Abordaje práctico del vértigo posicional paroxístico benigno recurrente

Healing criteria: How should an episode of benign paroxistic positional vertigo of posterior semicircular canal's resolution be defined? Prospective observational study

OBJECTIVES

To compare the outcome of the Epley maneuver (EM) in benign paroxysmal positional vertigo of the posterior canal (CSP-BPPV) depending on the definition used for recovery.

DESIGN

Multicenter observational prospective study.

SETTING

Otoneurology Units of 5 tertiary reference hospitals.

PARTICIPANTS

All patients presenting with unilateral CSP-BPPV assisted for 1-year period.

EXCLUSION CRITERIA

Spontaneous nystagmus, positive McClure-Pagnini maneuver, positive bilateral Dix-Hallpike maneuver (DHM), positive DHM for vertigo but negative for nystagmus and atypical nystagmus.

MAIN OUTCOME MEASURES

Response to EM was measured after 7 days in 3 different outcomes: disappearance of nystagmus during the DHM in the follow-up visit, disappearance of vertigo during the DHM and general status (GS) during daily life activities.

RESULTS

264 patients were recruited (68 male/166 female, mean age 62 years). After the EM, nystagmus disappeared in 67% of them, vertigo in 54% and 36% were asymptomatic in their daily life. These outcomes were strongly correlated, but they were not concordant in a clinically significant group of cases; only the 26% of patients met all of them. The healing process follows the next sequence: negativization of positional nystagmus, then disappearance of positional vertigo and, finally, the improvement of GS during daily life activities.

CONCLUSION

Nowadays, healing criteria for the resolution of an PSC-BPPV episode have not been specifically defined yet. Provided that other otoneurological disorders have been ruled out, the next resolution criterion is proposed: absence of nystagmus and specifically during control DHM and disappearance of symptoms during daily life activities.

Practice Guidelines for the Diagnosis and Management of Benign Paroxysmal Positional Vertigo Otoneurology Committee of Spanish Otorhinolaryngology and Head and Neck Surgery Consensus Document

Benign Paroxysmal Positional Vertigo is the most frequent episodic vestibular disorder. The purpose of this guide, requested by the committee on otoneurology of the Spanish Society of Otolaryngology and Head and Neck Surgery, is to supply a consensus document providing practical guidance for the management of BPPV. It is based on the Barany Society criteria for the diagnosis of BPPV. This guideline provides recommendations on each variant of BPPV, with a description of the different diagnostic tests and the therapeutic manoeuvres. For this purpose, we have selected the tests and manoeuvres supported by evidence-based studies or extensive series. Finally, we have also included a chapter on differential diagnosis and a section relating to general aspects in the management of BPPV.

Repositioning intervals in the modified Epley's maneuver and their effect on benign paroxysmal positional vertigo treatment outcome

INTRODUCTION

This study showed that short and long interval treatments achieved comparable success rates. There was no statistically significant difference in the rate of early and late recurrences between the two groups. Modified Epley maneuver can be applied in a short interval time with comparable success and recurrence rates which are as effective as in a long interval time.

OBJECTIVE

The Epley maneuver is called the particle repositioning or canalith repositioning procedure. If a short time interval in each position is effective, it will allow for reduced time and avoid unnecessary physical burden. How long of a stay in each position is not determined in the literature. There is an absence of comparative studies of the BPPV repositioning time. The aim of this study is to compare the treatment time in patients with benign paroxysmal positional vertigo (BPPV).

STUDY DESIGN

Longitudinal prospective study.

SETTING

Outpatient practice in a tertiary care facility.

SUBJECTS AND METHODS

Sixty consecutive patients with BPPV were included in this study. These patients were sequentially allocated to one of two groups (A or B). The interval times between each position in group A and B were 15 and 120 s, respectively. Modified Epley maneuver was performed in all patients. The maneuvers in both groups were exactly the same sequence of movements, except interval times.

RESULTS

The mean age of the patients was 49.25 years (range =19-76 years). Of the 60 patients, 48 (80%) were women and 12 (20%) were men. Successful outcome was achieved in 26 patients (86.7%) after the first modified Epley maneuver in both groups. Three patients from each group (total six patients) responded to the third modified Epley maneuver and the remaining two patients did not respond to any modified Epley maneuver. Therefore, the Semont maneuver was applied with a successful result.

Persistent benign paroxysmal positional vertigo: our experience and proposal for an alternative treatment

Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo. Despite the great efficacy of canalith repositioning procedures (CRPs), BPPV may persist (PBPPV). The aim of the study was to evaluate whether a prolonged and self-assessed temporal bone vibration (TBV) could change the outcome of PBPPV after 12 months of repeated treatments, in order to avoid further invasive and/or drug therapies. This evaluation was also conducted with respect to the entire BPPV population treated with CRPs. Seventy-two patients affected by PBPPV were enrolled in the study: 51 and 21 of them suffering from posterior semicircular canal (PSC) and lateral semicircular canal (LSC), respectively. PBPPV patients underwent a twice-a-day self-assessed TBV, using a common low-intensity massaging cushion. Patients were re-tested 1 week later and they were considered free from disease as the results of the positioning tests continued to be negative after 1 month. 70.6 % of PSC PBPPV and 61.9 % of LSC PBPPV patients had positive and statistically significant (P < 0.01) outcomes not biased by "age" and "gender" variables. The recurrence rate of BPPV (RBPPV) was also studied in the BPPV and PBPPV groups after a 12/24-month follow-up and any statistically significant result was found in multiple regression analysis between nuisance variables and RBPPV patients previously treated by CRPs or TBV. The present study suggests that the self-assessed and prolonged TBV could be an alternative treatment in patients affected by PBPPV otherwise addressed to undergo more invasive procedures and pharmacological treatment that are not completely side effects free.