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Zach H, Retter D, Schmoeger M, Rommer P, Willinger U, Schwarz FK, Wiest G. Seasonality of benign paroxysmal positional vertigo : A retrospective study from Central Europe. Wien Klin Wochenschr 2024; 136:25-31. [PMID: 37405489 PMCID: PMC10776474 DOI: 10.1007/s00508-023-02237-w] [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: 03/20/2023] [Accepted: 05/30/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND Although benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo in clinical practice, factors influencing the pathophysiology remain not fully understood. OBJECTIVE Here we aim to investigate possible seasonal influences on the occurrence of BPPV in Vienna, a city located in a Central European country with pronounced seasonal fluctuations. METHODS We retrospectively investigated data from 503 patients presenting with BPPV to the outpatient clinics of the Medical University of Vienna between 2007 and 2012. Analyses included age, gender, type of BPPV, seasonal assignment, as well as daylight hours and the temperature in Vienna at symptom onset. RESULTS Out of 503 patients (159 male, 344 female, ratio 1:2.2; mean age 60 ± 15.80 years), most patients presented with posterior (89.7%) and left-sided (43.1%) BPPV. There was a significant seasonal difference (χ2 p = 0.036) with the majority of symptoms occurring in winter seasons (n = 142), followed by springtime (n = 139). Symptom onset did not correlate with the average temperature (p = 0.24) but on the other hand very well with daylight hours (p < 0.05), which ranged from 8.4 h per day in December, to an average of 15.6 h in July. CONCLUSION Our results show a seasonal accumulation of BPPV during winter and springtime, which is in line with previous studies from other climatic zones, suggesting an association of this seasonality with varying vitamin D levels.
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Affiliation(s)
- Heidemarie Zach
- Neurotology Outpatient Clinic, Dept. of Neurology, Medical University of Vienna, Waehringerguertel 18-20, 1090, Vienna, Austria
| | - David Retter
- Neurotology Outpatient Clinic, Dept. of Neurology, Medical University of Vienna, Waehringerguertel 18-20, 1090, Vienna, Austria
| | - Michaela Schmoeger
- Neurotology Outpatient Clinic, Dept. of Neurology, Medical University of Vienna, Waehringerguertel 18-20, 1090, Vienna, Austria
| | - Paulus Rommer
- Neurotology Outpatient Clinic, Dept. of Neurology, Medical University of Vienna, Waehringerguertel 18-20, 1090, Vienna, Austria
| | - Ulrike Willinger
- Neurotology Outpatient Clinic, Dept. of Neurology, Medical University of Vienna, Waehringerguertel 18-20, 1090, Vienna, Austria
| | - Felix K Schwarz
- Neurotology Outpatient Clinic, Dept. of Neurology, Medical University of Vienna, Waehringerguertel 18-20, 1090, Vienna, Austria
| | - Gerald Wiest
- Neurotology Outpatient Clinic, Dept. of Neurology, Medical University of Vienna, Waehringerguertel 18-20, 1090, Vienna, Austria.
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Tjell C, Iglebekk W. Chronic Multicanalicular BPPV as a Possible Cause of mal de Débarquement Syndrome. Otol Neurotol 2023; 44:838-839. [PMID: 37525384 DOI: 10.1097/mao.0000000000003971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
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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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4
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Is a Mechanical Rotational Chair Superior to Manual Treatment Maneuvers on an Examination Bed in the Treatment of Benign Paroxysmal Positional Vertigo? Otol Neurotol 2022; 43:e235-e242. [PMID: 35015750 DOI: 10.1097/mao.0000000000003380] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare the efficacy of the TRV-chair, a mechanical rotational chair, against manual treatment maneuvers in the treatment of benign paroxysmal positional vertigo (BPPV). STUDY DESIGN Prospective open-label block-randomized controlled clinical trial. SETTING Tertiary referral center. SUBJECTS Seventy-four patients referred from primary care and subsequently diagnosed with BPPV. INTERVENTIONS Patients were randomized to diagnostics and treatment with either manual treatment maneuvers on an examination table or using the TRV-chair. MAIN OUTCOMES The primary outcome was treatment efficacy, defined as absence of positional nystagmus (with or without concomitant vertigo), following one treatment. Secondary outcomes were number of treatments necessary for treatment success and Dizziness Handicap Inventory (DHI) scores. RESULTS 61.1% of the subjects in the TRV-group and 63.2% in the manual treatment group were treated successfully (p = 0.856). The differences in the number of treatments necessary to achieve treatment success as well as pre- and post-treatment DHI-scores between the TRV-group and the manual treatment group were nonsignificant. CONCLUSIONS Traditional manual treatment maneuvers and treatment maneuvers performed with the TRV-chair are equally good at treating BPPV in patients referred directly from primary care.
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Andersson H, Jablonski GE, Nordahl SHG, Nordfalk K, Helseth E, Martens C, Røysland K, Goplen FK. The Risk of Benign Paroxysmal Positional Vertigo After Head Trauma. Laryngoscope 2021; 132:443-448. [PMID: 34487348 DOI: 10.1002/lary.29851] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 08/22/2021] [Accepted: 08/23/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Head trauma may cause dislodgement of otoconia and development of benign paroxysmal positional vertigo (BPPV). The risk of developing BPPV is expected to be highest shortly after the trauma, then decrease and approach the risk seen in the general population. The aim of this study was to estimate the risk-time curve of BPPV development after head trauma. STUDY DESIGN Prospective observational study. METHODS Patients with minimal, mild, or moderate head trauma treated at the Department of Neurosurgery or the Department of Orthopedic Emergency at Oslo University Hospital, were interviewed and examined for BPPV using the Dix-Hallpike and supine roll maneuvers. BPPV was diagnosed according to the International diagnostic criteria of the Bárány Society. Telephone interviews were conducted at 2, 6, and 12 weeks after the first examination. RESULTS Out of 117 patients, 21% developed traumatic BPPV within 3 months after the trauma. The corresponding numbers were 12% with minimal trauma, 24% with mild, and 40% with moderate trauma. The difference in prevalence between the groups was significant (P = .018). During the first 4 weeks after the trauma, it was observed 20, 3, 0, and 1 BPPV onsets, respectively. No BPPV cases were seen for the remainder of the 3-month follow-up. CONCLUSION The risk of developing BPPV after minimal-to-moderate head trauma is considerable and related to trauma severity. Most cases occur within few days after the trauma, but any BPPV occurring within the first 2 weeks after head trauma are likely due to the traumatic event. LEVEL OF EVIDENCE 3 Laryngoscope, 2021.
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Affiliation(s)
- Helene Andersson
- Medical Student at Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Greg Eigner Jablonski
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Otorhinolaryngology and Head and Neck Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Stein Helge Glad Nordahl
- Norwegian National Advisory Unit on Vestibular Disorders, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | | | - Eirik Helseth
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Neurosurgery, Oslo University Hospital, Oslo, Norway
| | - Camilla Martens
- Norwegian National Advisory Unit on Vestibular Disorders, Haukeland University Hospital, Bergen, Norway.,Department of Otorhinolaryngology, Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway
| | - Kjetil Røysland
- Department of Biostatistics, University of Oslo, Oslo, Norway
| | - Frederik Kragerud Goplen
- Norwegian National Advisory Unit on Vestibular Disorders, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Otorhinolaryngology, Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway
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Šarkić B, Douglas JM, Simpson A, Vasconcelos A, Scott BR, Melitsis LM, Spehar SM. Frequency of peripheral vestibular pathology following traumatic brain injury: a systematic review of literature. Int J Audiol 2021; 60:479-494. [PMID: 32907431 DOI: 10.1080/14992027.2020.1811905] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 08/12/2020] [Accepted: 08/12/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To establish the frequency of occurrence of peripheral vestibular dysfunction in adults who have sustained non-blast-related traumatic brain injury (TBI) as measured through the standard audiological vestibular test battery. DESIGN A systematic search of English language literature using MEDLINE, EMBASE, PsycINFO, CINAHL, hand-searching of reference lists and SCOPUS author search was conducted from January 1, 1990 to May 14, 2019. STUDY SAMPLES Twenty-three out of 417 originally identified articles were retained. TBI and peripheral vestibular findings were extracted and synthesised. RESULTS Quality appraisal using the Oxford Centre for Evidence-Based Medicine (OCEBM) revealed Level 2b as the highest level of evidence. None of the primary studies explored vestibular deficits in acute settings, with data collected from tertiary institutions and in 20 of 23 studies retrospectively. Although retrospective studies provided important data, they fail to control for numerous threats to internal validity. BPPV was the most frequently identified peripheral vestibular deficit following TBI, diagnosed in 39.7% of 239 participants across six of 23 studies. CONCLUSIONS Further prospective longitudinal research into comparative recovery trajectories in patients across TBI severity levels would provide additional information to guide clinical diagnosis, prognosis and management of this patient population.
