to evaluate the efficiency of an MRC in the treatment of posterior BPPV with three separate treatment modalities. Secondary objectives included subjective vertigo assessments. Results BPPV treatment with this MRC is very efficient with success rates up to 97.1 percent. The number of treatments required to achieve complete resolution of both objective findings and subjective symptoms was 1.5. Almost 47 percent of patients experienced complete resolution of both subjective and objective measures following one (first) treatment. All Dizziness Handicap Inventory scores decreased significantly post-treatment. Conclusion Treatment of posterior BPPV, with the MRC used in this study, was very efficient with both the Semont, the Epley, and the 360-degree backwards somersault maneuver. Based on the findings in this study, this fairly new MRC seems both effective and safe to use.
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Affiliation(s)
- Dan Dupont Hougaard
- Balance & Dizziness Centre, Department of Otolaryngology, Head & Neck Surgery and Audiology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Kirsten Duch
- Unit of Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | - Mathias Winther Bech
- Balance & Dizziness Centre, Department of Otolaryngology, Head & Neck Surgery and Audiology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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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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Kjærsgaard JB, Petersen NK, Hougaard DD. Adding Kinetic Energy Does Not Further Improve Treatment Outcomes With a Mechanical Reposition Chair: A Randomized Controlled Trial. Otol Neurotol 2023; 44:e33-e41. [PMID: 36509443 DOI: 10.1097/mao.0000000000003757] [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: 12/15/2022]
Abstract
OBJECTIVE To test if the addition of abrupt deaccelerations (kinetic energy) during treatment with a mechanical repositional chair (MRC) provides improved treatment efficacy with treatment of posterior benign paroxysmal positional vertigo (BPPV). STUDY DESIGN Randomized two-armed parallel open-labeled clinical trial. SETTING Tertiary referral center. PATIENTS Seventy patients diagnosed with posterior canalolithiasis BPPV were included. INTERVENTIONS All patients underwent diagnostics and treatment with an MRC. Patients were randomized to either a traditional Epley maneuver or a potentiated version of the Epley maneuver where kinetic energy was applied in five positions with 45-degree turns between each step. MAIN OUTCOME MEASURES Primary endpoint was the number of treatments needed before complete resolution of both subjective symptoms and objective signs of BPPV within the semicircular canal of interest. Secondary endpoints included the following: 1) number of patients requiring more than 10 treatments, 2) length of treatment in days before treatment(s) were successful, and 3) changes in total Dizziness Handicap Inventory scores before and after treatment. RESULTS No significant difference in the number of required treatments between the two treatment arms was found. Approximately three of four subjects were cured after two repositional maneuvers regardless of type of treatment. An equal length of treatment was seen with both groups, and the Dizziness Handicap Inventory scores were significantly lowered after treatment with no significant differences between the two types of treatment. CONCLUSIONS Both the traditional and the potentiated Epley maneuver are efficient in treatment of canalolithiasis of the posterior semicircular canals with MRC. Addition of kinetic energy with this subgroup of BPPV patients does not seem to add further efficacy to the treatment.
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Affiliation(s)
| | - Niels Krintel Petersen
- Balance & Dizziness Centre, Department of Otolaryngology, Head & Neck Surgery and Audiology, Aalborg University Hospital
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Hougaard DD, Valsted SH, Bruun NH, Bech MW, Talebnasab MH. Seven years of experience with treatment of benign paroxysmal positional vertigo with a mechanical rotational chair. Front Neurol 2022; 13:981216. [PMID: 36090886 PMCID: PMC9453247 DOI: 10.3389/fneur.2022.981216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/05/2022] [Indexed: 11/16/2022] Open
Abstract
Background Throughout the last decade, several mechanical rotational chairs have been developed for diagnostics and treatment of patients with a typical case history of benign paroxysmal positional vertigo. Sparse evidence, however, exists in terms of diagnostic accuracy and treatment efficiency with these mechanical rotational chairs. Also, recommendations for optimal use of these chairs are yet to be determined. Objective Primary objective was to evaluate overall treatment of benign paroxysmal positional vertigo with a mechanical rotational chair and secondary objectives included description of patient- and BPPV characteristics, determination of subjective and objective outcomes, as well as analyzation of recurrence- and recurrence-related risk factors following successful treatment. Methods Retrospective cohort study with 635 patients diagnosed with benign paroxysmal positional vertigo and treated by means of a mechanical rotational chair during a 7-year period from 2014 to 2021 at a tertiary University hospital. Patient- and disease-specific characteristics, treatment and recurrence data were collected through reviewing of patient records. Results The mean number of required treatments was 2.7 when accounting for a six percent treatment failure rate (defined as a need of more than 10 treatments), and 3.7 when not. Bilateral mono-canal affection required 3.8 treatments, unilateral multi-canal 3.5 treatments, and the combination of bilateral and multi-canal affection 5.2 treatments. All these scenarios were associated with significantly higher numbers of required treatments when compared to unilateral mono-canal affection, which required 1.9 treatments. The overall recurrence rate was 25.4 percent. Conclusion A mechanical rotational chair provides successful treatment of benign paroxysmal positional vertigo. Mechanical rotational chairs should primarily be reserved for the treatment of retractable and atypical benign paroxysmal positional vertigo patients. Many aspects of the optimal use of these chairs still require elaborative assessment.
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Affiliation(s)
- Dan Dupont Hougaard
- Balance and Dizziness Center, Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- *Correspondence: Dan Dupont Hougaard
| | - Sebastian Hygum Valsted
- Balance and Dizziness Center, Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Niels Henrik Bruun
- Unit of Clinical Biostatistics and Bioinformatics, Aalborg University Hospital, Aalborg, Denmark
| | - Mathias Winther Bech
- Balance and Dizziness Center, Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Michel Heide Talebnasab
- Balance and Dizziness Center, Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Aalborg University Hospital, Aalborg, Denmark
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Iglebekk W, Tjell C. High score of dizziness-handicap-inventory (DHI) in patients with chronic musculoskeletal pain makes a chronic vestibular disorder probable. Scand J Pain 2022; 22:561-568. [PMID: 35119799 DOI: 10.1515/sjpain-2021-0102] [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: 06/16/2021] [Accepted: 01/25/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES In patients with a vestibular disorder a high score of dizziness-handicap-inventory (DHI) is common. Patients with chronic lithiasis of multiple canals benign paroxysmal positional vertigo (mc-BPPV) can have incapacitating symptoms, e.g. headache, neck pain, musculoskeletal pain, and cognitive dysfunction. Patients with chronic musculoskeletal pain with few objective findings at an ordinary examination of the musculoskeletal system together with unsuccessful interventions can either receive a diagnosis of a biopsychosocial disorder or a diagnosis connected to the dominant symptom. The aim of this investigation is to examine if the DHI- and the DHI subscale scores are abnormal in 49 patients with chronic musculoskeletal pain disorders. In addition, explore the possibility of a chronic mc-BPPV diagnosis. METHODS Consecutive prospective observational cohort study at five different physiotherapy clinics. A personal interview using a structured symptom questionnaire consisting of 15 items. Modified Dizziness Handicap Inventory (DHI) including the Physical-, Catastrophic- and Emotional impact DHI subscale scores suggested by the Mayo Clinic was applied. RESULTS Eighty-four percent of the 49 patients have a pathological DHI-score and a potential underlying undiagnosed vestibular disorder. Very few patients have scores at the catastrophic subscale. A correlation is found between the number of symptoms of the structured scheme and the DHI-score. Results from all five physiotherapy clinics were similar. CONCLUSIONS Patients with a high number of symptoms and a high DHI-score can have a potential underlying treatable balance disorder like mc-BPPV. Increased awareness and treatment of mc-BPPV may reduce suffering and continuous medication in patients with chronic musculoskeletal pain. Regional Ethical Committee (No IRB 00001870).
