Modified particle repositioning procedure

Repeated canalith repositioning procedure in BPPV: Effects on recurrence and dizziness prevention

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.

Liberatory vertigo: a new prognostic factor for repositioning maneuvers

OBJECTIVE

This study suggests the new concept of liberatory vertigo to facilitate emergency department treatment of benign paroxysmal positional vertigo.

METHODS

The present prospective nonrandomized study enrolled 535 patients with typical forms of positional vertigo, who were treated following clinical practice guidelines. We observed the onset of liberatory vertigo during the maneuver as a prognostic factor, and we tested the correlation between that symptom and therapeutic effectiveness. A subjective evaluation of vertigo was made by way of a questionnaire. Data analysis was performed that made use of statistical software.

RESULTS

Complete recovery occurred in 287 patients (76.5%) with posterior semicircular canal positional vertigo and in 67 patients (80%) with horizontal semicircular canal positional vertigo; liberatory vertigo occurred in 195 (67.9%) and 59 (88%) of those cases, respectively. Differences in terms of recovery probability resulted regardless of the canal involved. Positive predictive value ranged from 93% to 97%.

CONCLUSIONS

In our sample, liberatory vertigo could predict the effectiveness of the maneuver regardless of the canal involved.

360-Degree Canalith Repositioning Procedure for the Horizontal Canal

OBJECTIVES: To evaluate the efficacy of modifications to the standard canalith repositioning procedure (CRP) in the treatment of benign positional vertigo (BPV) of the horizontal semicircular canal (HSC).

STUDY DESIGN AND SETTING: Prospective trial of 72 patients with BPV of the HSC treated with a modified 360-degree CRP.

RESULTS: 51 of the 62 patients treated for canalolithiasis made a complete recovery (82.2%) after a single 360-degree CRP.

CONCLUSIONS AND SIGNIFICANCE: It is proposed a full 360-degree rotation of the HSC involved. It is essential to begin rotation of the patient departing from the affected side towards the healthy side, especially for canal side cupulolithiasis and for canalithiasis of the ampullar branch of the HSC. The head resting on the chest at angle of 30-degree during rotating encourages free-floating debris in the HSC to move into the utricle. Instead of using an oscillator for oscillation of the mastoid bone the head is shaken manually.

Canalith Repositioning for Benign Paroxysmal Positional Vertigo

OBJECTIVE

To evaluate the efficacy of canalith repositioning maneuvers (Semont, Epley, and modified maneuvers) in the treatment of posterior canal benign paroxysmal positional vertigo (BPPV) in comparison to the rate of resolution in the untreated control cohort.

DATA SOURCES

Source articles were identified by a MEDLINE search of English language sources before 2004 plus manual crosschecks of bibliographies from identified articles, selected national meeting abstracts, review article references, and textbook chapters.

STUDY SELECTION

Each controlled trial that compared canalith repositioning patients to untreated control subjects in posterior canal benign positional vertigo (blinded and unblinded) was reviewed for inclusion.

DATA EXTRACTION

Data were abstracted systematically, scaled on validity and comparability, and cross-checked independently by another author.

DATA SYNTHESIS

Studies were combined with fixed effects meta-analysis to estimate spontaneous resolution, 95% confidence intervals (CI) of effect size, and heterogeneity.

CONCLUSION

Canalith repositioning is more effective than observation alone for the treatment of benign paroxysmal positional vertigo, despite spontaneous resolution rates of one in three at 3 weeks. Public health implications are discussed, based on the high frequency of unrecognized BPPV reported in elderly patients, and the improvements after canalith repositioning in postural control and health-related quality of life (SF 36 Health Survey) documented in the literature.

Efficacy of particle repositioning maneuver in BPPV: a prospective study

PURPOSE

A single blinded prospective randomized controlled trial was conducted in 40 patients with benign paroxysmal positional vertigo (BPPV) to determine the efficacy of particle repositioning maneuver (PRM).

MATERIALS AND METHODS

Out of 40 patients, 20 underwent PRM with the rest receiving a placebo treatment. Postprocedural instructions were given to all the patients who underwent PRM. Follow-up was for 1 year at regular intervals. Analysis was based on the symptomatic status and the Hallpike maneuver at each visit.

RESULTS

After the initial week, 95% showed complete resolution of symptoms with none reporting a recurrence after PRM. On the contrary, only 15% of the controls had complete resolution with 14 out of 20 reporting a recurrence of BPPV. Results remained more or less the same at the end of 4 weeks. Six months after PRM, 19 of 20 patients had no vertigo with a meager 5% showing recurrence versus 75% of controls reporting a recurrence with only 3 of 20 reporting a favorable symptom status. At the end of 1 year, 18 of 20 patients had complete relief from symptoms with only 10% showing Hallpike maneuver positive in the study group compared with 3 of 20 reporting a relief from symptoms with 90% turning out to be Hallpike maneuver positive in the control group.

CONCLUSIONS

This study establishes the efficacy of PRM in short- and long-term management of BPPV; the procedure is easy and simple.

Peripheral vestibular disorders with acute onset of vertigo

Disorders of the vestibular nerve and end organs are the most common causes of vertigo. The advances in recognizing different forms of canalolithiasis and cupulolithiasis, which sometimes present with continuous positional nystagmus, have revealed a peripheral vestibular aetiology in which central nervous system lesions were previously suspected. Treatments using repositioning manoeuvres are also successful in cases in which nystagmus does not appear, and when administered by less specialized physicians. In acute vestibulopathy, suspicions of the activation of herpes virus infections as a causative agent are increasing, but no reports on the treatment of such infections are yet available. New treatments are in development for use in Ménière's disease.

Benign positional vertigo without detectable nystagmus

OBJECTIVES

To demonstrate that for treatment of benign positional vertigo it is not necessary to identify a positional nystagmus.

STUDY DESIGN

Prospective trial of 43 patients with positional vertigo without clinical evidence of positional nystagmus who were treated with a modified canal-repositioning maneuver.

METHODS

Results were compared with the results obtained in the treatment of posterior semicircular cupolo-canalithiasis with typical positional nystagmus with the same repositioning maneuver.

RESULTS

Treatment of 43 patients with positional vertigo without positional nystagmus resulted in a 60.46% (26/43) complete recovery rate and a 6% (3/43) persistence of disorder rate compared with a 90% complete recovery rate obtained in 90 patients with typical benign positional paroxysmal vertigo (with positional nystagmus).

CONCLUSIONS

What is attempted by this work is to confirm that through clinical evaluation based on history and positioning tests alone, one can obtain acceptable results in treatment of supposed canalithiasis without having detected the pathognomonic nystagmus.