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Affiliation(s)
- Bojana Šarkić
- Discipline of Audiology, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria, Australia
| | - Jacinta M Douglas
- School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria, Australia
- Summer Foundation, Box Hill, Victoria, Australia
| | - Andrea Simpson
- School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria, Australia
| | - Alexandra Vasconcelos
- School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria, Australia
| | - Bethany R Scott
- School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria, Australia
| | - Lauren M Melitsis
- School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria, Australia
| | - Stephanie M Spehar
- School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, Victoria, Australia
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Lee HJ, Ahn SK, Yim CD, Kim SD, Hur DG. Prolonged Positional Downbeat Nystagmus in Benign Paroxysmal Positional Vertigo: A Case Report and Literature Review. Am J Audiol 2021; 30:235-240. [PMID: 33784182 DOI: 10.1044/2020_aja-20-00187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose This study aimed to report an unusual case of benign paroxysmal positional vertigo (BPPV), who showed prolonged positional downbeat nystagmus without latency and was diagnosed with cupulolithiasis of the anterior canal (AC). We compared this case with one of typical AC-BPPV, and possible mechanisms underlying the atypical characteristics were discussed. Method Two patients diagnosed with AC-BPPV were reported. Positional testing using video-oculography goggles was performed, and outcomes were measured via medical records and analysis of videos of the nystagmus. Results Downbeat nystagmus was observed in the contralateral Dix-Hallpike test in both cases. The torsional component was subtle or absent, but motion was induced toward the affected ear. The two cases differed in latency and duration of vertigo, as well as habituation. The patient with atypical nystagmus showed little or no latency and longer duration. Moreover, there was no habituation on repeated tests. The nystagmus showed several differences from that of typical AC-BPPV. Conclusions Based on our case, AC-BPPV may induce various unusual clinical manifestations of nystagmus. Accurate diagnosis requires careful consideration of the patient's symptoms and the characteristics of the nystagmus. Supplemental Material https://doi.org/10.23641/asha.14265356.
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Affiliation(s)
- Hyun-Jin Lee
- Department of Otorhinolaryngology, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, South Korea
| | - Seong Ki Ahn
- Department of Otorhinolaryngology, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, South Korea
- Institute of Health Sciences, Gyeongsang National University, Jinju, South Korea
| | - Chae Dong Yim
- Department of Otorhinolaryngology, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, South Korea
| | - Seong Dong Kim
- Department of Otorhinolaryngology, National Medical Center, Seoul, South Korea
| | - Dong Gu Hur
- Department of Otorhinolaryngology, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, South Korea
- Institute of Health Sciences, Gyeongsang National University, Jinju, South Korea
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Castellucci A, Malara P, Martellucci S, Botti C, Delmonte S, Quaglieri S, Rebecchi E, Armato E, Ralli M, Manfrin ML, Ghidini A, Asprella Libonati G. Feasibility of Using the Video-Head Impulse Test to Detect the Involved Canal in Benign Paroxysmal Positional Vertigo Presenting With Positional Downbeat Nystagmus. Front Neurol 2020; 11:578588. [PMID: 33178119 PMCID: PMC7593380 DOI: 10.3389/fneur.2020.578588] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/07/2020] [Indexed: 12/19/2022] Open
Abstract
Positional downbeat nystagmus (pDBN) represents a relatively frequent finding. Its possible peripheral origin has been widely ascertained. Nevertheless, distinguishing features of peripheral positional nystagmus, including latency, paroxysm and torsional components, may be missing, resulting in challenging differential diagnosis with central pDBN. Moreover, in case of benign paroxysmal positional vertigo (BPPV), detection of the affected canal may be challenging as involvement of the non-ampullary arm of posterior semicircular canal (PSC) results in the same oculomotor responses generated by contralateral anterior canal (ASC)-canalolithiasis. Recent acquisitions suggest that patients with persistent pDBN due to vertical canal-BPPV may exhibit impaired vestibulo-ocular reflex (VOR) for the involved canal on video-head impulse test (vHIT). Since canal hypofunction normalizes following proper canalith repositioning procedures (CRP), an incomplete canalith jam acting as a "low-pass filter" for the affected ampullary receptor has been hypothesized. This study aims to determine the sensitivity of vHIT in detecting canal involvement in patients presenting with pDBN due to vertical canal-BPPV. We retrospectively reviewed the clinical records of 59 consecutive subjects presenting with peripheral pDBN. All patients were tested with video-Frenzel examination and vHIT at presentation and after resolution of symptoms or transformation in typical BPPV-variant. BPPV involving non-ampullary tract of PSC was diagnosed in 78%, ASC-BPPV in 11.9% whereas in 6 cases the involved canal remained unidentified. Presenting VOR-gain values for the affected canal were greatly impaired in cases with persistent pDBN compared to subjects with paroxysmal/transitory nystagmus (p < 0.001). Each patient received CRP for BPPV involving the hypoactive canal or, in case of normal VOR-gain, the assumed affected canal. Each subject exhibiting VOR-gain reduction for the involved canal developed normalization of vHIT data after proper repositioning (p < 0.001), proving a close relationship with otoliths altering high-frequency cupular responses. According to our results, overall vHIT sensitivity in detecting the affected SC was 72.9%, increasing up to 88.6% when considering only cases with persistent pDBN where an incomplete canal plug is more likely to occur. vHIT should be routinely used in patients with pDBN as it may enable to localize otoconia within the labyrinth, providing further insights to the pathophysiology of peripheral pDBN.
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Affiliation(s)
- Andrea Castellucci
- ENT Unit, Department of Surgery, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Pasquale Malara
- Audiology and Vestibology Service, "Centromedico Bellinzona", Bellinzona, Switzerland
| | | | - Cecilia Botti
- ENT Unit, Department of Surgery, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy.,PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Silvia Delmonte
- ENT Unit, Department of Surgery, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Silvia Quaglieri
- ENT Unit, Policlinico San Matteo Fondazione (IRCCS), Pavia, Italy
| | | | - Enrico Armato
- ENT Unit, "SS Giovanni e Paolo" Hospital, Venice, Italy
| | - Massimo Ralli
- Head and Neck Department, ENT Clinic, Policlinico Umberto I, Rome, Italy.,Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | | | - Angelo Ghidini
- ENT Unit, Department of Surgery, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
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Vats AK. A case of apogeotropic horizontal canal benign paroxysmal positional vertigo that transformed to the geotropic variant during treatment with Appiani maneuver, followed by successful treatment with Gufoni maneuver. Physiother Theory Pract 2020; 38:952-960. [PMID: 32783761 DOI: 10.1080/09593985.2020.1805831] [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: 10/23/2022]
Abstract
Lesions at three possible sites can masquerade as apogeotropic horizontal semicircular canal benign paroxysmal positional vertigo (HSC-BPPV), namely: 1) short anterior (ampullary) arm canalolithiasis; and 2) culpulolithiasis, which may be either canal (Cup-C) or utricle-sided (Cup-U). There are no clinical methods or investigations to determine the exact pathological site when a patient with a history compatible with HSC-BPPV is found to have apogeotropic positional nystagmus on the supine roll test. Therefore, the treatment of apogeotropic variant of HSC-BPPV not only poses difficulties but the therapeutic options need to be tailored according to the ostensible localization of the pathology. If the apogeotropic HSC-BPPV is transformed into the geotropic variant, it becomes relatively easier to treat, as the treatment options for the latter are very well established. There are reports of cases of the apogeotropic variant of HSC-BPPV being transformed inadvertently during diagnostic positional tests as well as during therapeutic (intention-to-treat) positional maneuvers. I report here a case of an apogeotropic variant of right HSC-BPPV, that transformed into a geotropic variant during the therapeutic (intention-to-treat) Appiani maneuver, which was subsequently successfully treated with two sequences of Gufoni maneuver after transformation. The patient was followed up at one and 24 hours after the second sequence of Gufoni maneuver with a diagnostic supine roll test, which was negative. The case report is supported by seven videos of the diagnostic and therapeutic positional maneuvers revealing positional nystagmus, its appearance, change, and disappearance as clinical events unfolded during the examination and treatment.