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Affiliation(s)
| | - Carsten Tjell
- Specialist in Otorhinolaryngology, Head- and Neck Surgery, Vatnestrom, Norway
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Swain S, Vivek SA. Benign paroxysmal positional vertigo in pregnancy: Our experiences at a tertiary care teaching hospital of Eastern India. MUSTANSIRIYA MEDICAL JOURNAL 2022. [DOI: 10.4103/mj.mj_16_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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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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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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Patel DM, Gurumukhani JK, Patel MV, Patel MM, Patel C, Patel HD, Patel MV. Short Term Efficacy of Modified Epley’s Maneuvre Assisted by Visual Aid Dynamic Device Versus Unassisted Maneuvre for the Treatment of Posterior Canal BPPV. CURRENT DRUG THERAPY 2020. [DOI: 10.2174/1574885515999200706013308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Introduction:
Modified Epley’s maneuver is the recommended treatment for the Posterior
Canal (PC) BPPV. To enhance the efficacy of this maneuver, an easy to perform visual aid
device (DizzyFIX) guided modified Epley’s maneuver was studied.
Material and Methods:
This prospective, double-blind, randomized study included consecutive
patients with PC-BPPV based on clinical history, neuro-otological examination, and positive Dix-
Hallpike (DHP) test from January 2018 to March 2019 at a neurology clinic of western India. Patients
were randomly assigned treatment with either visual aid device assisted modified Epley’s
maneuver, which constituted the case group or by a placebo device guided modified Epley’s maneuver,
which constituted the control group. DizzyFIX was used as a visual aid device in the case
group. Patients were followed up at one hour and 24 hours with DHP by the blinded examiners to
observe for remission.
Results:
Out of 280 patients (140 patients in each group), 6 from the case, and 2 from the controls
were lost from the follow-up. Overall, 134 cases were compared to 138 controls. The success rate of
remission in the case and the control group at one-hour was 79.19% vs. 48.30%, respectively, with
a p-value of 0.003. Similarly, the success rate in the case and control group at 24 hours was 95.27%
vs. 80.62%, respectively, with a p-value of 0.011. At 1 hour, unadjusted Odd Ratio (OR) was 4.13,
(C.I. 95% 2.02- 8.46) and at 24 hours, it was 4.37, (C.I. 95% 1.39-13.77), which was significant
even after adjustment of co-variables (OR 4.02, C.I. 95% 2.34- 8.26) and (OR 4.11, C.I. 95% 2.30-
14.26), respectively.
Conclusion:
For short term treatment of PC-BPPV, DizzyFIX assisted modified Epley’s maneuver
is more efficacious than unassisted modified Epley’s maneuver.
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Affiliation(s)
- Dhruvkumar M. Patel
- Zydus Medical College and Hospital, Dahod, India, DM, Jay Neurocare and Physiotherapy Clinic, Bhavnagar, India
| | - Jayanti K. Gurumukhani
- Zydus Medical College and Hospital, Dahod, India, DM, Jay Neurocare and Physiotherapy Clinic, Bhavnagar, India
| | - Mukundkumar V. Patel
- Zydus Medical College and Hospital, Dahod, India, DM, Jay Neurocare and Physiotherapy Clinic, Bhavnagar, India
| | | | - Chilvana Patel
- University of Texas Medical Branch, Galveston, TX, United States
| | | | - Maurvi V. Patel
- Intern Doctor, B. J. Medical College, Ahmedabad, India; Jay Neurocare and Physiotherapy Clinic, Bhavnagar, India
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Martens C, Goplen FK, Aasen T, Gjestad R, Nordfalk KF, Nordahl SHG. Treatment of horizontal canal BPPV-a randomized sham-controlled trial comparing two therapeutic maneuvers of different speeds. Laryngoscope Investig Otolaryngol 2020; 5:750-757. [PMID: 32864448 PMCID: PMC7444789 DOI: 10.1002/lio2.420] [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: 03/31/2020] [Revised: 05/15/2020] [Accepted: 06/02/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To compare the effect of a high-speed barbecue maneuver with the modified Lempert maneuver and sham in patients with benign paroxysmal positional vertigo (BPPV) of the horizontal canal. METHODS Randomized sham-controlled, single blinded multicenter clinical trial in two university hospitals investigating consecutive patients with horizontal canal BPPV.Patients were randomly assigned to high-speed barbecue (HSB), modified Lempert maneuver (ML), or sham maneuver (SM). All treatments were performed in a biaxial rotational chair with weekly follow-up to a maximum of three treatment sessions. The final follow-up was 3 months after the last treatment. RESULTS Primary outcome: 2-week recovery rate per protocol. Secondary outcome: Cumulative recovery rate and Dizziness Handicap Inventory (DHI) scores after 3 months per protocol (HSB and ML) and intention to treat (all groups).Fifty-four patients were analyzed after 2 weeks (HSB = 17; ML = 20; SM = 17). Two-week recovery rate was 14/17 after HSB, 11/20 after ML, and 4/17 after SM, with significantly better recovery in HSB [OR 15.17, 95% CI (1.85, 124.63), P = .001] using sham as base level. Recovery rate after 3 months was 15/17 after HSB and 15/19 after ML. Cumulative recovery rate showed no significant differences between the two treatment groups [95% CI (0.30, 13.14), P = .46] in cure rate DHI [95% CI (-16.56, 15.02), P = .92]. No unexpected adverse events were observed. CONCLUSION Velocity change in horizontal canal BPPV treatment gives a faster initial recovery. Rapid recovery could reduce the disease burden. TRIAL REGISTRATION Clinicaltrials.gov. Identifier: NCT01905800. LEVEL OF EVIDENCE 1b.
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Affiliation(s)
- Camilla Martens
- Norwegian National Advisory Unit on Vestibular Disorders, Department of Otorhinolaryngology & Head Neck SurgeryHaukeland University HospitalBergenNorway
- Department of Clinical MedicineUniversity of BergenBergenNorway
| | - Frederik Kragerud Goplen
- Norwegian National Advisory Unit on Vestibular Disorders, Department of Otorhinolaryngology & Head Neck SurgeryHaukeland University HospitalBergenNorway
- Department of Clinical MedicineUniversity of BergenBergenNorway
| | - Torbjørn Aasen
- Norwegian National Advisory Unit on Vestibular Disorders, Department of Otorhinolaryngology & Head Neck SurgeryHaukeland University HospitalBergenNorway
| | - Rolf Gjestad
- Research DepartmentDivision of PsychiatryBergenNorway
| | - Karl Fredrik Nordfalk
- Department of Otorhinolaryngology & Head and Neck SurgeryOslo University HospitalOsloNorway
| | - Stein Helge Glad Nordahl
- Norwegian National Advisory Unit on Vestibular Disorders, Department of Otorhinolaryngology & Head Neck SurgeryHaukeland University HospitalBergenNorway
- Department of Clinical MedicineUniversity of BergenBergenNorway
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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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Lou Y, Cai M, Xu L, Wang Y, Zhuang L, Liu X. Efficacy of BPPV diagnosis and treatment system for benign paroxysmal positional vertigo. Am J Otolaryngol 2020; 41:102412. [PMID: 32057490 DOI: 10.1016/j.amjoto.2020.102412] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/28/2020] [Accepted: 02/02/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To evaluate the efficacy of automatic benign paroxysmal positional vertigo (BPPV) diagnosis and treatment system for BPPV compared with the manual repositioning group. METHODS Two hundred thirty patients diagnosed as idiopathic BPPV who were admitted from August 2018 to July 2019 in Zhejiang Hospital were included. Among them, 150 patients of posterior semicircular canal BPPV(pc-BPPV), 53 patients of horizontal semicircular canal BPPV(hc-BPPV), and 27 patients of horizontal semicircular canal calculus (hc-BPPV-cu) were randomly treated with BPPV diagnosis and treatment system(the experimental group) or manual repositioning (the control group). Resolution of vertigo and nystagmus on the Dix-Hallpike and Roll test on day 3,day 7,day 14 and day 28 follow-up after first treatment was the main outcome measure to assess the efficacy of treatment. RESULTS At 3-day and 7-day follow-up after treatment with BPPV diagnosis and treatment system, 79%, 91%had complete resolution of vertigo and nystagmus, the effective rate in the experimental group were significantly higher than those in the control group, the differences were statistically significant(P < .05). On day 14, the effective rate in the experimental group (96%) was slightly higher than that in the control group(91%), but there was no significant difference between the two groups. And at 28-day after the first treatment, the effective rate was 100% in the experimental group and the control group. The repositioning efficiency of pc-BPPV (the first, second, third treatment), hc-BPPV (the first, second, third treatment), hc-BPPV-cu(the first, second treatment) in the experimental group were higher than the control group, and the secondary reposition of pc-BPPV in the experimental group was significantly higher than the control group(96%vs.84%; P < .05). While for the hc-BPPV-cu patients, the effective rate of the third treatment in the experimental group was slightly lower than that of the control group, but the differences were not statistically significant. CONCLUSIONS BPPV diagnosis and treatment system is effective for the treatment of BPPV, with a better effective rate than those treated with manual maneuver, and is safe and easy to perform on patients.
