1
|
Veglia A. Extreme Frequency of Benign Paroxysmal Positional Vertigo Recurrences Unexplained by Any Known Risk Factors: A Case Report. J Int Adv Otol 2024; 20:365-367. [PMID: 39162022 PMCID: PMC11363178 DOI: 10.5152/iao.2024.231468] [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: 12/21/2023] [Accepted: 04/28/2024] [Indexed: 08/21/2024] Open
Abstract
Benign paroxysmal positional vertigo (BPPV) is a common vestibulopathy and involves failed dissolution and dislocation of calcium carbonate crystals into the semicircular canal. This causes short-lasting vertigo during changes in head position. Oftentimes, BPPV can be resolved within a single clinic visit, but secondary to many known risk factors, BPPV can recur. This case report follows a patient with extremely frequent recurrences despite a lack of known risk factors. A 55-year-old female experienced BPPV in December 2022, with successful canalith repositioning treatment from otolaryngology. On having a recurrence in March 2023, the patient underwent videonystagmography including caloric testing, and MRI, all of which showed normal findings besides left posterior-canal BPPV. From December 2022 to February 2024, the patient had 13 recurrences, each treated to resolution, confirmed by repeating positional tests and per subjective report for at least 2 weeks following. The incidence of BPPV recurrence is reported higher in females, however, this could not be interpreted as a causative factor. Though many other risk factors are documented in literature, this patient's history, demographics, imaging, and blood tests were all negative. This case report highlights a gap in knowledge of vestibular pathophysiology, as this patient's high rate of recurrence remains unexplained.
Collapse
Affiliation(s)
- Anthony Veglia
- Scottsdale Ear, Nose, & Throat, Scottsdale, Arizona, USA
| |
Collapse
|
2
|
Shu Y, Liao N, Fang F, Shi Q, Yan N, Hu Y. The relationship between psychological conditions and recurrence of benign paroxysmal positional vertigo: a retrospective cohort study. BMC Neurol 2023; 23:137. [PMID: 37004007 PMCID: PMC10064541 DOI: 10.1186/s12883-023-03169-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 03/16/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Psychological conditions have been found to be associated with an increased risk of incident benign paroxysmal positional vertigo (BPPV). However, much less is known on whether and how psychological conditions such as anxiety, insomnia and obsessive-compulsive disorder (OCD) affect the recurrence of BPPV. METHODS A retrospective cohort study of 2,612 outpatients and inpatients diagnosed with BPPV between September 2012 and August 2020. BPPV recurrence was followed up until February 2021. The Cox proportional hazard regression was used to analyze the association between psychological conditions and the risk of the first recurrence. Poisson regression was applied to analyze the association between psychological conditions and the number of recurrences in patients with at least one relapse. RESULTS During the follow-up, 391 patients had at least one BPPV recurrence. Female BPPV patients were more likely than male patients to experience relapses than male patients, but the characteristics of BPPV recurrence (number of recurrences and duration between recurrences) did not differ between men and women. After adjustment for sex, age and comorbidities, a heightened risk of first BPPV recurrence was found to be associated with anxiety (hazard ratio [HR]: 1.30, 95% confidence interval [CI]: 1.01, 1.68) and OCD (HR: 2.15, 95% CI: 1.31, 3.52). An increased risk of first BPPV recurrence associated with insomnia was only observed in male patients (HR: 2.22, 95% CI: 1.24, 3.98) but not in female patients (HR: 0.91, 95% CI: 0.63, 1.31). None of these psychological conditions were associated with the number of recurrences in patients who experienced recurrence. CONCLUSIONS The presence of anxiety and OCD increased the risk of first BPPV recurrence, as well as insomnia for male patients. These psychological conditions were not associated with the number of BPPV recurrences. Diagnosis and treatment of these psychological conditions could be a useful strategy to prevent the recurrence of BPPV.