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Affiliation(s)
- Ajay Kumar Vats
- Department of Medicine and Neurology, Chaudhary Hospital & Medical Research Centre Private Limited, Udaipur, India
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10
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A Possible Role of Video-Head Impulse Test in Detecting Canal Involvement in Benign Paroxysmal Positional Vertigo Presenting With Positional Downbeat Nystagmus. Otol Neurotol 2020; 41:386-391. [DOI: 10.1097/mao.0000000000002500] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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11
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Salmito MC, E Maia FCZ, Gretes ME, Venosa A, Ganança FF, Ganança MM, Mezzalira R, Bittar RSM, Gasperin AC, Pires APBDÁ, Ramos BF, Bertoldo C, Ferreira C, Real D, Guimarães HA, Oiticica J, Lavinsky J, Lopes KC, Duarte JA, Morganti LOG, Santos LMAD, Joffily L, Lavinsky L, Santos MADO, Mano PM, Araújo PIMPD, Mangabeira Albernaz PL, Cal R, Dorigueto RS, Guimarães RDCC, Carvalho RCBD. Neurotology: definitions and evidence-based therapies - Results of the I Brazilian Forum of Neurotology. Braz J Otorhinolaryngol 2020; 86:139-148. [PMID: 31902583 PMCID: PMC9422724 DOI: 10.1016/j.bjorl.2019.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 11/06/2019] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Neurotology is a rapidly expanding field of knowledge. The study of the vestibular system has advanced so much that even basic definitions, such as the meaning of vestibular symptoms, have only recently been standardized. OBJECTIVE To present a review of the main subjects of neurotology, including concepts, diagnosis and treatment of Neurotology, defining current scientific evidence to facilitate decision-making and to point out the most evidence-lacking areas to stimulate further new research. METHODS This text is the result of the I Brazilian Forum of Neurotology, which brought together the foremost Brazilian researchers in this area for a literature review. In all, there will be three review papers to be published. This first review will address definitions and therapies, the second one will address diagnostic tools, and the third will define the main diseases diagnoses. Each author performed a bibliographic search in the LILACS, SciELO, PubMed and MEDLINE databases on a given subject. The text was then submitted to the other Forum participants for a period of 30 days for analysis. A special chapter, on the definition of vestibular symptoms, was translated by an official translation service, and equally submitted to the other stages of the process. There was then a in-person meeting in which all the texts were orally presented, and there was a discussion among the participants to define a consensual text for each chapter. The consensual texts were then submitted to a final review by four professors of neurotology disciplines from three Brazilian universities and finally concluded. Based on the full text, available on the website of the Brazilian Association of Otorhinolaryngology and Cervical-Facial Surgery, this summary version was written as a review article. RESULT The text presents the official translation into Portuguese of the definition of vestibular symptoms proposed by the Bárány Society and brings together the main scientific evidence for each of the main existing therapies for neurotological diseases. CONCLUSION This text rationally grouped the main topics of knowledge regarding the definitions and therapies of Neurotology, allowing the reader a broad view of the approach of neurotological patients based on scientific evidence and national experience, which should assist them in clinical decision-making, and show the most evidence-lacking topics to stimulate further study.
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Affiliation(s)
- Márcio Cavalcante Salmito
- Universidade Federal de São Paulo (Unifesp), Escola Paulista de Medicina, Departamento de Otorrinolaringologia e Cirurgia Cérvico-Facial, Disciplina de Otologia e Otoneurologia, São Paulo, SP, Brazil.
| | | | - Mário Edvin Gretes
- Pontifícia Universidade Católica de Campinas (PUC-Campinas), Faculdade de Medicina, SP, Brazil
| | | | - Fernando Freitas Ganança
- Universidade Federal de São Paulo (Unifesp), Escola Paulista de Medicina, Departamento de Otorrinolaringologia e Cirurgia Cérvico-Facial, Disciplina de Otologia e Otoneurologia, São Paulo, SP, Brazil
| | - Maurício Malavasi Ganança
- Universidade Federal de São Paulo (Unifesp), Escola Paulista de Medicina, Departamento de Otorrinolaringologia e Cirurgia Cérvico-Facial, Disciplina de Otologia e Otoneurologia, São Paulo, SP, Brazil
| | - Raquel Mezzalira
- Universidade de Campinas (Unicamp), Disciplina de Otorrinolaringologia Cabeça e Pescoço, Campinas, SP, Brazil
| | - Roseli Saraiva Moreira Bittar
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Setor de Otoneurologia, São Paulo, SP, Brazil
| | | | | | | | - César Bertoldo
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Setor de Otoneurologia, São Paulo, SP, Brazil
| | - Cícero Ferreira
- Universidade Federal de São Paulo (Unifesp), Escola Paulista de Medicina, Departamento de Otorrinolaringologia e Cirurgia Cérvico-Facial, Disciplina de Otologia e Otoneurologia, São Paulo, SP, Brazil
| | - Danilo Real
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Setor de Otoneurologia, São Paulo, SP, Brazil
| | | | - Jeanne Oiticica
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Setor de Otoneurologia, São Paulo, SP, Brazil
| | - Joel Lavinsky
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil; Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Santa Casa de Porto Alegre, Porto Alegre, RS, Brazil
| | | | - Juliana Antoniolli Duarte
- Universidade Federal de São Paulo (Unifesp), Escola Paulista de Medicina, Departamento de Otorrinolaringologia e Cirurgia Cérvico-Facial, Disciplina de Otologia e Otoneurologia, São Paulo, SP, Brazil
| | - Lígia Oliveira Gonçalves Morganti
- Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Departamento de Otorrinolaringologia, Belo Horizonte, MG, Brazil
| | | | - Lúcia Joffily
- Hospital Universitário Gaffrée e Guinle, Universidade Federal do Estado do Rio de Janeiro (Unirio), Rio de Janeiro, RJ, Brazil
| | - Luíz Lavinsky
- Universidade Federal do Rio Grande do Sul (UFRGS), Faculdade de Medicina, Disciplina de Otorrinolaringologia, Porto Alegre, RS, Brazil
| | - Mônica Alcantara de Oliveira Santos
- Irmandade da Santa Casa de Misericórdia de São Paulo, Faculdade de Ciências Médicas, Departamento de Otorrinolaringologia, São Paulo, SP, Brazil; Instituto de Assistência Médica ao Servidor Público Estadual de São Paulo, São Paulo, SP, Brazil
| | - Patrícia Mauro Mano
- Hospital Federal dos Servidores do Rio de Janeiro, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Rio de Janeiro, RJ, Brazil
| | | | | | - Renato Cal
- Universidade Federal do Pará (UFPa), Faculdade de Medicina, Belém, PA, Brazil
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Can a Chronic BPPV With a History of Trauma be the Trigger of Symptoms in Vestibular Migraine, Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), and Whiplash Associated Disorders (WAD)? A Retrospective Cohort Study. Otol Neurotol 2020; 40:96-102. [PMID: 30303941 DOI: 10.1097/mao.0000000000002020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND In patients with chronic benign paroxysmal positional vertigo (BPPV), i.e., chronic vestibular multicanalicular canalithiasis (CVMCC), abnormal signals are transmitted from diseased labyrinths via the healthy vestibular nuclei complex to their end organs. The vestibulo-thalamo-cortical reflex as proposed in vestibular migraine is just one of these reflexes. In a group of patients diagnosed with CVMCC otolith repositioning maneuvers specific for each semicircular canal (SCC) ameliorated pain and other symptoms in 90%. Increased awareness of CVMCC may reduce suffering and continuous medication. OBJECTIVE To evaluate if CVMCC can be the trigger of symptoms in vestibular migraine, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), and whiplash associated disorders (WAD). STUDY DESIGN Retrospective consecutive observational cohort study. SETTING Ambulatory at a private Otoneurology Centre. PATIENTS One hundred sixty-three patients with CVMCC and a history of trauma. INTERVENTION Based on the symptoms (structured symptom questionnaire), the patients are post hoc sub grouped according to the criteria of the different diagnoses. MAIN OUTCOME MEASURE Frequency of patients with CVMCC who fulfill the criteria of the different diagnoses. RESULTS 98% of all patients with CVMCC fulfill the Barany Society criteria of a probable vestibular migraine; 17% fulfill the International Classification of Headache Disorders defined vestibular migraine criteria; 63% fulfill the Fukuda criteria of ME/CFS; 100% of the patients with WAD suffer from CVMCC. CONCLUSION This survey supports the hypothesis that CVMCC can be the trigger of symptoms in vestibular migraine, ME/CFS, and WAD. The actual diagnosis the patient receives is often in accordance with the patient's dominant symptom.