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West N, Bloch SL, Moller MN, Hansen S, Klokker M. Reposition Chair Treatment Improves Subjective Outcomes in Refractory Benign Paroxysmal Positional Vertigo. J Int Adv Otol 2020; 15:146-150. [PMID: 31058604 DOI: 10.5152/iao.2019.5659] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Despite increasing utilization of reposition devices in the management of benign paroxysmal positional vertigo (BPPV), knowledge on subjective outcomes is insufficient. The objective of the present study was to evaluate subjective vertigo complaints and vertigo-associated emotional distress during reposition chair management for refractory BPPV. MATERIALS AND METHODS This was a prospective observational cohort study of subjective and objective data of 31 patients suffering from refractory BPPV representing failed conventional repositioning treatment. At the beginning of each visit, the patients filled out the Dizziness Handicap Inventory (DHI), the Visual Analog Scale (VAS), and the Hospital Anxiety and Depression Scale (HADS). Treatment and re-evaluation were repeated every 2 weeks until the patient was declared disease-free. RESULTS Complete remission of BPPV required a mean of two treatments. Mean DHI score decreased from 45 points prior to first treatment to 22 points by finished treatment (p<0.001). Similarly, mean VAS score was reduced from 58 to 25 points (p<0.001), and HADS decreased from 8 to 5 points (p<0.001). Patients with cupulolithiasis reported worse vertigo complaints than those with canalolithiasis. All scores correlated positively. CONCLUSION Patients with refractory BPPV improved significantly by reposition chair management according to all subjective outcomes. Thus, the reposition device could significantly reduce disease burden in the group of patients with BPPV who failed to respond to conventional management. The strong correlation between the scores suggests VAS as a useful tool for vertigo-related patient complaints.
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Affiliation(s)
- Niels West
- Department of Otorhinolaryngology, Head and Neck Surgery, Rigshospitalet, Copenhagen, Denmark
| | - Sune Land Bloch
- Department of Otorhinolaryngology, Head and Neck Surgery, Rigshospitalet, Copenhagen, Denmark
| | - Martin Nue Moller
- Department of Otorhinolaryngology, Head and Neck Surgery, Rigshospitalet, Copenhagen, Denmark
| | - Soren Hansen
- Department of Otorhinolaryngology, Head and Neck Surgery, Rigshospitalet, Copenhagen, Denmark
| | - Mads Klokker
- Department of Otorhinolaryngology, Head and Neck Surgery, Rigshospitalet, Copenhagen, Denmark
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Oya R, Imai T, Takenaka Y, Sato T, Oshima K, Ohta Y, Inohara H. Clinical significance of cervical and ocular vestibular evoked myogenic potentials in benign paroxysmal positional vertigo: a meta-analysis. Eur Arch Otorhinolaryngol 2019; 276:3257-3265. [PMID: 31605189 DOI: 10.1007/s00405-019-05674-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 09/27/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE As the pathological cause of benign paroxysmal positional vertigo (BPPV), the dislocation or degeneration of otoconia in the utricle and saccule is suggested. Vestibular evoked myogenic potential (VEMP) could reflect otolithic dysfunction due to these etiologies of BPPV. The aim of this study was to validate the clinical significance of cervical (c) and ocular (o) VEMP in BPPV by a meta-analysis of previous articles. METHODS Articles related to BPPV with data on cVEMP and oVEMP were collected. The following keywords were used to search PubMed and Scopus for English language articles: benign paroxysmal positional vertigo or BPPV and vestibular evoked myogenic potential or VEMP. RESULTS The p13 latency in cVEMP and n1 latency in oVEMP were slightly but significantly prolonged in BPPV patients compared to control patients. AR in oVEMP of BPPV patients also showed higher value than that of control patients. However, the n23 latency and AR in cVEMP and p1 latency in oVEMP showed no significant difference between BPPV and control patients. Furthermore, latencies in VEMPs also showed no significant difference between an affected and a non-affected ear in BPPV patients. CONCLUSIONS Our results indicated that otolith dysfunction of BPPVs was detected by latencies in VEMPs, and AR in oVEMP more sensitively reflects the difference between affected and non-affected ears in BPPV patients. The otolith dysfunction of BPPV might be induced by the systemic condition. However, the differences of latencies between BPPV patients and control patients were too small to use VEMPs as a prognostic predictor.
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Affiliation(s)
- Ryohei Oya
- Department of Otorhinolaryngology Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, Japan.
| | - Takao Imai
- Department of Otorhinolaryngology Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, Japan
| | - Yukinori Takenaka
- Department of Otorhinolaryngology Head and Neck Surgery, Kansai Medical Hospital, 1-7-2 Shinsenrinishimachi, Toyonaka, Osaka, Japan
| | - Takashi Sato
- Department of Otorhinolaryngology Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, Japan
| | - Kazuo Oshima
- Department of Otorhinolaryngology Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, Japan
| | - Yumi Ohta
- Department of Otorhinolaryngology Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, Japan
| | - Hidenori Inohara
- Department of Otorhinolaryngology Head and Neck Surgery, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, Japan
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Early experience with a multi-axial, whole body positioning system in the treatment of Benign Paroxysmal Positional Vertigo (BPPV). J Clin Neurosci 2019; 61:186-188. [DOI: 10.1016/j.jocn.2018.10.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 10/07/2018] [Indexed: 11/22/2022]
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Balatsouras DG, Koukoutsis G, Fassolis A, Moukos A, Apris A. Benign paroxysmal positional vertigo in the elderly: current insights. Clin Interv Aging 2018; 13:2251-2266. [PMID: 30464434 PMCID: PMC6223343 DOI: 10.2147/cia.s144134] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Balance disorders, unsteadiness, dizziness and vertigo in the elderly are a significant health problem, needing appropriate treatment. One third of elderly patients with vertigo were diagnosed with benign paroxysmal positional vertigo (BPPV), the most common cause of dizziness in both primary care specialist Neurology and Ear Nose Throat settings. BPPV presents a specific paroxysmal positional nystagmus which can be obtained using the appropriate diagnostic positional test and can be treated effectively using specific therapeutic maneuvers. This review presents current insights into the diagnostic, pathogenetic and therapeutic aspects of BPPV in the elderly. BPPV in older patients does not differ significantly from BPPV in younger patients, with regard to pathogenesis, diagnosis and treatment. However, in older patients, its prevalence is higher and it responds less effectively to treatment, having a tendency for recurrence. Specific issues which should be considered in the elderly are: 1) difficulty in obtaining an accurate history; 2) difficulty in performing the diagnostic and therapeutic maneuvers, which should be executed with slow and gentle movements and extremely cautiously to avoid any vascular or orthopedic complications; and 3) the relation between BPPV and falls.