Collapse
Affiliation(s)
- Yuexin Shu
- School of Public Health, Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Nannan Liao
- University-Town Hospital of Chongqing Medical University, Chongqing, 401331, People's Republic of China
| | - Fang Fang
- University-Town Hospital of Chongqing Medical University, Chongqing, 401331, People's Republic of China
| | - Qiuling Shi
- School of Public Health, Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Ning Yan
- University-Town Hospital of Chongqing Medical University, Chongqing, 401331, People's Republic of China.
| | - Yaoyue Hu
- School of Public Health, Chongqing Medical University, Chongqing, 400016, People's Republic of China.
| |
Collapse
|
3
|
Moen CM, Kontorinis G. Analysis of patient variables including socioeconomic indicators and their association with recurrence rates and persistence of benign paroxysmal positional vertigo: A retrospective case series. Clin Otolaryngol 2023. [PMID: 36938827 DOI: 10.1111/coa.14050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 01/13/2023] [Accepted: 03/05/2023] [Indexed: 03/21/2023]
Affiliation(s)
- Christy M Moen
- Department of Otolaryngology, Head and Neck Surgery, Queen Elizabeth University Hospital, Glasgow, UK
| | - Georgios Kontorinis
- Department of Otolaryngology, Head and Neck Surgery, Queen Elizabeth University Hospital, Glasgow, UK.,Glasgow University Medical School, University of Glasgow, Glasgow, UK
| |
Collapse
|
4
|
Li S, Wang Z, Liu Y, Cao J, Zheng H, Jing Y, Han L, Ma X, Xia R, Yu L. Risk Factors for the Recurrence of Benign Paroxysmal Positional Vertigo: A Systematic Review and Meta-Analysis. EAR, NOSE & THROAT JOURNAL 2020; 101:NP112-NP134. [PMID: 32776833 DOI: 10.1177/0145561320943362] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Benign paroxysmal positional vertigo (BPPV) has a high recurrence rate, but the risk factor-associated recurrence are elusive. METHODS Searches were performed in PubMed, Embase, Cochrane library, Web of science, Chinese National Knowledge Infrastructure, and Sino Med up to November 3, 2019. The effect size was analyzed by odds ratio and 95% CI. Data from eligible studies were meta-analyzed using Stata version 15.0. RESULTS Our search resulted in a total of 4076 hits. Twenty-four outcomes of sixty articles were included in the meta-analysis. Risk factors for the recurrence of BPPV included female gender, age (≥65years), hyperlipidemia, diabetes, hypertension, migraine, cervical spondylosis, osteopenia/osteoporosis, head trauma, otitis media, abnormal vestibular evoked myogenic potential, and long use of computers. No significant differences were found in side, type of the involved semicircular canals, smoking, alcohol consumption, stroke, ear surgery, duration of vertigo before treatment, the times of repositioning, Meniere disease, sleep disorders, hypercholesterolemia, and 25-hydroxy vitamin D. CONCLUSION These findings strengthen clinical awareness of early warning to identify patients with potential relapse risk of BPPV and clinicians should counsel patients regarding the importance of follow-up after diagnosis of BPPV.
Collapse
Affiliation(s)
- Shichang Li
- Department of Otorhinolaryngology Head and neck surgery, 71185Peking University People's Hospital, Beijing, China
| | - Zijing Wang
- Department of Otorhinolaryngology Head and neck surgery, 71185Peking University People's Hospital, Beijing, China
| | - Yan Liu
- Department of Otorhinolaryngology Head and neck surgery, 71185Peking University People's Hospital, Beijing, China
| | - Jie Cao
- Department of Otorhinolaryngology Head and neck surgery, 71185Peking University People's Hospital, Beijing, China
| | - Hongwei Zheng
- Department of Otorhinolaryngology Head and neck surgery, 71185Peking University People's Hospital, Beijing, China
| | - Yuanyuan Jing
- Department of Otorhinolaryngology Head and neck surgery, 71185Peking University People's Hospital, Beijing, China
| | - Lin Han
- Department of Otorhinolaryngology Head and neck surgery, 71185Peking University People's Hospital, Beijing, China
| | - Xin Ma
- Department of Otorhinolaryngology Head and neck surgery, 71185Peking University People's Hospital, Beijing, China
| | - Ruiming Xia
- Department of Otorhinolaryngology Head and neck surgery, 71185Peking University People's Hospital, Beijing, China
| | - Lisheng Yu
- Department of Otorhinolaryngology Head and neck surgery, 71185Peking University People's Hospital, Beijing, China
| |
Collapse
|
5
|