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13
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Hoppes CW, Klatt BN, Dunlap PM, Jacks B, Whitney SL. Management of Benign Paroxysmal Positional Vertigo in an Adult With Severe Osteogenesis Imperfecta. Laryngoscope 2019; 130:2241-2244. [PMID: 31800107 DOI: 10.1002/lary.28431] [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: 08/27/2019] [Revised: 10/29/2019] [Accepted: 11/06/2019] [Indexed: 11/10/2022]
Abstract
The purpose of this case report was to describe the evaluation and management of atypical benign paroxysmal positional vertigo (BPPV) in an adult with severe osteogenesis imperfecta. A 29-year-old male was referred to a physical therapist with extensive experience in vestibular rehabilitation who provided horizontal canal BPPV treatment with a canalith repositioning maneuver over two treatment sessions. The individual's symptoms had reduced by 65% and his nystagmus during the roll test was reduced. Extreme care is needed to safely reposition individuals living with severe osteogenesis imperfecta, but the repositioning can reduce symptoms and improve quality of life. Laryngoscope, 130:2241-2244, 2020.
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Affiliation(s)
- Carrie W Hoppes
- Army-Baylor University Doctoral Program in Physical Therapy, Fort Sam Houston, Texas
| | - Brooke N Klatt
- The Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Pamela M Dunlap
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Beth Jacks
- E Jacks Physical Therapy, Wexford, Pennsylvania, U.S.A
| | - Susan L Whitney
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania
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14
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The Efficacy of a Home Treatment Program Combined With Office-Based Canalith Repositioning Procedure for Benign Paroxysmal Positional Vertigo—A Randomized Controlled Trial. Otol Neurotol 2019; 40:951-956. [DOI: 10.1097/mao.0000000000002310] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Wagner AR. Atypical variants of posterior canal benign paroxysmal positional vertigo after canalith repositioning: a case report. HEARING, BALANCE AND COMMUNICATION 2019. [DOI: 10.1080/21695717.2018.1534471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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16
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Olajide T, Adegbiji W, Olubi O, Olajuyin O, Aluko A. Clinicoepidemiology of benign paroxysmal positional vertigo in Nigerian. J Family Med Prim Care 2019; 8:3220-3224. [PMID: 31742145 PMCID: PMC6857368 DOI: 10.4103/jfmpc.jfmpc_555_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 08/22/2019] [Accepted: 09/24/2019] [Indexed: 11/19/2022] Open
Abstract
Objective: Benign paroxysmal positional vertigo (BPPV) is poorly reported in developing countries. This study aimed at determining the prevalence, aetiology, and comorbid illnesses of benign paroxysmal positional vertigo in our center. Materials and Methods: This was a prevalence hospital-based study of all patients with the diagnosis of benign paroxysmal positional vertigo (BPPV). Pretested interviewer assisted questionnaire was administered to obtain data. Otoscopic examination, otoneurologic review, followed by mandatory Dix Hallpike maneuver and supine roll test was performed on all patients to diagnose posterior, lateral or anterior canal benign paroxysmal positional vertigo. All the data obtained were collated and analyzed by using SPSS version 16.0. Results: Prevalence was 1.9%. Peak prevalence of 37.0% was at age group 41–50 years. Male accounted for 46.1% with male to female ratio of 1:1.2. Benign paroxysmal positional vertigo accounted for 62.3% urban dwellers, 33.1% postsecondary education, 39.6% Civil servant and 33.8% married. There were 99.4% unilateral and 64.3% right benign paroxysmal positional vertigo. Idiopathic was 70.1% while trauma, migraine, and inner ear disorder were 20.8%, 7.1%, and 1.9%, respectively. Benign paroxysmal positional vertigo was 66.2% posterior semicircular canal followed by 24.7% lateral semicircular canal and 0.6% anterior semicircular canal. Commonly associated comorbid illnesses were visual disorder, hypertension, arthritis, and diabetes mellitus in 27.9%, 23.4%, 22.1%, and 2.6%, respectively. Conclusion: Benign paroxysmal positional vertigo is common otologic disorder. It is associated with significant comorbid illnesses. Early detection will reduce morbidity and mortality. Improvement in the level of health care at primary level and health education to create awareness among the populace is to be encouraged.
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Pérez-Vázquez P, Franco-Gutiérrez V, Soto-Varela A, Amor-Dorado JC, Martín-Sanz E, Oliva-Domínguez M, Lopez-Escamez JA. Practice Guidelines for the Diagnosis and Management of Benign Paroxysmal Positional Vertigo Otoneurology Committee of Spanish Otorhinolaryngology and Head and Neck Surgery Consensus Document. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.otoeng.2018.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Jilla AM, Roberts RA, Johnson CE. Teaching Patient-Centered Counseling Skills for Assessment, Diagnosis, and Management of Benign Paroxysmal Positional Vertigo. Semin Hear 2018; 39:52-66. [PMID: 29422713 PMCID: PMC5802993 DOI: 10.1055/s-0037-1613705] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Audiologists are an integral part of the management of those with dizziness and vestibular disorders. However, little research has been performed on counseling approaches for patients who present with dizziness as a primary concern. Accordingly, it is important that audiology students are provided with didactic and experiential learning opportunities for the assessment, diagnosis, and management of this population. Benign paroxysmal positional vertigo is the most common vestibular disorder among adults. Doctor of Audiology students, at a minimum, should be provided with learning opportunities for counseling patients with this particular disorder. Implementation of patient-centered counseling is applied across various parts of the patient encounter from initial intake to treatment and patient education. The purpose of this article is to present the available evidence and to apply widely accepted theories and techniques to counseling those with benign paroxysmal positional vertigo. Didactic resources and experiential learning activities are provided for use in coursework or as a supplement to clinical education.
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Affiliation(s)
- Anna Marie Jilla
- Hearing Evaluation, Rehabilitation, and Outcomes (HERO) Laboratory, Department of Communication Sciences and Disorders, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Richard A. Roberts
- Department of Hearing and Speech Sciences Vanderbilt University Medical Center, Nashville, Tennessee
| | - Carole E. Johnson
- Hearing Evaluation, Rehabilitation, and Outcomes (HERO) Laboratory, Department of Communication Sciences and Disorders, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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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: 54] [Impact Index Per Article: 7.7] [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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Practice Guidelines for the Diagnosis and Management of Benign Paroxysmal Positional Vertigo Otoneurology Committee of Spanish Otorhinolaryngology and Head and Neck Surgery Consensus Document. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2017; 69:345-366. [PMID: 28826856 DOI: 10.1016/j.otorri.2017.05.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 05/04/2017] [Indexed: 11/21/2022]
Abstract
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.