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Affiliation(s)
- D G Balatsouras
- Department of ENT, Tzanion General Hospital of Piraeus, Piraeus, Greece,
| | - G Koukoutsis
- Department of ENT, Tzanion General Hospital of Piraeus, Piraeus, Greece,
| | - A Fassolis
- Department of ENT, Tzanion General Hospital of Piraeus, Piraeus, Greece,
| | - A Moukos
- Department of ENT, Tzanion General Hospital of Piraeus, Piraeus, Greece,
| | - A Apris
- Department of ENT, Nicosia General Hospital, Nicosia, Cyprus
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Luryi AL, LaRouere M, Babu S, Bojrab DI, Zappia J, Sargent EW, Schutt CA. Traumatic versus Idiopathic Benign Positional Vertigo: Analysis of Disease, Treatment, and Outcome Characteristics. Otolaryngol Head Neck Surg 2018; 160:131-136. [DOI: 10.1177/0194599818797892] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective To compare characteristics between traumatic and idiopathic benign paroxysmal positional vertigo (BPPV) focusing on outcomes. Study Design Retrospective chart review. Setting High-volume tertiary otology center. Subjects and Methods Records of patients with BPPV treated at a single institution from 2007 to 2017 were analyzed. Traumatic BPPV was defined as BPPV symptoms beginning within 30 days following head trauma. Patient, disease, treatment, and outcome characteristics were compared between traumatic and idiopathic BPPV groups. Results A total of 1378 patients with BPPV were identified, 110 (8%) of which had traumatic BPPV. The overall resolution rate was 76%, and the recurrence rate was 38%. Patients with traumatic BPPV were younger (mean age: 61 vs 65 years, P = .007) and more likely to be male (40% vs 27%, P = .004) than patients with idiopathic BPPV. Traumatic BPPV was more likely to affect both ears (32% vs 19%, P = .009). No significant association was detected between trauma history and resolution rate, recurrence rate, number of treatment visits, or affected semicircular canals. Conclusion Patients with traumatic BPPV are more likely to be young and male than those with idiopathic disease. Although traumatic BPPV is often bilateral, outcomes for traumatic BPPV may be similar to those for idiopathic BPPV, contrary to prior reports.
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Affiliation(s)
- Alexander L. Luryi
- Department of Surgery, School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Michael LaRouere
- Department of Neurotology, Michigan Ear Institute, St John Providence Hospital and Medical Centers, Farmington Hills, Michigan, USA
| | - Seilesh Babu
- Department of Neurotology, Michigan Ear Institute, St John Providence Hospital and Medical Centers, Farmington Hills, Michigan, USA
| | - Dennis I. Bojrab
- Department of Neurotology, Michigan Ear Institute, St John Providence Hospital and Medical Centers, Farmington Hills, Michigan, USA
| | - John Zappia
- Department of Neurotology, Michigan Ear Institute, St John Providence Hospital and Medical Centers, Farmington Hills, Michigan, USA
| | - Eric W. Sargent
- Department of Neurotology, Michigan Ear Institute, St John Providence Hospital and Medical Centers, Farmington Hills, Michigan, USA
| | - Christopher A. Schutt
- Department of Neurotology, Michigan Ear Institute, St John Providence Hospital and Medical Centers, Farmington Hills, Michigan, USA
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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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Luryi AL, Lawrence J, LaRouere M, Babu S, Bojrab DI, Zappia J, Sargent EW, Schutt CA. Treatment of Patients With Benign Paroxysmal Positional Vertigo and Severe Immobility Using the Particle Repositioning Chair: A Retrospective Cohort Study. Ann Otol Rhinol Laryngol 2018; 127:390-394. [PMID: 29732909 DOI: 10.1177/0003489418771988] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
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.
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Affiliation(s)
- Alexander L Luryi
- 1 Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Juliana Lawrence
- 1 Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Michael LaRouere
- 2 Department of Neurotology, Michigan Ear Institute, St. John Providence Hospital and Medical Centers, Novi, Michigan, USA
| | - Seilesh Babu
- 2 Department of Neurotology, Michigan Ear Institute, St. John Providence Hospital and Medical Centers, Novi, Michigan, USA
| | - Dennis I Bojrab
- 2 Department of Neurotology, Michigan Ear Institute, St. John Providence Hospital and Medical Centers, Novi, Michigan, USA
| | - John Zappia
- 2 Department of Neurotology, Michigan Ear Institute, St. John Providence Hospital and Medical Centers, Novi, Michigan, USA
| | - Eric W Sargent
- 2 Department of Neurotology, Michigan Ear Institute, St. John Providence Hospital and Medical Centers, Novi, Michigan, USA
| | - Christopher A Schutt
- 2 Department of Neurotology, Michigan Ear Institute, St. John Providence Hospital and Medical Centers, Novi, Michigan, USA
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Luryi AL, Wright D, Lawrence J, Babu S, LaRouere M, Bojrab DI, Sargent EW, Zappia J, Schutt CA. Analysis of non-posterior canal benign paroxysmal positional vertigo in patients treated using the particle repositioning chair: A large, single-institution series. Am J Otolaryngol 2018; 39:313-316. [PMID: 29544670 DOI: 10.1016/j.amjoto.2018.03.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 03/05/2018] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Alexander L Luryi
- Department of Surgery, Yale University School of Medicine, New Haven, CT, United States
| | - David Wright
- Department of Neurotology, Michigan Ear Institute, St. John Providence Hospital and Medical Centers, Novi, MI, United States
| | - Juliana Lawrence
- Department of Surgery, Yale University School of Medicine, New Haven, CT, United States
| | - Seilesh Babu
- Department of Neurotology, Michigan Ear Institute, St. John Providence Hospital and Medical Centers, Novi, MI, United States
| | - Michael LaRouere
- Department of Neurotology, Michigan Ear Institute, St. John Providence Hospital and Medical Centers, Novi, MI, United States
| | - Dennis I Bojrab
- Department of Neurotology, Michigan Ear Institute, St. John Providence Hospital and Medical Centers, Novi, MI, United States
| | - Eric W Sargent
- Department of Neurotology, Michigan Ear Institute, St. John Providence Hospital and Medical Centers, Novi, MI, United States
| | - John Zappia
- Department of Neurotology, Michigan Ear Institute, St. John Providence Hospital and Medical Centers, Novi, MI, United States
| | - Christopher A Schutt
- Department of Neurotology, Michigan Ear Institute, St. John Providence Hospital and Medical Centers, Novi, MI, United States.
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von Brevern M, Bertholon P, Brandt T, Fife T, Imai T, Nuti D, Newman-Toker D. Benign paroxysmal positional vertigo: Diagnostic criteria Consensus document of the Committee for the Classification of Vestibular Disorders of the Bárány Society. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2017; 68:349-360. [PMID: 29056234 DOI: 10.1016/j.otorri.2017.02.007] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 02/28/2017] [Indexed: 11/18/2022]
Abstract
This article presents operational diagnostic criteria for benign paroxysmal positional vertigo (BPPV), formulated by the Committee for Classification of Vestibular Disorders of the Bárány Society. The classification reflects current knowledge of clinical aspects and pathomechanisms of BPPV and includes both established and emerging syndromes of BPPV. It is anticipated that growing understanding of the disease will lead to further development of this classification.
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Affiliation(s)
| | - Pierre Bertholon
- Department of Otolaryngology, Head and Neck Surgery, Bellvue Hospital, Saint-Etienne, Francia
| | - Thomas Brandt
- Institute of Clinical Neuroscience, Ludwig-Maximilian University, Múnich, Alemania
| | - Terry Fife
- Barrow Neurological Institute, University of Arizona College of Medicine, Phoenix, EE. UU
| | - Takao Imai
- Department of Otolaryngology, Head and Neck Surgery, Osaka University Graduate School of Medicine, Osaka, Japón
| | - Daniele Nuti
- Department of Otolaryngology, Head and Neck Surgery, University of Siena, Siena, Italia
| | - David Newman-Toker
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, EE. UU
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Liu X, Treister R, Yan Y, Wang H, Li X. Automated Mechanical Repositioning Treatment for Posterior Canal Benign Paroxysmal Positional Vertigo: A Single-Center Experience and Literature Review. Eur Neurol 2017; 78:240-246. [DOI: 10.1159/000480429] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 08/15/2017] [Indexed: 11/19/2022]
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Shan X, Wang A, Wang E. Benign paroxysmal positional vertigo secondary to laparoscopic surgery. SAGE Open Med Case Rep 2017; 5:2050313X17692938. [PMID: 28255446 PMCID: PMC5315360 DOI: 10.1177/2050313x17692938] [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: 11/16/2016] [Accepted: 01/13/2017] [Indexed: 11/22/2022] Open
Abstract
Objectives: Benign paroxysmal positional vertigo is a common vestibular disorder and it may be idiopathic or secondary to some conditions such as surgery, but rare following laparoscopic surgery. Methods: We report two cases of benign paroxysmal positional vertigo secondary to laparoscopic surgery, one after laparoscopic cholecystectomy in a 51-year-old man and another following laparoscopic hysterectomy in a 60-year-old woman. Results: Both patients were treated successfully with manual or device-assisted canalith repositioning maneuvers, with no recurrence on the follow-up of 6 -18 months. Conclusions: Benign paroxysmal positional vertigo is a rare but possible complication of laparoscopic surgery. Both manual and device-assisted repositioning maneuvers are effective treatments for this condition, with good efficacy and prognosis.