Sreenivas V, Sima NH, Philip S. The Role of Comorbidities in Benign Paroxysmal Positional Vertigo. EAR, NOSE & THROAT JOURNAL 2019; 100:NP225-NP230. [PMID: 31565984 DOI: 10.1177/0145561319878546] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To assess the correlation between the comorbidities, such as hypertension, diabetes, thyroid disorders, hearing loss, hyperlipidemia, and vitamin D deficiency and benign paroxysmal positional vertigo (BPPV) and to determine the high-risk groups for recurrence of symptoms. DESIGN Descriptive analytical study. MATERIALS AND METHODS Patients who met the inclusion criteria underwent complete ear, nose, and throat examination, including Dix-Hallpike test and roll-over test and blood pressure recording. Investigations included pure tone audiometry, random blood sugar/fasting blood sugar, serum thyroid-stimulating hormone, fasting serum total cholesterol, and serum vitamin D levels. Patients were followed up for a period of 6 months to 1 year. RESULTS Older age-group has an increased risk of BPPV and recurrence of symptoms. About 45.1% of the patients with BPPV who were detected to have symptoms of hypertension were also more common with hypertensive. Diabetes mellitus was found to have an increased risk of BPPV and its recurrence. The presence of other comorbidities, such as abnormal thyroid function test (9%), sensorineural hearing loss (14%), hypercholesterolemia (46%), and vitamin D deficiency (79%) didn't show any significant risk for recurrence. CONCLUSION The presence of comorbidities worsens the status of BPPV, causing more frequent otolith detachment. Hence, it increases the risk of recurrence even after successful repositioning maneuver. Patients presenting with BPPV should therefore be evaluated and treated for these comorbidities along with the repositioning maneuvers.
Collapse
Affiliation(s)
- V Sreenivas
- Department of Otorhinolaryngology-Head and Neck Surgery, St. Johns Medical College, Bangalore, Karnataka, India
| | - Natashya H Sima
- Department of Otorhinolaryngology-Head and Neck Surgery, St. Johns Medical College, Bangalore, Karnataka, India
| | - Sumy Philip
- Department of Otorhinolaryngology-Head and Neck Surgery, Raihan Institute of Medical Sciences, Eratupeta, Kottayam, Kerala
| |
Collapse
|
6
|
Wei W, Sayyid ZN, Ma X, Wang T, Dong Y. Presence of Anxiety and Depression Symptoms Affects the First Time Treatment Efficacy and Recurrence of Benign Paroxysmal Positional Vertigo. Front Neurol 2018; 9:178. [PMID: 29619005 PMCID: PMC5871662 DOI: 10.3389/fneur.2018.00178] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 03/07/2018] [Indexed: 01/30/2023] Open
Abstract
Objectives To investigate the possible effects of anxiety and/or depression symptoms on the treatment outcomes and recurrence of benign paroxysmal positional vertigo (BPPV). Methods This is a retrospective study conducted at a single institution. 142 consecutive patients diagnosed with idiopathic BPPV at the Department of Otology in Shengjing Hospital of China Medical University between October 2016 and July 2017 were retrospectively reviewed. 127 patients were finally included in this study. Zung self-rating anxiety scale (SAS) and Zung self-rating depression scale (SDS) were used to evaluate the presence of anxiety and/or depression, respectively, in our BPPV patients. A significant score (at or above 50 for SAS and 53 for SDS) represents the presence of clinically significant symptoms. Two-tailed Student’s t-test, χ2 test, and logistic regression analysis were used as appropriate. A p value less than 0.05 was considered statistically significant. Results The prevalence of anxiety and/or depression symptoms in BPPV patients in the present study was 49.61%. The effectiveness of the first time canalith repositioning maneuver (CRM) was 70.08%. With weekly follow-up treatments of CRM, the success rate increased to 97.64% by 1 month. The total recurrence rate at 6-month follow-up post-cure was 14.17%. Holding all other variables constant, patients with psychiatric symptoms (Relative-risk ratio: 3.160; p = 0.027) and patients with non-posterior semicircular canal (PSC) involvement (Relative-risk ratio: 7.828, p = 0.013) were more likely to experience residual dizziness (RD) even after effective CRM treatment. Psychiatric symptoms (Relative-risk ratio: 6.543; p = 0.001) and female gender (Relative-risk ratio: 4.563; p = 0.010) are risk factors for the failure of first time CRM. In addition, BPPV patients with psychiatric symptoms (Odds ratio: 9.184, p = 0.008) were significantly more likely to experience recurrences within the first 6 months after a successful maneuver. Conclusion Anxiety-depression status significantly reduced the efficacy of the first time CRM and increased the risk for recurrence. Other factors, such as female gender and non-PSC involvement are also susceptible risk factors for BPPV patients to require multiple treatments and experience delayed recovery. A screening for psychiatric symptoms in BPPV patients and active treatment of these symptoms would benefit both physicians and patients in understanding and improving the prognosis of the disease and treatment options.