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Bhattacharyya N, Gubbels SP, Schwartz SR, Edlow JA, El-Kashlan H, Fife T, Holmberg JM, Mahoney K, Hollingsworth DB, Roberts R, Seidman MD, Prasaad Steiner RW, Tsai Do B, Voelker CCJ, Waguespack RW, Corrigan MD. Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update) Executive Summary. Otolaryngol Head Neck Surg 2017; 156:403-416. [PMID: 28248602 DOI: 10.1177/0194599816689660] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The American Academy of Otolaryngology-Head and Neck Surgery Foundation has published a supplement to this issue of Otolaryngology-Head and Neck Surgery featuring the "Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update)." To assist in implementing the guideline recommendations, this article summarizes the rationale, purpose, and key action statements. The 14 recommendations developed emphasize diagnostic accuracy and efficiency, reducing the inappropriate use of vestibular suppressant medications, decreasing the inappropriate use of ancillary testing, and increasing the appropriate therapeutic repositioning maneuvers. An updated guideline is needed due to new clinical trials, new systematic reviews, and the lack of consumer participation in the initial guideline development group.
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Affiliation(s)
- Neil Bhattacharyya
- 1 Department of Otolaryngology, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Samuel P Gubbels
- 2 Department of Otolaryngology, School of Medicine and Public Health, University of Colorado, Aurora, Colorado, USA
| | - Seth R Schwartz
- 3 Department of Otolaryngology, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Jonathan A Edlow
- 4 Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Hussam El-Kashlan
- 5 Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Terry Fife
- 6 Barrow Neurological Institute and College of Medicine, University of Arizona, Phoenix, Arizona, USA
| | - Janene M Holmberg
- 7 Intermountain Hearing and Balance Center, Salt Lake City, Utah, USA
| | | | | | - Richard Roberts
- 10 Alabama Hearing and Balance Associates, Inc, Birmingham, Alabama, USA
| | - Michael D Seidman
- 11 Department of Otolaryngology-Head and Neck Surgery, College of Medicine, University of Central Florida, Orlando, Florida, USA
| | - Robert W Prasaad Steiner
- 12 Department of Health Management and Systems Science and Department of Family and Geriatric Medicine, School of Public Health and Information Science, University of Louisville, Louisville, Kentucky, USA
| | - Betty Tsai Do
- 13 Department of Otorhinolaryngology, Health Sciences Center, University of Oklahoma, Oklahoma City, Oklahoma, USA
| | - Courtney C J Voelker
- 14 Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Richard W Waguespack
- 15 Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Maureen D Corrigan
- 16 American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
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22
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Yang XK, Zheng YY, Yang XG. Theoretical observation on diagnosis maneuver for benign paroxysmal positional vertigo. Acta Otolaryngol 2017; 137:567-571. [PMID: 28084876 DOI: 10.1080/00016489.2016.1271451] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
CONCLUSION To make a comprehensive analysis with a variety of diagnostic maneuvers is conducive to the correct diagnosis and classification of BPPV. OBJECTIVE Based on the standard spatial coordinate-based semicircular canal model for theoretical observation on diagnostic maneuvers for benign paroxysmal positional vertigo (BPPV) to analyze the meaning and key point of each step of the maneuver. MATERIALS AND METHODS This study started by building a standard model of semicircular canal with space orientation by segmentation of the inner ear done with the 3D Slicer software based on MRI scans, then gives a demonstration and observation of BPPV diagnostic maneuvers by using the model. RESULTS The supine roll maneuver is mainly for diagnosis of lateral semicircular canal BPPV. The Modified Dix-Hallpike maneuver is more specific for the diagnosis of posterior semicircular canal BPPV. The side-lying bow maneuver designed here is theoretically suitable for diagnosis of anterior semicircular canal BPPV.
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Affiliation(s)
- Xiao-kai Yang
- Neurology Department, Wenzhou People’s Hospital, Wenzhou, Zhejiang, PR China
| | - Yan-yan Zheng
- Neurology Department, Wenzhou People’s Hospital, Wenzhou, Zhejiang, PR China
| | - Xiao-guo Yang
- Neurology Department, Wenzhou People’s Hospital, Wenzhou, Zhejiang, PR China
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23
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Bhattacharyya N, Gubbels SP, Schwartz SR, Edlow JA, El-Kashlan H, Fife T, Holmberg JM, Mahoney K, Hollingsworth DB, Roberts R, Seidman MD, Steiner RWP, Do BT, Voelker CCJ, Waguespack RW, Corrigan MD. Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update). Otolaryngol Head Neck Surg 2017; 156:S1-S47. [DOI: 10.1177/0194599816689667] [Citation(s) in RCA: 363] [Impact Index Per Article: 51.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Objective This update of a 2008 guideline from the American Academy of Otolaryngology—Head and Neck Surgery Foundation provides evidence-based recommendations to benign paroxysmal positional vertigo (BPPV), defined as a disorder of the inner ear characterized by repeated episodes of positional vertigo. Changes from the prior guideline include a consumer advocate added to the update group; new evidence from 2 clinical practice guidelines, 20 systematic reviews, and 27 randomized controlled trials; enhanced emphasis on patient education and shared decision making; a new algorithm to clarify action statement relationships; and new and expanded recommendations for the diagnosis and management of BPPV. Purpose The primary purposes of this guideline are to improve the quality of care and outcomes for BPPV by improving the accurate and efficient diagnosis of BPPV, reducing the inappropriate use of vestibular suppressant medications, decreasing the inappropriate use of ancillary testing such as radiographic imaging, and increasing the use of appropriate therapeutic repositioning maneuvers. The guideline is intended for all clinicians who are likely to diagnose and manage patients with BPPV, and it applies to any setting in which BPPV would be identified, monitored, or managed. The target patient for the guideline is aged ≥18 years with a suspected or potential diagnosis of BPPV. The primary outcome considered in this guideline is the resolution of the symptoms associated with BPPV. Secondary outcomes considered include an increased rate of accurate diagnoses of BPPV, a more efficient return to regular activities and work, decreased use of inappropriate medications and unnecessary diagnostic tests, reduction in recurrence of BPPV, and reduction in adverse events associated with undiagnosed or untreated BPPV. Other outcomes considered include minimizing costs in the diagnosis and treatment of BPPV, minimizing potentially unnecessary return physician visits, and maximizing the health-related quality of life of individuals afflicted with BPPV. Action Statements The update group made strong recommendations that clinicians should (1) diagnose posterior semicircular canal BPPV when vertigo associated with torsional, upbeating nystagmus is provoked by the Dix-Hallpike maneuver, performed by bringing the patient from an upright to supine position with the head turned 45° to one side and neck extended 20° with the affected ear down, and (2) treat, or refer to a clinician who can treat, patients with posterior canal BPPV with a canalith repositioning procedure. The update group made a strong recommendation against postprocedural postural restrictions after canalith repositioning procedure for posterior canal BPPV. The update group made recommendations that the clinician should (1) perform, or refer to a clinician who can perform, a supine roll test to assess for lateral semicircular canal BPPV if the patient has a history compatible with BPPV and the Dix-Hallpike test exhibits horizontal or no nystagmus; (2) differentiate, or refer to a clinician who can differentiate, BPPV from other causes of imbalance, dizziness, and vertigo; (3) assess patients with BPPV for factors that modify management, including impaired mobility or balance, central nervous system disorders, a lack of home support, and/or increased risk for falling; (4) reassess patients within 1 month after an initial period of observation or treatment to document resolution or persistence of symptoms; (5) evaluate, or refer to a clinician who can evaluate, patients with persistent symptoms for unresolved BPPV and/or underlying peripheral vestibular or central nervous system disorders; and (6) educate patients regarding the impact of BPPV on their safety, the potential for disease recurrence, and the importance of follow-up. The update group made recommendations against (1) radiographic imaging for a patient who meets diagnostic criteria for BPPV in the absence of additional signs and/or symptoms inconsistent with BPPV that warrant imaging, (2) vestibular testing for a patient who meets diagnostic criteria for BPPV in the absence of additional vestibular signs and/or symptoms inconsistent with BPPV that warrant testing, and (3) routinely treating BPPV with vestibular suppressant medications such as antihistamines and/or benzodiazepines. The guideline update group provided the options that clinicians may offer (1) observation with follow-up as initial management for patients with BPPV and (2) vestibular rehabilitation, either self-administered or with a clinician, in the treatment of BPPV.