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Affiliation(s)
- Xizheng Shan
- Department of Otolaryngology Head and Neck Surgery and Institute of Vertigo, General Hospital of Chinese People's Armed Police Forces, Beijing, China
| | - Amy Wang
- Accident and Emergency Department, Aintree University Hospital, Liverpool, UK
| | - Entong Wang
- Department of Otolaryngology Head and Neck Surgery and Institute of Vertigo, General Hospital of Chinese People's Armed Police Forces, Beijing, China
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Davies R, Luxon LM, Bamiou DE, Bronstein A. Neuro-Otology. Neurology 2016. [DOI: 10.1002/9781118486160.ch15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Martens C, Goplen FK, Nordfalk KF, Aasen T, Nordahl SHG. Prevalence and Characteristics of Positional Nystagmus in Normal Subjects. Otolaryngol Head Neck Surg 2016; 154:861-7. [PMID: 26908561 DOI: 10.1177/0194599816629640] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 01/08/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVE In clinical practice, patients are often referred due to a finding of positional nystagmus that does not always appear to correlate with clinical symptoms of benign paroxysmal positional vertigo. To know when to consider nystagmus to be of clinical relevance, it is necessary to know the prevalence and characteristics of positional nystagmus in a healthy population. STUDY DESIGN Case series of 75 healthy subjects. SETTING Two tertiary referral centers in Norway. SUBJECTS AND METHODS Seventy-five adult subjects aged 40 ± 13 years (mean ± SD; range, 21-87) without a history of vertigo or balance disorder were included from 2013 to 2015. The subjects underwent 6 different standardized positional tests in a repositioning chair. Videonystagmography was used to record eye movements. Of 1350 recordings, 1329 were included and analyzed. RESULTS Positional nystagmus was detected in 88% of the subjects. The most common finding was nystagmus in the Dix-Hallpike position, which occurred in 55% of the subjects. The 95th percentile of the maximum slow-phase velocity for each subject was found to be 5.06° per second (n = 54) in the horizontal plane and 6.48° per second (n = 48) in the vertical plane. CONCLUSION Positional nystagmus is a common finding in normal subjects and occurred in 88% of the healthy subjects in the present study. Horizontal direction-changing apogeotropic or geotropic nystagmus may occur in asymptomatic subjects. However, nystagmus that is of the paroxysmal type or has a slow-phase velocity greater than approximately 5° per second in the horizontal plane or 6.5° per second in the vertical plane should be considered outside the 95th percentile.
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Affiliation(s)
- Camilla Martens
- National Competence Service for Vestibular Disorders, Department of Otorhinolaryngology, Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway
| | - Frederik Kragerud Goplen
- National Competence Service for Vestibular Disorders, Department of Otorhinolaryngology, Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway
| | - Karl Fredrik Nordfalk
- Department of Otorhinolaryngology, Head and Neck Surgery, Oslo University Hospital, Oslo, Norway
| | - Torbjørn Aasen
- National Competence Service for Vestibular Disorders, Department of Otorhinolaryngology, Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway
| | - Stein Helge Glad Nordahl
- National Competence Service for Vestibular Disorders, Department of Otorhinolaryngology, Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Efficacy of Computer-Controlled and Modified Roll Maneuver for Treatment of Geotropic Lateral Canal Benign Paroxysmal Positional Vertigo. Otol Neurotol 2015; 36:1412-6. [PMID: 26134939 DOI: 10.1097/mao.0000000000000813] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the short-term efficacy of computer-controlled and modified roll maneuver (CMRM) versus conventional roll maneuver (RM) for treatment of geotropic lateral canal benign paroxysmal positional vertigo (BPPV). STUDY DESIGN Prospective case-controlled study. SETTING Academic hospital. PATIENTS One hundred consecutive patients diagnosed as having unilateral idiopathic geotropic lateral canal BPPV with a duration of symptoms of less than 2 weeks. INTERVENTIONS Fifty-two patients (aged 32-80 yr; mean, 55.9 yr; 18 men and 34 women) were treated with CMRM that was composed of three sequential 360-degree rotations and 48 patients (aged 30-71 yr; mean, 52.4 yr; 20 men and 28 women) treated with RM that consisted of one 360-degree rotation. MAIN OUTCOME MEASURES Resolution of vertigo on the supine roll test at 48 hours after initial maneuver and the number of maneuvers required for final resolution of vertigo were main outcome measures to assess the efficacy of treatment. RESULTS On the supine roll test at 48-hour follow-up after initial maneuver, 44 (84.6%) of 52 CMRM-treated patients and 23 (54.2%) of 48 RM-treated patients had resolution of vertigo (p < 0.01). All patients obtained final resolution of vertigo with a maximum of five maneuvers in each group, but the CMRM group had less mean number of maneuvers required for final resolution of vertigo compared with the RM group (1.23 ± 0.39 versus 1.63 ± 0.68, p < 0.05). No significant adverse effects and complications occurred aside from two patients with conversion into posterior canal BPPV in each treatment. CONCLUSION The CMRM consisting of three sequential 360-degree rotations for geotropic lateral canal BPPV has a higher initial success rate compared with the conventional RM consisting of one 360-degree rotation.
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Abstract
Benign paroxysmal positional vertigo (BPPV) is a common cause of vertigo characterized by brief episodes provoked by head movements. The first attack of BPPV usually occurs in bed or upon getting up. Because it often begins abruptly, it can be alarming and lead to emergency department evaluation. The episodes of spinning often last 10 to 20 seconds, but may occasionally last as long as 1 minute. There are several forms of BPPV. In nearly all cases, highly effective treatment can be offered to patients. This article reviews the current state of our understanding of this condition and its management.
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Repositioning chairs in benign paroxysmal positional vertigo: implications and clinical outcome. Eur Arch Otorhinolaryngol 2015; 273:573-80. [DOI: 10.1007/s00405-015-3583-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 02/24/2015] [Indexed: 10/23/2022]
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Shan X, Peng X, Wang E. Efficacy of computer-controlled repositioning procedure for benign paroxysmal positional vertigo. Laryngoscope 2014; 125:715-9. [PMID: 25302789 DOI: 10.1002/lary.24961] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 08/19/2014] [Accepted: 09/15/2014] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS To evaluate the short-term efficacy of the computer-controlled canalith repositioning procedure (CRP) for treatment of posterior canal benign paroxysmal positional vertigo (BPPV) compared with the current standard CRP. STUDY DESIGN Prospective case series. METHODS One hundred thirty-two patients diagnosed as having idiopathic posterior canal BPPV, with an age range of 28 to 86 years (mean 56 years), 47 men and 85 women, were treated with computer-controlled CRP mimicking the Epley maneuver. Resolution of vertigo and nystagmus on the Dix-Hallpike test at 1-week follow-up after treatment was the main outcome measure to assess the efficacy of treatment. RESULTS At 1-week follow-up after treatment with computer-controlled CRP, 108 (81.8%) of 132 patients had complete resolution of vertigo and nystagmus, nine (6.8%) had resolution of vertigo but presence of nystagmus, and 15 (11.4%) had provoked vertigo and nystagmus on the Dix-Hallpike test. The 81.8% success rate was comparable to those who received current standard CRP treatment in randomized controlled trials at about 80%. No significant adverse effects or complications occurred in the patients treated with computer-controlled CRP, aside from two patients (1.5%) with conversion into lateral canal BPPV. CONCLUSIONS Computer-controlled CRP is effective for the treatment of posterior canal BPPV, with a success rate similar to those treated with the Epley maneuver, and is safe and easy to perform on patients.
