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Lee JM, Lee HJ. Different clinical course of BPPV according to the medical conditions. Sci Rep 2024; 14:12941. [PMID: 38839867 PMCID: PMC11153214 DOI: 10.1038/s41598-024-63882-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 06/03/2024] [Indexed: 06/07/2024] Open
Abstract
Dizziness is one of the most prevalent complaints in medicine, and benign paroxysmal positional vertigo (BPPV) accounts for one-third of all cases. The present study was aimed at identifying differences in the course and prognosis of BPPV depending on the patient's medical condition during hospitalization. Patients in group 1 were hospitalized due to trauma, those in group 2 for scheduled surgery, and those in group 3 for medical treatment. The intervals from admission to symptom onset, surgery to symptom onset, and symptom onset to ENT department referral were compared. The interval from admission to symptom onset was shortest in group 1 (3.1 ± 8.0 days) and differed significantly from that in group 3 (20.0 ± 35.0 days, p < 0.001). The interval from surgery to symptom onset for group 2 was 5.6 ± 5.8 days and was significantly shorter than that from admission to symptom onset for group 3 (p = 0.014). The interval from symptom onset to ENT referral in group 3 (2.0 ± 2.8 days) was significantly shorter than in groups 1 and 2 (4.1 ± 5.1 and 4.0 ± 3.6 days, p = 0.008 and p = 0.002, respectively). The findings imply that the course of BPPV differed according to the patients' medical condition.
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Affiliation(s)
- Jeon Mi Lee
- Department of Otorhinolaryngology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Hyun Jin Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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Smith RM, Burgess C, Beattie J, Newdick A, Tahtis V, Sahu B, Golding JF, Marsden J, Seemungal BM. Treating benign paroxysmal positional vertigo in acute traumatic brain injury: a prospective, randomised clinical trial assessing safety, feasibility, and efficacy. BMJ Neurol Open 2024; 6:e000598. [PMID: 38818242 PMCID: PMC11138307 DOI: 10.1136/bmjno-2023-000598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 05/06/2024] [Indexed: 06/01/2024] Open
Abstract
Background Benign paroxysmal positional vertigo (BPPV) affects approximately half of acute, moderate-severe traumatic brain injury (TBI) patients. To date, there have been no rigorous studies of BPPV assessment or treatment in this cohort. We aimed to determine the safety, practicability, and efficacy of therapist-led BPPV management in acute TBI and the feasibility of a larger effectiveness trial. Methods This was a multi-centre, three-arm, parallel-groups, randomised, feasibility trial. Recruitment was via convenience sampling. The main inclusion criteria were age over 18 years and a confirmed, non-penetrating, acute TBI. BPPV-positive patients were randomly allocated to one of three interventions (repositioning manoeuvres, Brandt-Daroff exercises or advice) using minimisation criteria. Outcome assessors were blinded to the intervention. Results Of 2014 patients screened for inclusion, 180 were assessed for BPPV. Of those assessed, 34% (62/180) had BPPV, and 58 patients received an intervention. Therapist-led interventions were delivered safely and accurately according to intervention monitoring criteria. Resolution of BPPV was observed in 35/58 (60%) patients. The resolution rate was highest following repositioning manoeuvres (78%), followed by the advice (53%) and Brandt-Daroff interventions (42%). 10 patients experienced recurrence. This was observed more frequently in those with skull fractures and bilateral or mixed BPPV. Conclusions Overall, the results provide strong evidence for the feasibility of a future trial. Therapist-led management of BPPV in acute TBI was safe and practicable. Repositioning manoeuvres seemingly yielded a superior treatment effect. However, given the high recurrence rate of post-traumatic BPPV, the optimal time to treat according to patients' specific recurrence risk requires further investigation. Trial registration ISRCTN91943864, https://doi.org/10.1186/ISRCTN91943864.