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Affiliation(s)
- Neil Bhattacharyya
- Department of Otolaryngology, Harvard Medical School, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Samuel P. Gubbels
- Department of Otolaryngology, School of Medicine and Public Health, University of Colorado, Aurora, Colorado, USA
| | - Seth R. Schwartz
- Department of Otolaryngology, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Jonathan A. Edlow
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Hussam El-Kashlan
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Terry Fife
- Barrow Neurological Institute and College of Medicine, University of Arizona, Phoenix, Arizona, USA
| | | | | | | | - Richard Roberts
- Alabama Hearing and Balance Associates, Inc, Birmingham, Alabama, USA
| | - Michael D. Seidman
- Department of Otolaryngology–Head and Neck Surgery, College of Medicine, University of Central Florida, Orlando, Florida, USA
| | - Robert W. Prasaad Steiner
- Department of Health Management and Systems Science and Department of Family and Geriatric Medicine, School of Public Health and Information Science, University of Louisville, Louisville, Kentucky, USA
| | - Betty Tsai Do
- Department of Otorhinolaryngology, Health Sciences Center, University of Oklahoma, Oklahoma City, Oklahoma, USA
| | - Courtney C. J. Voelker
- Department of Otolaryngology–Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Richard W. Waguespack
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Maureen D. Corrigan
- American Academy of Otolaryngology–Head and Neck Surgery Foundation, Alexandria, Virginia, USA
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Elzière M, Devèze A, Bartoli C, Levy G. Post-traumatic balance disorder. Eur Ann Otorhinolaryngol Head Neck Dis 2016; 134:171-175. [PMID: 27964839 DOI: 10.1016/j.anorl.2016.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The causes of balance disorder are many and various, and the subjective syndrome of cranial trauma patients is diagnosed by elimination. Progress in otoneurologic functional exploration and brain imaging, however, now generally allow this functional complaint to be given an objective basis. In recent years, new diagnoses have improved recognition of such pathologies in the appraisal of corporal injury for compensation purposes. The present article seeks to detail etiology and, by a review of the literature, to determine factors liable to influence management and appraisal in particular.
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Affiliation(s)
- M Elzière
- Service ORL, hôpital européen, 6, rue Désirée-Clary, 13003 Marseille, France.
| | - A Devèze
- Service ORL, Ramsay générale de santé, hôpital Clairval, 13009 Marseille, France
| | - C Bartoli
- UMR T24, IFSTTAR, laboratoire biomécanique appliqué, Aix-Marseille université, 13915 Marseille cedex, France; Service de médecine légale et droit de la santé, Aix-Marseille université, UFR médecine Timone, 27, boulevard Jean-Moulin, 13385 Marseille cedex 5, France
| | - G Levy
- 18, rue Gounod, 06000 Nice, France
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Persistent Down-Beating Torsional Positional Nystagmus: Posterior Semicircular Canal Light Cupula? Case Rep Otolaryngol 2016; 2016:1249325. [PMID: 27668113 PMCID: PMC5030422 DOI: 10.1155/2016/1249325] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Revised: 08/14/2016] [Accepted: 08/17/2016] [Indexed: 11/17/2022] Open
Abstract
A 16-year-old boy with rotatory positional vertigo and nausea, particularly when lying down, visited our clinic. Initially, we observed vertical/torsional (downward/leftward) nystagmus in the supine position, and it did not diminish. In the sitting position, nystagmus was not provoked. Neurological examinations were normal. We speculated that persistent torsional down-beating nystagmus was caused by the light cupula of the posterior semicircular canal. This case provides novel insights into the light cupula pathophysiology.
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Nuti D, Masini M, Mandalà M. Benign paroxysmal positional vertigo and its variants. HANDBOOK OF CLINICAL NEUROLOGY 2016; 137:241-56. [PMID: 27638076 DOI: 10.1016/b978-0-444-63437-5.00018-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Benign paroxysmal positional vertigo is a common labyrinthine disorder caused by a mechanic stimulation of the vestibular receptors within the semicircular canals. It is characterized by positional vertigo and positional nystagmus, both provoked by changes in the position of the head with respect to gravity. The social impact of the disease and its direct and indirect costs to healthcare systems are significant owing to impairment of daily activities and increased risk of falls. The first description of a patient with benign paroxysmal positional vertigo is from Robert Bárány in 1921, but the features of the syndrome and the diagnostic maneuver were well described by Dix and Hallpike in 1952. Since then, the gradually increasing interest of otolaryngologists and neurologists has led to a progressive advance in the knowledge of this labyrinthine disorder with regard to its epidemiologic, pathophysiologic, clinical, and therapeutic aspects. Despite the often effective diagnosis and treatment of most cases of benign paroxysmal positional vertigo, the physiopathologic explanations of the disease are mainly speculative. In this chapter, we describe the epidemiologic, pathophysiologic, clinical, and therapeutic aspects of benign paroxysmal positional vertigo.
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Affiliation(s)
- D Nuti
- Department of Otology and Skull Base Surgery, University of Siena, Siena, Italy.
| | - M Masini
- Department of Social, Political and Cognitive Sciences, University of Siena, Siena, Italy
| | - M Mandalà
- Department of Otology and Skull Base Surgery, University of Siena, Siena, Italy
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27
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Effectiveness of the Parnes particle repositioning manoeuvre for posterior canal benign paroxysmal positional vertigo. The Journal of Laryngology & Otology 2015; 129:1188-93. [PMID: 26456180 DOI: 10.1017/s0022215115002704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Benign paroxysmal positional vertigo is a common vestibular disorder that negatively affects an individual's health-related quality of life. This study aimed to examine the effectiveness of the Parnes particle repositioning manoeuvre as an intervention for individuals with posterior canal benign paroxysmal positional vertigo. METHODS The de-identified records of 155 individuals treated with the Parnes manoeuvre were examined. Descriptive statistics were calculated, including the frequency and valid per cent of participants whose nystagmus was resolved with the Parnes manoeuvre. RESULTS In all, nystagmus was resolved with the Parnes manoeuvre in 145 participants (93.5 per cent). The mean number of manoeuvres needed to resolve the nystagmus was 1.3. CONCLUSION The Parnes manoeuvre proved to be as effective as the Epley canalith repositioning manoeuvre, currently the most common intervention, in treating individuals with posterior canal benign paroxysmal positional vertigo.
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Iglebekk W, Tjell C, Borenstein P. Treatment of chronic canalithiasis can be beneficial for patients with vertigo/dizziness and chronic musculoskeletal pain, including whiplash related pain. Scand J Pain 2015; 8:1-7. [PMID: 29911614 DOI: 10.1016/j.sjpain.2015.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 02/03/2015] [Indexed: 10/23/2022]
Abstract
Background and aim Chronic musculoskeletal pain, e.g. whiplash associated disorders (WAD), fibromyalgia and myalgia, causes significant burden on both the individual and on society as a whole. In a previous study, the authors concluded that there is a likely connection between chronic benign paroxysmal positional vertigo (BPPV)/canalithiasis and headache, neck pain, generalized pain, fatigue, cognitive dysfunctions as well as tinnitus. The balance dysfunction in BPPV/canalithiasis is dynamic and not static. This leads to a perpetual postural mismatch. The vicious cycle of a disturbed equilibrium control system may be the driving force behind the vicious cycle of pain. The aim of this study is to investigate if otolith-repositioning manoeuvres in patients with chronic BPPV/canalithiasis can be beneficial. Methods During a period of about two years a prospective observational study on patients with chronic musculoskeletal pain referred for physiotherapy was performed. Those with a Dizziness Handicap Inventory (DHI) inquiry score above 20 underwent further investigations to diagnose chronic BPPV/canalithiasis. Diagnostic criteria: (A) The diagnosis of BPPV/canalithiasis was confirmed with the following: (1) specific history of vertigo or dizziness provoked by acceleration/deceleration, AND (2) nystagmus and symptoms during at least one of the test positions; (B) the disorder had persisted for at least one year. Specific otolith repositioning manoeuvre for each semi-circular canal (SCC) was performed. Symptom questionnaire ("yes" or "no" answers during a personal interview) and a follow-up questionnaire were used. Results The responders of the follow-up questionnaire constituted the study group. Thirty-nine patients responded (i.e. 87%) (31 females, 8 males) with a median age of 44 years (17-65). The median duration of the disease was5 years. Seventy-nine percent had ahistory ofhead or neck trauma. The DHI median score was 48 points (score >60 indicates a risk of fall). The video-oculography confirmed BPPV/canalithiasis in more than one semi-circular canal in all patients. In the present study the frequency of affected anterior semi-circular canal (SSC) was at a minimum of 26% and could be as high as 65%. Ninety-five percent suffered from headache, 92% from neck pain, 54% had generalized pain, and 56% had temporo-mandibular joint region pain. Fatigue (97%), aggravation by physical exertion (87%), decreased ability to concentrate (85%) aswellas visual disturbances (85%) were the most frequently reported symptoms, and 49% suffered from tinnitus. The median number of otolith repositioning manoeuvres done was six (2-29). Median time span between finishing otolith repositioning manoeuvres and answering the questionnaire was 7 months. Effects of treatment and conclusion The present study has shown that repositioning of otoliths in the SCCs in nearly all patients with chronic BPPV/canalithiasis ameliorated pain and other symptoms. The correlation between vertigo/dizziness and the majority of symptoms was significant. Therefore, there is strong evidence to suggest that there is a connection between chronic BPPV/canalithiasis and chronic pain as well as the above-mentioned symptoms. Implications Patients with unexplained pain conditions should be evaluated withthe Dizziness Handicap Inventory-questionnaire, which can identify treatable balance disorders.