Collapse
Affiliation(s)
- Wei Wei
- Department of Otology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zahra N Sayyid
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Xiulan Ma
- Department of Otology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Tian Wang
- Department of Otolaryngology-Head and Neck Surgery, Second Xiangya Hospital of Central South University, Changsha, China
| | - Yaodong Dong
- Department of Otology, Shengjing Hospital of China Medical University, Shenyang, China
| |
Collapse
|
7
|
Tirelli G, Nicastro L, Gatto A, Tofanelli M. Repeated canalith repositioning procedure in BPPV: Effects on recurrence and dizziness prevention. Am J Otolaryngol 2017; 38:38-43. [PMID: 27806891 DOI: 10.1016/j.amjoto.2016.09.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 09/25/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE To evaluate whether a repeated canalith repositioning procedure (CRP) influences the residual symptoms and the rate of recurrence of benign paroxysmal positional vertigo (BPPV) in patients with post-CRP dizziness. MATERIALS AND METHODS In this retrospective study, we analyzed 292 patients at the referral center for ENT diseases with a first episode of BPPV treated with a single CRP following clinical practice guidelines. In 178 patients (67.9%) who presented dizziness after BPPV recovery at the follow-up visit, 94 patients underwent CRP (treated group) and 84 did not (non-treated group). A subjective evaluation of vertigo was made by way of a questionnaire. The rates of recurrence of BPPV and residual dizziness were statistically compared between the treated and the non-treated groups; survival analysis was carried out as well. RESULTS In an observational period ranging from 1 to 6years, BPPV recurred in 122 subjects (46.6%) of the investigated population. Among the patients with residual dizziness, the difference in rate of recurrence of BPPV between the treated group and the non-treated group was not statistically significant (p=0.84). The treated group presented a significantly higher rate of recovery from dizziness compared to the non-treated group (p<0.001). CONCLUSIONS A repeated CRP in patients with post-CRP dizziness increased the rate of recovery from dizziness but had no influence on BBPV recurrence.
Collapse
|
8
|
Wallace B, Lifshitz J. Traumatic brain injury and vestibulo-ocular function: current challenges and future prospects. Eye Brain 2016; 8:153-164. [PMID: 28539811 PMCID: PMC5398755 DOI: 10.2147/eb.s82670] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Normal function of the vestibulo-ocular reflex (VOR) coordinates eye movement with head movement, in order to provide clear vision during motion and maintain balance. VOR is generated within the semicircular canals of the inner ear to elicit compensatory eye movements, which maintain stability of images on the fovea during brief, rapid head motion, otherwise known as gaze stability. Normal VOR function is necessary in carrying out activities of daily living (eg, walking and riding in a car) and is of particular importance in higher demand activities (eg, sports-related activities). Disruption or damage in the VOR can result in symptoms such as movement-related dizziness, blurry vision, difficulty maintaining balance with head movements, and even nausea. Dizziness is one of the most common symptoms following traumatic brain injury (TBI) and is considered a risk factor for a prolonged recovery. Assessment of the vestibular system is of particular importance following TBI, in conjunction with oculomotor control, due to the intrinsic neural circuitry that exists between the ocular and vestibular systems. The purpose of this article is to review the physiology of the VOR and the visual-vestibular symptoms associated with TBI and to discuss assessment and treatment guidelines for TBI. Current challenges and future prospects will also be addressed.