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Affiliation(s)
- Xizheng Shan
- Department of Otolaryngology-Head and Neck Surgery, General Hospital of Chinese People's Armed Police Forces, Beijing, China
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Keall PJ, Barton M, Crozier S. The Australian Magnetic Resonance Imaging–Linac Program. Semin Radiat Oncol 2014; 24:203-6. [DOI: 10.1016/j.semradonc.2014.02.015] [Citation(s) in RCA: 255] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Tan J, Yu D, Feng Y, Song Q, You J, Shi H, Yin S. Comparative study of the efficacy of the canalith repositioning procedure versus the vertigo treatment and rehabilitation chair. Acta Otolaryngol 2014; 134:704-8. [PMID: 24807849 DOI: 10.3109/00016489.2014.899711] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Vertigo treatment and rehabilitation chair (TRV) may be suggested as the first choice for patients with posterior canal benign paroxysmal positional vertigo (p-BPPV). OBJECTIVE To investigate the short- and long-term treatment efficacy of the canalith repositioning procedure (CRP) versus TRV for patients with p-BPPV. METHODS A total of 165 patients with unilateral p-BPPV were assigned to either the CRP group or the TRV group. Patients were assessed at 1 week, 4 weeks, 3 months, and 6 months after their first treatment. The numbers of treatment sessions required for successful repositioning in both groups at 4 weeks, 3 months, and 6 months were recorded. RESULTS Treatment efficacy of patients in the TRV group was significantly better than that of patients in the CRP group 1 week after the first treatment. The number of treatment sessions needed for successful repositioning was significantly lower in the TRV group than in the CRP group at 4 weeks and 3 months after the first treatment.
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Affiliation(s)
- Jun Tan
- Department of Otolaryngology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital , Shanghai , China
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Bockisch CJ, Straumann D, Weber KP. Curing a 96-year-old patient afflicted with benign paroxysmal positional vertigo on a motorized turntable. Clin Interv Aging 2014; 9:589-91. [PMID: 24748776 PMCID: PMC3986337 DOI: 10.2147/cia.s58785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Dizziness in the elderly is a serious health concern due to the increased morbidity caused by falling. The most common cause of dizziness in the elderly, benign paroxysmal positional vertigo (BPPV), is frequently undiagnosed, and bedside treatment of these patients can be difficult due to neck and back stiffness, which makes repeated and accurate repositioning maneuvers difficult. Case presentation After a fall, a 96-year-old woman was referred by a resident neurologist for intractable BPPV. The patient was placed on a motorized turntable and repositioned to remove the calcite particles from the affected posterior semicircular canal. Video monitoring of the eyes allowed confirmation of the diagnosis, as well as an immediate evaluation of the effectiveness of the maneuver. Conclusion Every patient with dizziness or imbalance, even in the absence of typical complaints of BPPV, should be tested with provocation maneuvers, because the clinical picture of BPPV is not always typical. Even if elderly patients with dizziness are very frail, the completion of provocation maneuvers is imperative, since the therapeutic maneuvers are extremely effective. A motorized turntable is very helpful to perform the repositioning accurately and safely.
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Affiliation(s)
- Christopher J Bockisch
- Department of Neurology, University Hospital Zurich ; Department of Ophthalmology, University Hospital Zurich ; Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Zurich
| | - Dominik Straumann
- Department of Neurology, University Hospital Zurich ; Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Konrad P Weber
- Department of Neurology, University Hospital Zurich ; Department of Ophthalmology, University Hospital Zurich
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Causes and characteristics of horizontal positional nystagmus. J Neurol 2014; 261:1009-17. [DOI: 10.1007/s00415-013-7223-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 12/17/2013] [Accepted: 12/17/2013] [Indexed: 10/25/2022]
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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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Choi SJ, Lee JB, Lim HJ, Park HY, Park K, In SM, Oh JH, Choung YH. Clinical Features of Recurrent or Persistent Benign Paroxysmal Positional Vertigo. Otolaryngol Head Neck Surg 2012; 147:919-24. [DOI: 10.1177/0194599812454642] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives To identify clinical features and causes of recurrent or persistent benign paroxysmal positional vertigo (BPPV) and to analyze the effectiveness of frequently repeated canalith repositioning procedures (CRPs). Study Design Case series with chart review. Setting Academic university hospital. Methods The authors retrospectively reviewed the clinical records of 120 patients who were diagnosed with BPPV at the Dizziness Clinic in Ajou University Hospital, Korea, between 2004 and 2008. “Persistent” and “recurrent” BPPV were respectively defined as BPPV continuing more than 2 weeks and recurring BPPV in the same canals after at least 2 weeks of a symptom-free interval following previous successful treatments. The authors treated patients with frequently repeated CRPs such as the modified Epley maneuver or a barbecue rotation every 2 or 3 days in the outpatient clinic. Results Among 120 patients with BPPV, 93 (77.5%) were typical, 15 (12.5%) were persistent, and 12 (10.0%) were recurrent. Although the most common cause was idiopathic in both recurrent and persistent BPPV, secondary causes, including trauma, were much more common in recurrent and persistent BPPV than in typical BPPV. Typical and recurrent BPPV developed most commonly in the posterior semicircular canals. Persistent BPPV was most commonly detected in the lateral semicircular canals. After frequently repeated CRPs, 91.7% and 86.7% of the patients with recurrent or persistent BPPV, respectively, had resolution of nystagmus and vertigo. Conclusion Recurrent and persistent BPPV are not rare diseases and occur with a higher incidence than expected, especially in patients with secondary causes. However, they can be successfully treated with frequently repeated CRPs.