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VanDerHeyden CM, Carender WJ, Heidenreich KD. Nystagmus discordance with 2-dimensional videonystagmography in posterior semicircular canal benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 2015; 152:724-8. [PMID: 25560403 DOI: 10.1177/0194599814564373] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 11/25/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The Dix-Hallpike test is a standard component of the videonystagmography test battery and can diagnose posterior semicircular canal benign paroxysmal positional vertigo. The purpose of this study is to determine the prevalence of discordant, equivocal, and concordant nystagmus tracings in active posterior semicircular canal benign paroxysmal positional vertigo when compared directly with the eye video. STUDY DESIGN Case series with chart review of patients diagnosed with posterior semicircular canal benign paroxysmal positional vertigo by 2-dimensional videonystagmography from August 1, 2007, to August 1, 2012. SETTING A tertiary vestibular test laboratory. SUBJECTS AND METHODS Ninety-six adults (4 had bilateral involvement) with posterior semicircular canal benign paroxysmal positional vertigo were included. A total of 100 videos with accompanying videonystagmography tracings were reviewed to determine nystagmus trajectory as well as globe position. Descriptive statistics were used to describe prevalence. Fisher exact test was used to compare proportions. RESULTS Sixty-two percent of cases involved benign paroxysmal positional vertigo of the right posterior semicircular canal, while 38% involved the left posterior semicircular canal. The prevalence of discordant, equivocal, and concordant tracings was 65% (65/100), 29% (29/100), and 6% (6/100). All tracing errors involved the horizontal channel. There was no association between tracing accuracy and the ear of involvement or globe position (P > .05). CONCLUSIONS Two-dimensional videonystagmography tracings are not reliable for identifying nystagmus trajectory in posterior semicircular canal benign paroxysmal positional vertigo.
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Affiliation(s)
- Crystal M VanDerHeyden
- Division of Otology-Neurotology, Department of Otolaryngology- Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Wendy J Carender
- Division of Otology-Neurotology, Department of Otolaryngology- Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Katherine D Heidenreich
- Division of Otology-Neurotology, Department of Otolaryngology- Head and Neck Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
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The Incidence of Benign Paroxysmal Positional Vertigo (BPPV) in Patients Admitted to an Acquired Brain Injury Unit. BRAIN IMPAIR 2014. [DOI: 10.1017/brimp.2014.16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Objective: Brain injury is described as one potential cause of benign paroxysmal positional vertigo (BPPV); however, there is little information regarding the actual incidence in people who have suffered a brain injury. The objectives of this study were to determine the incidence of BPPV in a group of inpatients with a brain injury and to document the pattern of recovery.Methods: A retrospective chart review was used to collate data associated with dizziness and BPPV for all inpatients admitted to an acquired brain injury (ABI) unit over 1 year.Results: Data from 89 individuals were collated. Forty-three individuals reported dizziness and 13 of these were clinically diagnosed with BPPV. All cases of BPPV occurred in individuals with traumatic brain injury (TBI) with 17.6% of this diagnostic group affected. Over half the cases were diagnosed with bilateral BPPV. Seventy per cent of individuals with BPPV required multiple treatments to resolve all symptoms.Conclusions: Forty-one per cent of the inpatients who reported dizziness, and were able to be assessed, received a clinical diagnosis of BPPV. The study highlights the high incidence of BPPV following TBI, the importance of specifically enquiring about vertigo symptoms and undertaking appropriate assessment, and the increased complexity of treating BPPV in this group.
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Canal conversion between anterior and posterior semicircular canal in benign paroxysmal positional vertigo. Otol Neurotol 2014; 34:1725-8. [PMID: 23928513 DOI: 10.1097/mao.0b013e318294227a] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the characteristics of canal conversion between the anterior and posterior semicircular canals in benign paroxysmal positional vertigo (BPPV). STUDY DESIGN Retrospective chart review. SETTING Secondary referral center. PATIENTS A total of 709 patients who were treated with the Epley maneuver for BPPV of the anterior or posterior semicircular canal. INTERVENTIONS Vestibular examinations with videonystagmography and the canalith repositioning procedure (CRP) to treat BPPV. RESULTS Canal conversion between the anterior and posterior semicircular canals was observed in 18 (2.9%) patients who underwent CRP. In 13 (2.3%) of 564 patients initially diagnosed with posterior canal BPPV (PC-BPPV), switch to anterior canal BPPV (AC-BPPV) was observed at a follow-up visit. In 5 (12.1%) of 41 patients who presented with AC-BPPV, canal switch to PC-BPPV occurred more frequently (p = 0.005). The average number of CRPs before nystagmus resolution was 3.6 in conversion cases versus 1.6 in the nonconversion group (p < 0.001). CONCLUSION Canal conversion between the anterior and posterior semicircular canals can occur during treatment. The possibility of canal conversions should be considered for appropriate management of BPPV of the vertical semicircular canals.