Collapse
Affiliation(s)
- Bridgett Wallace
- 360 Balance and Hearing, Department of Physical Therapy, Austin, TX
- Concussion Health, Department of Clinical Education, Austin, TX
- Conquering Concussions, Scottsdale, AZ
- Barrow Neurological Institute at Phoenix Children’s Hospital, Phoenix, AZ
| | - Jonathan Lifshitz
- Barrow Neurological Institute at Phoenix Children’s Hospital, Phoenix, AZ
- Department of Child Health, University of Arizona College of Medicine-Phoenix, Phoenix, AZ
- The CACTIS Foundation, Scottsdale
- Phoenix VA Healthcare System, Phoenix, AZ
- Department of Psychology, Arizona State University, Tempe, AZ, USA
| |
Collapse
|
9
|
Ribeiro KMOBD, Freitas RVDM, Ferreira LMDBM, Deshpande N, Guerra RO. Effects of balance Vestibular Rehabilitation Therapy in elderly with Benign Paroxysmal Positional Vertigo: a randomized controlled trial. Disabil Rehabil 2016; 39:1198-1206. [DOI: 10.1080/09638288.2016.1190870] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Karyna Myrelly Oliveira Bezerra de Ribeiro
- Post-Graduation Program in Health Sciences, Federal University of Rio Grande do Norte, Natal, Brazil
- Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil
| | | | | | - Nandini Deshpande
- Faculty of Health Sciences, School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | - Ricardo Oliveira Guerra
- Post-Graduation Program in Health Sciences, Federal University of Rio Grande do Norte, Natal, Brazil
- Post-Graduation Program of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil
| |
Collapse
|
10
|
Peluso ÉTP, Quintana MI, Ganança FF. Anxiety and depressive disorders in elderly with chronic dizziness of vestibular origin. Braz J Otorhinolaryngol 2016; 82:209-14. [PMID: 26515771 PMCID: PMC9449034 DOI: 10.1016/j.bjorl.2015.04.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 04/06/2015] [Accepted: 04/08/2015] [Indexed: 11/30/2022] Open
Abstract
Introduction Dizziness is one of the most prevalent symptoms in the elderly. Anxiety and depression are common in dizzy adult patients, but there is scarce information about comorbidity between vestibular disturbances and psychiatric disorders in the aged. Objective To assess the prevalence of anxiety and depression disorders in elderly with chronic dizziness of vestibular origin. Methods Transversal study that used the Brazilian version of the Composite International Diagnostic Interview 2.1 to assess anxiety and depressive disorders in elderly patients (≥60 years old) with chronic dizziness. Results Most of the 44 patients included in the study were female (88.6%) with a mean age of 71 years (±7.5), 68.1% had experienced dizziness for 1 year or more. The most prevalent diagnosis was benign paroxysmal positional vertigo (52.3%). The prevalence of generalized anxiety disorder and specific phobias during life were 29.5% and 22.7%, respectively, and, in the last 12 months, 18.2% and 15.9%. There was no patient with panic disorder, agoraphobia or social phobia. The prevalence of depressive disorder during life was 45.4%, and, in the last 12 months, were 11.3%. Conclusion Aged patients with chronic dizziness had high prevalence of some mental disorders.
Collapse
Affiliation(s)
- Érica Toledo Piza Peluso
- Professional Master's Program in Body Balance Rehabilitation and Social Inclusion, Universidade Anhanguera de São Paulo, São Paulo, SP, Brazil.
| | - Maria Inês Quintana
- Department of Psychiatry and Medical Psychology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Fernando Freitas Ganança
- Department of Otolaryngology and Head and Neck Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| |
Collapse
|
11
|
Ribeiro KMOBDF, Ferreira LMDBM, Freitas RVDM, Silva CND, Deshpande N, Guerra RO. "Positive to Negative" Dix-Hallpike test and Benign Paroxysmal Positional Vertigo recurrence in elderly undergoing Canalith Repositioning Maneuver and Vestibular Rehabilitation. Int Arch Otorhinolaryngol 2016; 20:344-352. [PMID: 27746838 PMCID: PMC5063735 DOI: 10.1055/s-0036-1572528] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 11/15/2015] [Indexed: 11/06/2022] Open
Abstract
Introduction Benign Paroxysmal Positional Vertigo is the most common cause of dizziness in elderly people. Recent studies have shown that the elderly present higher Benign Paroxysmal Positional Vertigo recurrence and that vertiginous symptomatology remission varies according to comorbidities and the therapeutic techniques applied. Objective To assess the short-term effectiveness of Vestibular Rehabilitation in addition to Canalith Repositioning Maneuver on positive to negative Dix-Hallpike test, on recurrence and number of maneuvers to achieve a negative test in elderly patients with chronic Benign Paroxysmal Positional Vertigo. Methods In this randomized controlled trial, 7 older adults (median age: 69 years, range 65–78) underwent Canalith Repositioning Maneuver and Vestibular Rehabilitation for thirteen weeks. Seven older adults (median age: 73 years, range 65–76) in the control group received only Canalith Repositioning Maneuver. The participants were assessed at baseline (T0), one (T1), five (T5), nine (T9), and thirteen weeks (T13). We assessed the differences between the groups by Mann-Whitney and Fisher exact tests, and used the Friedman and Wilcoxon tests to determine the intragroup differences. Results No significant differences were found between groups for the positive to negative Dix-Hallpike test, recurrence, and number of maneuvers to achieve a negative test. The number of maneuvers to achieve negative Dix-Hallpike test was lower in intragroup comparisons in the experimental group. Conclusion The findings suggest that additional Vestibular Rehabilitation did not influence the positive to negative Dix-Hallpike test, recurrence, or number of maneuvers to achieve a negative test in elderly patients with chronic Benign Paroxysmal Positional Vertigo.