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Affiliation(s)
- Rebecca M Smith
- Centre for Vestibular Neurology, Department of Brain Sciences, Imperial College London, London, UK
| | - Caroline Burgess
- School of Population Health & Environmental Studies, King's College London, London, UK
| | - Jenna Beattie
- Occupational Therapy, Imperial College Healthcare NHS Trust, London, UK
| | - Abby Newdick
- Physiotherapy, St George's Healthcare NHS Trust, London, UK
| | - Vassilios Tahtis
- Occupational Therapy, King's College Hospital NHS Foundation Trust, London, London, UK
| | - Bithi Sahu
- Centre for Vestibular Neurology, Department of Brain Sciences, Imperial College London, London, UK
| | | | - Jonathan Marsden
- School of Health Professions, University of Plymouth, Plymouth, Plymouth, UK
| | - Barry M Seemungal
- Centre for Vestibular Neurology, Department of Brain Sciences, Imperial College London, London, UK
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Kim CH, Kim H, Jung T, Lee DH, Shin JE. Clinical characteristics of benign paroxysmal positional vertigo after traumatic brain injury. Brain Inj 2024; 38:341-346. [PMID: 38297437 DOI: 10.1080/02699052.2024.2310790] [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: 02/02/2023] [Accepted: 01/23/2024] [Indexed: 02/02/2024]
Abstract
INTRODUCTION The aim of the present study was to evaluate the characteristics of brain injury and to assess the relationship between them and treatment outcomes in patients with traumatic benign paroxysmal positional vertigo (t-BPPV). MATERIALS AND METHODS Sixty-three consecutive patients who were diagnosed with BPPV within 2 weeks after head trauma were included. RESULTS Cerebral concussion, intracranial hemorrhages (ICH), skull fracture without ICH, and hemorrhagic contusion were observed in 68%, 24%, 5%, and 3% of t-BPPV patients, respectively. BPPV with single canal involvement was observed in 52 (83%) patients and that with multiple canal involvement was observed in 11 (17%) patients. The number of treatment sessions was not significantly different according to the cause of head trauma (p = 0.252), type of brain injury (p = 0.308) or location of head trauma (p = 0.287). The number of recurrences was not significantly different according to the cause of head trauma (p = 0.308), type of brain injury (p = 0.536) or location of head trauma (p = 0.138). CONCLUSION The present study demonstrated that there were no significant differences in treatment sessions until resolution and the mean number of recurrences according to the type of brain injury.
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Affiliation(s)
- Chang-Hee Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Hansol Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Taesik Jung
- Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Dong-Han Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Jung Eun Shin
- Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea
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Peñaloza-Polo P, Santandreu-Jiménez ME, Bárbara-Bataller E, Méndez-Suárez JL. [Patient with cervical spinal cord injury and benign paroxysmal positional vertigo treated with particle repositioning maneuvers]. Rehabilitacion (Madr) 2023; 57:100805. [PMID: 37352599 DOI: 10.1016/j.rh.2023.100805] [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: 09/20/2022] [Revised: 12/19/2022] [Accepted: 01/29/2023] [Indexed: 06/25/2023]
Abstract
Benign paroxysmal positional vertigo (BPPV) is characterized by short, sudden episodes of vertigo when the head moves in specific positions. The treatment is particle repositioning maneuvers. BPPV usually is underdiagnosed, unreported and therefore not adequately treated. We present the case of a patient with spinal cord injury and BPPV. A 72-year-old patient who suffered a C5 fracture with spinal cord injury C5 AIS C that required surgical fixation. In the spinal cord injury unit BPPV of the left lateral semicircular canal was documented and treated using specific repositioning maneuvers, the patient progressively improved and was able to complete the rehabilitation treatment. The spinal cord injury unit with access to vestibular rehabilitation units can carry out the diagnosis and specific treatment of BPPV, minimizing the risks for the patient.