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Affiliation(s)
- Seong Jun Choi
- Department of Otorhinolaryngology, College of Medicine, Konyang University, Daejeon, Republic of Korea
| | - Jong Bin Lee
- Department of Otorhinolaryngology, College of Medicine, Konyang University, Daejeon, Republic of Korea
| | - Hye Jin Lim
- Department of Otolaryngology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Hun Yi Park
- Department of Otolaryngology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Keehyun Park
- Department of Otolaryngology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Seung Min In
- Department of Otorhinolaryngology, College of Medicine, Konyang University, Daejeon, Republic of Korea
| | - Jeong Hyun Oh
- Department of Otorhinolaryngology, College of Medicine, Konyang University, Daejeon, Republic of Korea
| | - Yun-Hoon Choung
- Department of Otolaryngology, Ajou University School of Medicine, Suwon, Republic of Korea
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Hunt WT, Zimmermann EF, Hilton MP. Modifications of the Epley (canalith repositioning) manoeuvre for posterior canal benign paroxysmal positional vertigo (BPPV). Cochrane Database Syst Rev 2012; 2012:CD008675. [PMID: 22513962 PMCID: PMC6885068 DOI: 10.1002/14651858.cd008675.pub2] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Benign paroxsymal positional vertigo (BPPV) is a syndrome characterised by short-lived episodes of vertigo associated with rapid changes in head position. It is a common cause of vertigo presenting to primary care and specialist otolaryngology (ENT) clinics. BPPV of the posterior canal is a specific type of BPPV for which the Epley (canalith repositioning) manoeuvre is a verified treatment. A range of modifications of the Epley manoeuvre are used in clinical practice, including post-Epley vestibular exercises and post-Epley postural restrictions. OBJECTIVES To assess whether the various modifications of the Epley manoeuvre for posterior canal BPPV enhance its efficacy in clinical practice. SEARCH METHODS We searched the Cochrane ENT Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the search was 15 December 2011. SELECTION CRITERIA Randomised controlled trials of modifications of the Epley manoeuvre versus a standard Epley manoeuvre as a control in adults with posterior canal BPPV diagnosed with a positive Dix-Hallpike test. Specific modifications sought were: application of vibration/oscillation to the mastoid region, vestibular rehabilitation exercises, additional steps in the Epley manoeuvre and post-treatment instructions relating to movement restriction. DATA COLLECTION AND ANALYSIS Two authors independently selected studies from the search results and the third author reviewed and resolved any disagreement. Two authors independently extracted data from the studies using standardised data forms. All authors independently assessed the trials for risk of bias. MAIN RESULTS The review includes 11 trials involving 855 participants. A total of nine studies used post-Epley postural restrictions as their modification of the Epley manoeuvre. There was no evidence of a difference in the results for post-treatment vertigo intensity or subjective assessment of improvement in individual or pooled data. All nine trials included the conversion of a positive to a negative Dix-Hallpike test as an outcome measure. Pooled data identified a significant difference from the addition of postural restrictions in the frequency of Dix-Hallpike conversion when compared to the Epley manoeuvre alone. In the experimental group 88.7% (220 out of 248) patients versus 78.2% (219 out of 280) in the control group converted from a positive to negative Dix-Hallpike test (risk ratio (RR) 1.13, 95% confidence interval (CI) 1.05 to 1.22, P = 0.002). No serious adverse effects were reported, however three studies reported minor complications such as neck stiffness, horizontal BPPV, dizziness and disequilibrium in some patients.There was no evidence of benefit of mastoid oscillation applied during the Epley manoeuvre, or of additional steps in the Epley manoeuvre. No adverse effects were reported. AUTHORS' CONCLUSIONS There is evidence supporting a statistically significant effect of post-Epley postural restrictions in comparison to the Epley manoeuvre alone. However, it important to note that this statistically significant effect only highlights a small improvement in treatment efficacy. An Epley manoeuvre alone is effective in just under 80% of patients with typical BPPV. The additional intervention of postural restrictions has a number needed to treat (NNT) of 10. The addition of postural restrictions does not expose the majority of patients to risk of harm, does not pose a major inconvenience, and can be routinely discussed and advised. Specific patients who experience discomfort due to wearing a cervical collar and inconvenience in sleeping upright may be treated with the Epley manoeuvre alone and still expect to be cured in most instances.There is insufficient evidence to support the routine application of mastoid oscillation during the Epley manoeuvre, or additional steps in an 'augmented' Epley manoeuvre. Neither treatment is associated with adverse outcomes. Further studies should employ a rigorous randomisation technique, blinded outcome assessment, a post-treatment Dix-Hallpike test as an outcome measure and longer-term follow-up of patients.
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Affiliation(s)
- William T Hunt
- Royal Devon & Exeter HospitalPeninsula College of Medicine and DentistryBarrack RoadExeterUKEX2 5DW
| | - Eleanor F Zimmermann
- Royal Devon & Exeter HospitalPeninsula College of Medicine and DentistryBarrack RoadExeterUKEX2 5DW
| | - Malcolm P Hilton
- Royal Devon and Exeter NHS TrustENT DepartmentBarrack RoadExeterUKEX2 5DW
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Benign paroxysmal positional vertigo with multiple canal involvement. Am J Otolaryngol 2012; 33:250-8. [PMID: 21917354 DOI: 10.1016/j.amjoto.2011.07.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Revised: 07/20/2011] [Accepted: 07/27/2011] [Indexed: 11/23/2022]
Abstract
PURPOSE The aims of this study were to describe the frequency and clinical features of benign paroxysmal positional vertigo (BPPV) with multiple canal involvement and to evaluate the results of treatment by appropriate canalith repositioning procedures. MATERIALS AND METHODS A total of 345 patients were referred for BPPV between 2006 and 2010. Thirty-two of them (9.3%) who had BPPV of multiple canals were studied. Thirteen were men (mean age, 60.4 years) and 19 were women (mean age, 56.8 years). Dix-Hallpike and supine roll tests were performed for diagnosis. Canalith repositioning procedures for treatment included modified Epley, barbecue, Gufoni, and anterior BPPV-specific maneuvers. RESULTS Twenty-one patients had bilateral posterior canal BPPV, and 11 had mixed canal BPPV either on the same side (7 patients) or on both sides (4 patients). Thirty-one patients were cured with an average of 2.9 therapeutic sessions per patient. Recurrences occurred in 5 patients (15.6%). CONCLUSIONS Benign paroxysmal positional vertigo of multiple canals is not rare and presents a clinical challenge. However, accurate diagnosis results in successful treatment comparable with BPPV of 1 canal.
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Welgampola MS, Bradshaw A, Halmagyi GM. Practical Neurology Part 4: Dizziness on head movement. Med J Aust 2011; 195:518-22. [DOI: 10.5694/mja11.11001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Accepted: 10/04/2011] [Indexed: 11/17/2022]
Affiliation(s)
- Miriam S Welgampola
- Department of Neurology, Royal Prince Alfred Hospital, Sydney, NSW
- Central Clinical School, University of Sydney, Sydney, NSW
| | - Andrew Bradshaw
- Department of Neurology, Royal Prince Alfred Hospital, Sydney, NSW
| | - G Michael Halmagyi
- Department of Neurology, Royal Prince Alfred Hospital, Sydney, NSW
- Central Clinical School, University of Sydney, Sydney, NSW
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Involvement of the Anterior Semicircular Canal in Posttraumatic Benign Paroxysmal Positioning Vertigo. Otol Neurotol 2011; 32:1285-90. [DOI: 10.1097/mao.0b013e31822e94d9] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Blau P, Shoup A. Reliability of a rating scale used to distinguish direction of eye movement using infrared/video ENG recordings during repositioning maneuvers. Int J Audiol 2009; 46:427-32. [PMID: 17654084 DOI: 10.1080/14992020701355082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The purpose of this study was to determine the validity of the nystagmus rating scale (NRS) and to assess inter- and intra-rater reliability of audiologists and experts using the scale. Face and content validity was established by eliciting feedback from two neurotologists and one neurologist. A training tape was developed to describe the rating scale and provide practice with patterns of nystagmus in benign paroxysmal positional vertigo (BPPV). Eye movements of 34 patients, ages 33 to 82 years, were videotaped using infrared/video ENG during repositioning maneuvers. Six randomly paired audiologists and six experts viewed the videotape recordings and completed the NRS for each pattern. Cohen's kappa coefficients were calculated to determine inter-rater reliability. The kappa values were 0.31 with 41% agreement for audiologists, and 0.48 with 59% agreement for experts. Intra-rater reliability for a subgroup of audiologists was 0.55 with 64% agreement, and for experts was 0.75 with 81% agreement. In summary, even in this experienced population, additional training in viewing nystagmus patterns is needed to improve reliability among clinicians during diagnosis and treatment.
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Affiliation(s)
- Patricia Blau
- Department of Otolaryngology, The University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75235-8876, USA.
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López-Escámez JA. Role of vestibular testing in diagnosis of benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 2009; 141:7-9; author reply 10-1. [PMID: 19559949 DOI: 10.1016/j.otohns.2009.03.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2009] [Revised: 03/12/2009] [Accepted: 03/19/2009] [Indexed: 11/26/2022]
Abstract
Diagnosis and treatment of benign paroxysmal positional vertigo (BPPV) is a mixture of empiricism of particle repositioning with the rationally-based knowledge obtained from clinical observations, histopathology, and neurophysiological experiments. The recently published clinical practice guideline on BPPV makes recommendations on the management of BPPV. One of the statements discourages the use of radiographic or vestibular testing, unless the diagnosis was uncertain or there were additional signs or symptoms unrelated to BPPV. The role of video-oculography in diagnosis and treatment of BPPV is argued, since vestibular testing has provided key relevant information to understand positional nystagmus in patients with BPPV.
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Affiliation(s)
- José A López-Escámez
- Otology & Neurotology Group CTS495, Research Department, Hospital de Poniente, El Ejido, Almería, Spain.