Collapse
Affiliation(s)
| | | | | | - Camila Nicácio da Silva
- Department of Physiotherapy, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Nandini Deshpande
- Faculty of Health Sciences, School of Rehabilitation Therapy, Queen's University, Kingston, Canada
| | - Ricardo Oliveira Guerra
- Department of Physiotherapy, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| |
Collapse
|
12
|
Silva C, Amorim AM, Paiva A. Benign Paroxysmal Positional Vertigo – A Review of 101 Cases. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.otoeng.2014.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
13
|
Silva C, Amorim AM, Paiva A. Benign paroxysmal positional vertigo--a review of 101 cases. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2015; 66:205-9. [PMID: 25865125 DOI: 10.1016/j.otorri.2014.09.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 08/26/2014] [Accepted: 09/01/2014] [Indexed: 10/23/2022]
Abstract
INTRODUCTION AND OBJECTIVE Benign paroxysmal positional vertigo is one of the most common vestibular disorders, with a lifetime prevalence of 2.4%. This study aimed to assess age, gender, lesion type and site, association with other vestibular diseases, progression and recurrence in a Portuguese population. METHODS This was a retrospective observational study of 101 patients diagnosed with benign paroxysmal positional vertigo by the same senior doctor, in a tertiary academic hospital, between January 2009 and May 2011. RESULTS A total of 101 cases were pooled, with a mean age of 56.57±15.33 years (15-90 years). From these, 72.3% were women. The posterior canal was affected in 72.3%, the lateral in 24.7%, the anterior in 2% and multiple canals in 1%. Unilateral canal and left labyrinth involvement were more frequent. The therapeutic maneuver used most was Epley's. Recurrence was observed in 10.9% of the cases. It was idiopathic in 83.2% of cases. No association was found between the number of maneuvers necessary to treat benign paroxysmal positional vertigo and etiology. CONCLUSION Benign paroxysmal positional vertigo is more frequent in female subjects, in the 6th decade and involves preferably the posterior semicircular canal of the right labyrinth. In most cases it is idiopathic and treatment with repositioning maneuvers has a mean success of 90%. Our results were in accordance with the literature; nevertheless, in this study the left labyrinth was most affected and the follow-up period was variable.
Collapse
Affiliation(s)
- Clara Silva
- Otorhinolaryngology and Head and Neck Surgery Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
| | - Ana Margarida Amorim
- Otorhinolaryngology and Head and Neck Surgery Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - António Paiva
- Otorhinolaryngology and Head and Neck Surgery Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| |
Collapse
|
14
|
Vaz DP, Gazzola JM, Lança SM, Dorigueto RS, Kasse CA. Clinical and functional aspects of body balance in elderly subjects with benign paroxysmal positional vertigo. Braz J Otorhinolaryngol 2013; 79:150-7. [PMID: 23670318 PMCID: PMC9444521 DOI: 10.5935/1808-8694.20130027] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Accepted: 12/14/2012] [Indexed: 11/25/2022] Open
Abstract
Benign paroxysmal positional vertigo (BPPV) may compromise the balance of elderly subjects. Objective To observe the effects of the Epley maneuver in elderly subjects with BPPV and assess clinical and functional aspects of body balance. Method This is a prospective clinical study. Patients diagnosed with BPPV (Dix-Hallpike test) were submitted to the Timed Up & Go (TUG) test, the Clinical Test of Sensory Interaction and Balance (CTSIB), and lower limb testing before and after they were repositioned using the modified Epley maneuver. Results most subjects were females, and the group's mean age was 70.10 years (SD = 7.00). All patients had canalithiasis of the posterior canal. The following symptoms improved after the maneuver: postural instability (p = 0.006), nausea and vomiting (p = 0.021), and tinnitus (p = 0.003). Subjects improved their times significantly in the TUG and lower limb tests after the Epley maneuver (p < 0.001). Patients performed better on the CTSIB after the Epley maneuver on condition 2 (p < 0.003), condition 3 (p < 0.001), condition 4 (p < 0.001), condition 5 (p < 0.001), and condition 6 (p < 0.001). Conclusion Clinical and functional aspects of body balance in elderly with BPPV improved after treatment with the modified Epley maneuver.