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Affiliation(s)
- P Peñaloza-Polo
- Servicio de Rehabilitación, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, España.
| | - M E Santandreu-Jiménez
- Servicio de Rehabilitación, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, España; Facultad de Medicina, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, España
| | - E Bárbara-Bataller
- Unidad de Lesionados Medulares, Servicio de Rehabilitación, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, España
| | - J L Méndez-Suárez
- Unidad de Lesionados Medulares, Servicio de Rehabilitación, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, España
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Chen X, Zheng X, Chen Y, Xu S. Otosyphilis as a rare cause of secondary benign paroxysmal positional vertigo: a case report. J Int Med Res 2023; 51:3000605231153317. [PMID: 37365906 DOI: 10.1177/03000605231153317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023] Open
Abstract
Otosyphilis is a rare cause of audiovestibular dysfunction that can easily be misdiagnosed. Here, we report a rare case in which a patient presented with secondary benign paroxysmal positional vertigo (BPPV) 2 weeks after symptoms of otosyphilis appeared. The Dix-Hallpike test showed a classical response in the head-hanging left position. The patient was treated with intravenous penicillin G and the canalith repositioning maneuver, which completely resolved the vertigo. The patient's audiovestibular symptoms resolved gradually. The elevated cerebrospinal fluid (CSF) white blood cell (WBC) count returned to normal and the results of the Treponema pallidum particle agglutination (TPPA) test were negative at the 3-month follow-up. This report suggests that otosyphilis should be considered in the differential diagnosis of audiovestibular dysfunction in patients at risk. Additionally, clinicians should remain vigilant about the possibility of secondary BPPV in patients with otosyphilis who report positional vertigo.
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Affiliation(s)
- Xiang Chen
- Department of Internal Medicine, Shengsi County People's Hospital, Zhoushan City, China
| | - Xiaofen Zheng
- Department of Internal Medicine, Shengsi County People's Hospital, Zhoushan City, China
| | - Yingzhi Chen
- Department of Internal Medicine, Shengsi County People's Hospital, Zhoushan City, China
| | - Shanhu Xu
- Department of Neurology, Zhejiang Hospital, Hangzhou City, China
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Marroney N, Beattie J, Hildebrand N, Flint T, Smith RM. Does training therapists to manage benign paroxysmal positional vertigo in patients with acute traumatic brain injury reduce vestibular neurology referrals? Brain Inj 2022; 36:822-826. [PMID: 35133230 DOI: 10.1080/02699052.2022.2034955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE Dizziness is common in patients with acute traumatic brain injury (aTBI). However, patients are not always managed by the ward team but instead are referred to a visiting vestibular neurology team or referred for outpatient follow-up. We aimed to ascertain whether training trauma ward therapists to manage a common form of post-traumatic dizziness (Benign paroxysmal positional vertigo [BPPV]) reduced referrals to a visiting vestibular neurology team. DESIGN Referrals of patients with aTBI with complaints of dizziness to the visiting vestibular neurology team were audited from the Major Trauma Centre at Imperial College Healthcare NHS Foundation Trust, London, UK. Ward therapists subsequently received training on management of BPPV. Referrals to the vestibular neurology service were re-audited. Therapist confidence in assessing and treating BPPV was also assessed pre and post-training. RESULTS Pre-training, referral rate to the visiting vestibular neurology service was eight patients per month. Following training, referrals to the vestibular neurology service reduced by 35%. Therapist confidence improved significantly following training. CONCLUSIONS Training trauma ward therapists to manage BPPV reduced referrals to a visiting vestibular neurology service. Further research is necessary to assess implications for service and patient level parameters, such as length of stay and time to discharge.