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Tomaz A, Ganança MM, Ganança CF, Ganança FF, Caovilla HH, Harker L. Benign Paroxysmal Positional Vertigo: Concomitant Involvement of Different Semicircular Canals. Ann Otol Rhinol Laryngol 2009; 118:113-7. [DOI: 10.1177/000348940911800206] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: We evaluated the simultaneous ipsilateral or contralateral involvement of the posterior and lateral, anterior and lateral, or posterior and anterior semicircular canals in patients with benign paroxysmal positional vertigo (BPPV). Methods: The files of 2,345 patients with BPPV were analyzed. Results: Single-canal BPPV occurred in 2,310 cases (98.5%) — Unilaterally in 2,058 (89.1%) and bilaterally in 252 (10.9%). Multiple-canal BPPV occurred in 35 cases (1.5%). Of these 35 cases, there was simultaneous involvement of the posterior and lateral canals on the same side (23) or on opposite sides (9) in 32 cases (91.4%). Simultaneous involvement of the anterior canal on one side and the posterior canal on the opposite side occurred in 2 cases (5.7%), and that of the anterior canal on one side and the lateral canal on the opposite side occurred in 1 case (2.9%). All cases represented canalithiasis. Conclusions: Multiple-canal BPPV was rare, and usually involved canals on the same side; simultaneous involvement of the posterior and lateral canals was much more common than involvement of the anterior and posterior canals or the anterior and lateral canals. Trauma increased the risk for multiple-canal BPPV, but not the risk for bilateral single-canal BPPV. Cupulolithiasis was not a factor in multiple-canal BPPV.
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Abordaje práctico del vértigo posicional paroxístico benigno recurrente. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2008. [DOI: 10.1016/s0001-6519(08)75990-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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López-Escámez JA. Practical Approach to Recurrent Benign Paroxysmal Positional Vertigo. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2008. [DOI: 10.1016/s2173-5735(08)70263-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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López Escámez JA, Molina MI, Zapata C, Palma MJ, Gómez Fiñana M, Gámiz MJ, Fernández Pérez A. [Oculomotor response to the vertical cephalic autorotatory test in patients with benign paroxistic positional vertigo of the posterior canal]. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2007; 57:210-6. [PMID: 16768198 DOI: 10.1016/s0001-6519(06)78695-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To evaluate the eye movement response to the head auto-rotation test (HART) in the vertical plane in patients with benign paroxysmal positional vertigo. PATIENTS AND METHODS DESIGN A transversal, descriptive study. SETTING UP: Outpatient clinic in a general Hospital. INDIVIDUALS 34 posterior canal BPPV cases with a video-oculographic diagnosis, older than 18 years old, 7 of them were not able to perform the HART. INTERVENTION HART was performed by a an electrooculographic system with simultaneous recording of head movement by an acelerometer in the vertical plane (Vorteq, Micromedical Instruments). The HART with eyes fixation was performed 3 times to determine its reliability. MAIN OUTCOME MEASURES Gain, asymmetry and phase for the vertical VOR respectively. A statistical analysis was carried out to determine the test reliability and the number of individuals with an abnormal result. RESULTS Gain is the only variable that showed a reproducible result in the HART for the active head movement at 1-2 Hz (test-retest reliability 0.83-0.89). The values of gain showed a moderate correlation at the frequencies 1-3 Hz (correlation 0.60-0.87). Asymmetry and phase were not reproducible variables (correlation < 0.55). Thirteen of 27 (48%) patients presented a decrease of the vertical gain, another 13 showed normal values and one case showed raised values. CONCLUSION Gain is the only useful variable in the vertical HART. Forty-eight percent of patients with posterior canal BPPV have a reduced vertical gain, suggesting an impairment of inferior vestibular nerve function.
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Affiliation(s)
- J A López Escámez
- Grupo de Otología y Otoneurología, CTS495, Unidad de Otorrinolaringología, Area de Cirugía, Hospital de Poniente de Almería, El Ejido.
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Abstract
OBJECTIVE Evaluate the frequency and characteristics of benign paroxysmal positional vertigo (BPPV) arising from involvement of the anterior semicircular canal (AC) as compared with the posterior canal (PC) and horizontal canal (HC). STUDY DESIGN Prospective review of patients with BPPV. SETTING Tertiary referral center. PATIENTS A total of 260 patients who were evaluated for vertigo were identified as experiencing BPPV. INTERVENTIONS Standard vestibular assessment including the use of electrooculography (EOG) or video-oculography (VOG) was completed on all patients. Based on EOG/VOG findings, the BPPV origin was attributed to AC, PC, or HC involvement secondary to canalithiasis versus cupulolithiasis. Treatment was performed with canalith repositioning maneuvers (CRMs) appropriate for type of canal involvement. RESULTS For the 260 patients, the positionally induced nystagmus patterns suggested the canal of origin to be AC in 21.2%, PC in 66.9%, and HC in 11.9%. Cupulolithiasis was observed in 27.3% of the AC, 6.3% of the PC, and 41.9% of the HC patients. Head trauma was confirmed in the history preceding the onset of vertigo in 36.4% of the AC, versus 9.2% of the PC and 9.7% of the HC patients (p < 0.001). The number of CRMs completed to treat the BPPV did not differ between canals involved (1.32 for AC, 1.49 for PC, and 1.34 for HC). CONCLUSION The direction of subtle vertical-beating nystagmus underlying the torsional component is critical in differentiating AC versus PC origin; EOG/VOG aids in accurate assessment of the vertical component for the diagnosis of canal involvement. AC involvement may be more prevalent than previously appreciated, particularly if the examiner does not appreciate the vertical component of the nystagmus or the diagnosis is made without the assistance of EOG/VOG. Head trauma history is significantly more frequent in AC versus other forms of BPPV, and patients with a history of head trauma should be examined closely for AC involvement. CRM is as successful for treatment of AC BPPV as for other types of BPPV.
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Lopez-Escamez JA, Molina MI, Gamiz MJ. Anterior semicircular canal benign paroxysmal positional vertigo and positional downbeating nystagmus. Am J Otolaryngol 2006; 27:173-8. [PMID: 16647981 DOI: 10.1016/j.amjoto.2005.09.010] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2005] [Indexed: 11/15/2022]
Abstract
PURPOSE The aim of this study was to describe the clinical features and video-oculographic findings in patients with anterior semicircular canal benign paroxysmal positional vertigo (BPPV). MATERIALS AND METHODS STUDY DESIGN This is a prospective case series. SETTING The study was set at an outpatient clinic in a general hospital. PATIENTS Fourteen individuals with symptoms of BPPV and positional downbeating nystagmus (pDBN) were included in the study. The diagnosis was based on a history of brief episodes of vertigo and the presence of pDBN confirmed in the video-oculographic examination during Dix-Hallpike test (DH) or head-hanging maneuver. INTERVENTION Patients were treated by particle repositioning maneuver and the effectiveness was evaluated at 7, 30, and 180 days posttreatment. The treatment was repeated up to 4 times if pDBN was persistent. MAIN OUTCOME MEASURES The main outcome measure is the number of patients without pDBN at 30 and 180 days. RESULTS Video-oculography showed a predominant pDBN in response to DH. Of the 14 patients, 7 had arterial hypertension, and 5 of 14 cases presented abnormalities on the caloric test. Horizontal spontaneous nystagmus was found in 3 of 14 individuals. Positional nystagmus at different positional test was observed in 5 of 14 individuals, suggesting the involvement of several canals. Of the 14 patients, 10 (71%) did not present vertigo, and the positional tests were negative at 30 days. However, 3 cases presented a positive DH with persistence of BPPV episodes and pDBN at 30 days, and another developed a contralateral posterior canal affectation. One of the patients maintained a persistent pDBN at 180 days despite the repeated maneuvers. CONCLUSIONS Video-oculography demonstrates that anterior canal BPPV is characterized by a predominant downbeating nystagmus in response to DH. These individuals may show alterations in the vestibular caloric, and they can have multicanal affectation.
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Affiliation(s)
- Jose A Lopez-Escamez
- Otology and Neurotology Group, CTS495, Department of Surgery, Hospital de Poniente de Almería, El Ejido, Almería, Spain.
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