Collapse
|
15
|
Do YK, Kim J, Park CY, Chung MH, Moon IS, Yang HS. The effect of early canalith repositioning on benign paroxysmal positional vertigo on recurrence. Clin Exp Otorhinolaryngol 2011; 4:113-7. [PMID: 21949575 PMCID: PMC3173700 DOI: 10.3342/ceo.2011.4.3.113] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2010] [Accepted: 12/12/2010] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Benign paroxysmal positional vertigo (BPPV) can be treated using a simple repositioning maneuver. This study demonstrates the effects of early repositioning therapy in patients with BPPV, especially with regard to recurrence. METHODS We enrolled 138 consecutive patients who had been diagnosed with BPPV in the emergency rooms and ENT out-patient clinics of Chung-Ang University Hospital and Samyook Medical Center from January to June 2009. All patients immediately underwent appropriate canalith repositioning procedures (CRPs) depending on canalith type and location. The CRPs were performed daily until the patient's symptoms were resolved. The patients were classified into two groups according to the duration between symptom onset and initial treatment: less than 24 hours (early repositioning group, n=66) and greater 24 hours (delayed repositioning group, n=72). We prospectively compared the numbers of treatments received and the recurrence rates between the two groups. RESULTS Follow-up periods ranged from 8 to 14 months, 77 cases involved posterior canal BPPV, 48 cases were lateral canal BPPV (of which 20 cases were cupulolithiasis), and 13 cases were multiple canal BPPV. BPPV recurrence was found in a total of 46 patients (33.3%). The necessary numbers of CRPs were 2.3 for the early repositioning group and 2.5 for the late repositioning group, a difference that was not statistically significant (P=0.582). The early repositioning group showed a recurrence rate of 19.7%, and the delayed repositioning group showed a recurrence rate of 45.8% (P=0.002). CONCLUSION Performing repositioning treatments as soon as possible after symptom onset may be an important factor in the prevention of BPVV recurrence.
Collapse
Affiliation(s)
- Youn-Kyoung Do
- Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jin Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Chong Yoon Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Myung-Hyun Chung
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - In Seok Moon
- Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hoon-Shik Yang
- Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| |
Collapse
|
16
|
Ganança FF, Gazzola JM, Ganança CF, Caovilla HH, Ganança MM, Cruz OLM. Elderly falls associated with benign paroxysmal positional vertigo. Braz J Otorhinolaryngol 2010; 76:113-20. [PMID: 20339699 PMCID: PMC9446013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2009] [Accepted: 07/29/2009] [Indexed: 09/04/2024] Open
Abstract
UNLABELLED Benign Paroxysmal Positional Vertigo (BPPV) can cause falls, especially in the elderly. AIM to study whether or not elderly patients with BPPV have a reduction on their falls after the particle repositioning maneuver (PRM). MATERIALS AND METHODS retrospective study including elderly with BPPV who had fall(s) during the last year. All patients were submitted to the PRM according to the affected semicircular canal (SCC). After the abolition of positioning vertigo and nystagmus, the patients were submitted to a 12 month follow-up and were investigated about the number of fall(s). Wilcoxon's test was performed to compare the number of fall(s) before and after 12 months of the PRM. RESULTS One hundred and twenty one patients were included in the study. One hundred and one patients presented involvement of the posterior SCC, 16 of the lateral and four of the anterior. We noticed a reduction on the number of falls, with statistically significant difference when all the patients were analyzed together (p<0.001), the posterior canal BPPV patients (p<0,001) and the lateral canal VPPB patients (p=0.002). We also found a tendency of statistically significant difference for the anterior canal BPPV patients (p=0.063). CONCLUSION BPPV elderly patients had indeed a reduction on the number of falls after the PRM.
Collapse
|