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Affiliation(s)
- Natalie Marroney
- Physiotherapy Department, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Jenna Beattie
- Occupational Therapy Department, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Natalie Hildebrand
- Physiotherapy Department, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Thomas Flint
- Physiotherapy Department, Imperial College Healthcare NHS Foundation Trust, London, UK
| | - Rebecca M Smith
- Brain and Vestibular Group, Neuro-otology Unit, Department of Brain Sciences, Imperial College London, London, UK
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Teggi R, Guidetti R, Gatti O, Guidetti G. Recurrence of benign paroxysmal positional vertigo: experience in 3042 patients. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2021; 41:461-466. [PMID: 34734582 PMCID: PMC8569667 DOI: 10.14639/0392-100x-n1233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 05/10/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Benign paroxysmal positional vertigo (BPPV) is a disorder of the inner ear with a high rate of recurrence. Vascular disorders, migraine and autoimmune disorders have been considered facilitating factors for relapsing episodes. Our aim was to assess the role of vascular disorders, migraine and anti-thyroid antibodies in patients with recurrences. METHODS We retrospectively analysed records of 3042 patients treated for BPPV without other lifetime vertigo. Clinical data included previous vascular disorders of the central nervous system, heart disorders, migraine and recent head trauma. The presence of anti-thyroid autoantibodies was assessed in all patients. RESULTS Mean age of the first BPPV was 52.8 ± 14.5 years; there were 2339 females (76.9%), while 2048 (67.3%) of patients presented recurrences within two years of follow-up. Previous disorders of the central nervous system, presence of anti-thyroid antibodies, head trauma and migraine showed an association with recurrences. Above all, in subjects having the first BPPV while aged between 40 and 60 years, anti-thyroid antibodies were predictive for recurrences. CONCLUSIONS Our data are consistent with the hypothesis that anti-thyroid autoantibodies may play a role in recurrences in subjects with initial manifestations between 40 and 60 years.
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Affiliation(s)
- Roberto Teggi
- Division of Otolaryngology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Omar Gatti
- Division of Otolaryngology, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Gan Z, Zhou S, Yang H, He F, Wei D, Bai Y, Wang Y, Wang Y, Fu W, Han J. Self-Treatment of Posterior Canal Benign Paroxysmal Positional Vertigo: A Preliminary Study. Front Med (Lausanne) 2021; 8:654637. [PMID: 33996859 PMCID: PMC8116577 DOI: 10.3389/fmed.2021.654637] [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: 01/17/2021] [Accepted: 03/15/2021] [Indexed: 12/04/2022] Open
Abstract
Objectives: The purpose of this study is to investigate a modified Epley maneuver for self-treatment of posterior canal benign paroxysmal positional vertigo (PC-BPPV). Methods: The study recruited 155 patients with PC-BPPV. All patients were randomized into the Epley maneuver group (n = 77) and modified Epley maneuver group (n = 78). We analyzed the resolution rate (1 day and 1 week), residual symptoms after the maneuver, and adverse effects. Results: It was found that the modified Epley maneuver group had a higher resolution rate than that of the Epley maneuver group in the treatment of PC-BPPV after 1 day of the initial maneuver (p < 0.05). However, there was no difference in resolution rate between the Epley maneuver group and the modified Epley maneuver group in resolution rate after 1 week of the initial maneuver (p > 0.05). The modified Epley maneuver group had fewer residual symptoms than that of the Epley maneuver group 1 week after treatment of PC-BPPV (p < 0.05). Significant improvements were also observed in average DHI scores in patients who underwent the modified Epley maneuver compared to the Epley maneuver (p < 0.05). There was no significant difference in adverse effects between the two groups (p > 0.05). Conclusions: The modified Epley maneuver has a satisfactory therapeutic efficacy with less residual symptoms and could be recommended as a self-treatment for patients with PC-BPPV.
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Affiliation(s)
- Zhuangqin Gan
- Department of Neurology, Qionghai People's Hospital, Qionghai, China
| | - Shiling Zhou
- Department of Neurology, Qionghai People's Hospital, Qionghai, China
| | - Hui Yang
- Department of Neurology, Qionghai People's Hospital, Qionghai, China
| | - Feng He
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Dong Wei
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Ya Bai
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Yuanyuan Wang
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Yingxia Wang
- Department of Neurology, Qionghai People's Hospital, Qionghai, China
| | - Wei Fu
- Department of Geriatrics, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Junliang Han
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
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Di Cesare T, Tricarico L, Passali GC, Sergi B, Paludetti G, Galli J, Picciotti PM. Traumatic benign paroxysmal positional vertigo: personal experience and comparison with idiopathic BPPV. Int J Audiol 2020; 60:393-397. [PMID: 32959692 DOI: 10.1080/14992027.2020.1821253] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Benign paroxysmal positional vertigo (BPPV) is the most common cause of vestibular vertigo, with post-traumatic origin in about 15% of cases. Management and prognosis of traumatic BPPV (T-BPPV) are still debated, especially about recurrence. The aim was to compare T-BPPV to idiopathic (I-BPPV). DESIGN AND STUDY SAMPLE We analysed data about 795 BPPV patients: 716 idiopathic (90%) and 79 post-traumatic (10%), evaluating clinical history and bedside-examination, treating all patients with repositioning manoeuvres and reassessing them until the resolution of symptoms and nystagmus. RESULTS Persistence rate in T-BPPV and I-BPPV patients was significantly different (p = 0.0074, OR = 2.31), respectively 12.6% and 5%. Also the rate of bilateral disease (p = 0.0063, OR = 4.72) and multicanalar involvement (p = 0.0183; OR = 4.67) were significantly higher in T-BPPV patients . There were no significant differences in age and sex distribution, side and canal interested. In T-BPPV group, the resolution rate with one manoeuvre was lower than I-BPPV (p = 0.0132: OR: 0,56). Recurrence rate was 38% in the T-BPPV group and 30.6% in the I-BPPV group, without significant difference. CONCLUSIONS T-BPPV resulted different from I-BPPV in the resolution rate, bilateral or multiple canal involvement and persistence rate. T-BPPV and I-BPPV does not differ for recurrence rate, suggesting that, after resolution, the natural course of post-traumatic and idiopathic BPPV is similar.
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Affiliation(s)
- Tiziana Di Cesare
- ENT and Head Neck Surgery Department, Catholic University, Rome, Italy
| | - Laura Tricarico
- ENT and Head Neck Surgery Department, Catholic University, Rome, Italy
| | | | - Bruno Sergi
- Otolaryngology, Catholic University, Rome, Italy
| | - Gaetano Paludetti
- ENT and Head Neck Surgery Department, Catholic University, Rome, Italy.,Otolaryngology, Catholic University, Rome, Italy
| | - Jacopo Galli
- ENT and Head Neck Surgery Department, Catholic University, Rome, Italy.,Otolaryngology, Catholic University, Rome, Italy
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Abstract
The pathophysiological mechanism underlying benign paroxysmal positional vertigo (BPPV) is related to free-floating debris/otoliths in the semicircular canal (canalolithiasis) or debris/otoliths attached to the cupula (cupulolithiasis). These debris/otoliths are considered to originally accumulate after detachment from the neuroepithelium of the utricular macula secondary to a type of degeneration. An idiopathic form, which is assumed to occur spontaneously, is diagnosed when the causative pathology is obscure. However, an association between various other systemic or inner ear conditions and BPPV has been reported, indicating the existence of secondary BPPV. This study was performed to present the first review of the pathology underlying BPPV following a complete PubMed/Medline search. In total, 1932 articles published from 1975 to 2018 were reviewed. The articles were classified according to 17 potentially causative factors (aging; migraine; Meniere's disease; infection; trauma; idiopathic sudden sensorineural hearing loss; sleeping habits; osteoporosis and vitamin D insufficiency; hyperglycemia and diabetes mellitus; chronic head and neck pain; vestibule or semicircular canal pathology; pigmentation disorders; estrogen deficiency; neurological disorders; autoimmune, inflammatory, or rheumatologic disorders; familial or genetic predisposition; and allergy). A discussion of the underlying cause of BPPV for each factor is presented.
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Affiliation(s)
- Sertac Yetiser
- Department of Otolaryngology-Head and Neck Surgery, Anadolu Medical Center, Gebze, Kocaeli, Turkey
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