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Gold DR, Morris L, Kheradmand A, Schubert MC. Repositioning Maneuvers for Benign Paroxysmal Positional Vertigo. Curr Treat Options Neurol 2014; 16:307. [DOI: 10.1007/s11940-014-0307-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Iglebekk W, Tjell C, Borenstein P. Pain and other symptoms in patients with chronic benign paroxysmal positional vertigo (BPPV). Scand J Pain 2013; 4:233-240. [PMID: 29913653 DOI: 10.1016/j.sjpain.2013.06.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 06/11/2013] [Indexed: 11/26/2022]
Abstract
Background and aim A diagnosis of chronic benign paroxysmal positional vertigo (BPPV) is based on brief attacks of rotatory vertigo and concomitant nystagmus elicited by rapid changes in head position relative to gravity. However, the clinical course of BPPV may vary considerably from a self-limiting to a persisting and/or recurrent disabling problem. The authors' experience is that the most common complaints of patients with chronic BPPV are nautical vertigo or dizziness with other symptoms including neck pain, headache, widespread musculoskeletal pain, fatigue, and visual disturbances. Trauma is believed to be the major cause of BPPV in individuals younger than fifty years. Chronic BPPV is associated with high morbidity. Since these patients often suffer from pain and do not have rotatory vertigo, their symptoms are often attributed to other conditions. The aim of this study was to investigate possible associations between these symptoms and chronic BPPV. Methods During 2010 a consecutive prospective cohort observational study was performed. Diagnostic criteria: (A) BPPV diagnosis confirmed by the following: (1) a specific history of vertigo/dizziness evoked by acceleration/deceleration, (2) nystagmus in the first position of otolith repositioning maneuvers, and (3) appearing and disappearing nystagmus during the repositioning maneuvers; (B) the disorder has persisted for at least six months. (C) Normal MRI of the cerebrum. EXCLUSION CRITERIA (A) Any disorder of the central nervous system (CNS), (B) migraine, (C) active Ménière's disease, and (D) severe eye disorders. Symptom questionnaire ('yes or no' answers during a personal interview) and Dizziness Handicap Inventory (DHI) were used. Results We included 69 patients (20 males and 49 females) with a median age of 45 years (range 21-68 years). The median duration of the disease was five years and three months. The video-oculography confirmed BPPV in more than one semicircular canal in all patients. In 15% there was a latency of more than 1 min before nystagmus occurred. The Dizziness Handicap Inventory (DHI) median score was 55.5 (score >60 indicates a risk of fall). Seventy-five percent were on 50-100% sick leave. Eighty-one percent had a history of head or neck trauma. Nineteen percent could not recall any history of trauma. In our cohort, nautical vertigo and dizziness (81%) was far more common than rotatory vertigo (20%). The majority of patients (87%) reported pain as a major symptom: neck pain (87%), headache (75%) and widespread pain (40%). Fatigue (85%), visual disturbances (84%), and decreased concentration ability (81%) were the most frequently reported symptoms. In addition, unexpected findings such as involuntary movements of the extremities, face, neck or torso were found during otolith repositioning maneuvers (12%). We describe one case, as an example, how treatment of his BPPV also resolved his chronic, severe pain condition. Conclusion This observational study demonstrates a likely connection between chronic BPPV and the following symptoms: nautical vertigo/dizziness, neck pain, headache, widespread pain, fatigue, visual disturbances, cognitive dysfunctions, nausea, and tinnitus. Implications Patients with complex pain conditions associated with nautical vertigo and dizziness should be evaluated with the Dizziness Handicap Inventory (DHI)-questionnaire which can identify treatable balance disorders in patients with chronic musculoskeletal pain.
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Affiliation(s)
| | | | - Peter Borenstein
- Neurology, University of Boraas, School of Health Sciences, Boraas, Sweden
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Imbaud-Genieys S. Anterior semicircular canal benign paroxysmal positional vertigo: a series of 20 patients. Eur Ann Otorhinolaryngol Head Neck Dis 2013; 130:303-7. [PMID: 23845290 DOI: 10.1016/j.anorl.2012.01.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Revised: 12/09/2011] [Accepted: 01/30/2012] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The purpose of this study is to define the diagnostic criteria for anterior semicircular canal benign paroxysmal positional vertigo (BPPV) based on clinical data and the available anatomical and pathophysiological data. MATERIAL AND METHOD Between July 2006 and June 2007, 4320 patients consulting for otoneurological disease were investigated by otological examination, videonystagmography and neurological examination. RESULTS BPPV was diagnosed in 1430 patients, involving the posterior semicircular canal in 1325 patients, the horizontal semicircular canal in 85 patients, the posterior semicircular canal and ipsilateral anterior (superior) semicircular canal in 19 patients and the anterior semicircular canal only in one patient. In the 20 patients with anterior semicircular canal BPPV, the Dix-Hallpike (DH) test induced ageotropic horizontal torsional nystagmus beating towards the uppermost ear in the lateral supine position with reversal on standing. The modified Epley manoeuvre was effective in 94.1% of cases on the 8th day and in 97.5% of cases at 1 month. DISCUSSION/CONCLUSION Nystagmus beating towards the uppermost ear on the DH test is consistent with BPPV involving the anterior semicircular canal of the uppermost ear. The torsional component of nystagmus and not just the vertical component must be taken into account to facilitate the diagnosis with videonystagmoscopy glasses and identify the affected side. The anterior semicircular canal is rarely affected due to its anatomical position. Settling of otoconia in this canal requires hyperextension of the head. Treatment is simple, consisting of the modified Epley particle repositioning manoeuvre.
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Affiliation(s)
- S Imbaud-Genieys
- Centre d'Explorations Fonctionnelles Otoneurologiques, 10, rue Falguière, 75015 Paris, France.
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Cambi J, Astore S, Mandalà M, Trabalzini F, Nuti D. Natural course of positional down-beating nystagmus of peripheral origin. J Neurol 2013; 260:1489-96. [PMID: 23292207 DOI: 10.1007/s00415-012-6815-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 12/17/2012] [Accepted: 12/19/2012] [Indexed: 11/26/2022]
Abstract
The aim of this study was to assess the natural course of positional down-beating nystagmus (pDBN) and vertigo in patients with no evidence of central nervous system involvement and of presumed peripheral origin. Fifty-three patients with pDBN had a complete otoneurological examination. All subjects, apart from three (excluded from the study), showed no additional neurological signs and normal brain imaging. Patients were randomly assigned to two groups: with or without treatment with exercise. Patients were seen again after 24 h, and then weekly for up to 6 months. Forty-seven patients (94%) showed pDBN in the straight head-hanging position and in a Dix-Hallpike position. A torsional component was detected in 17 patients (34%). The mean latency and duration of pDBN was 4.7 ± 5 s and 40.1 ± 22 s, respectively. After 2 weeks, only 12 patients (24%) still had pDBN and all but one patient had recovered by 1 month. Twenty patients (40%) were diagnosed with a typical posterior canal benign paroxysmal positional vertigo (PC BPPV) before or after pDBN. This study assessed for the first time the natural course of presumed peripheral pDBN, which was characterized by a spontaneous remission in 24 patients in the first week and in 49 patients within 4 weeks. pDBN is much more common than previously suggested, with about the same frequency as lateral canal BPPV. Furthermore, the clinical characteristics of pDBN have been highlighted, as well as its possible relationship to PC BPPV.
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Affiliation(s)
- Jacopo Cambi
- ENT Department, University of Siena, Siena, Italy
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Shih CP, Wang CH. Supine to prolonged lateral position: a novel therapeutic maneuver for posterior canal benign paroxysmal positional vertigo. J Neurol 2012; 260:1375-81. [DOI: 10.1007/s00415-012-6807-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Revised: 12/11/2012] [Accepted: 12/12/2012] [Indexed: 11/28/2022]
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Lateral canal benign paroxysmal positional vertigo and decompression illness. Am J Emerg Med 2012; 31:451.e1-2. [PMID: 22944556 DOI: 10.1016/j.ajem.2012.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 06/21/2012] [Indexed: 11/21/2022] Open
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Kinne BL. An Alternative Treatment Option for Anterior Canal Benign Paroxysmal Positional Vertigo. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2012. [DOI: 10.3109/02703181.2012.700004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Cohen HS, Cox C, Springer G, Hoffman HJ, Young MA, Margolick JB, Plankey MW. Prevalence of abnormalities in vestibular function and balance among HIV-seropositive and HIV-seronegative women and men. PLoS One 2012; 7:e38419. [PMID: 22675462 PMCID: PMC3364989 DOI: 10.1371/journal.pone.0038419] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Accepted: 05/09/2012] [Indexed: 11/28/2022] Open
Abstract
Background Most HIV-seropositive subjects in western countries receive highly active antiretroviral therapy (HAART). Although many aspects of their health have been studied, little is known about their vestibular and balance function. The goals of this study were to determine the prevalences of vestibular and balance impairments among HIV-seropositive and comparable seronegative men and women and to determine if those groups differed. Methods Standard screening tests of vestibular and balance function, including head thrusts, Dix-Hallpike maneuvers, and Romberg balance tests on compliant foam were performed during semiannual study visits of participants who were enrolled in the Baltimore and Washington, D. C. sites of the Multicenter AIDS Cohort Study and the Women's Interagency HIV Study. Results No significant differences by HIV status were found on most tests, but HIV-seropositive subjects who were using HAART had a lower frequency of abnormal Dix-Hallpike nystagmus than HIV-seronegative subjects. A significant number of nonclassical Dix-Hallpike responses were found. Age was associated with Romberg scores on foam with eyes closed. Sex was not associated with any of the test scores. Conclusion These findings suggest that HAART-treated HIV infection has no harmful association with vestibular function in community-dwelling, ambulatory men and women. The association with age was expected, but the lack of association with sex was unexpected. The presence of nonclassical Dix-Hallpike responses might be consistent with central nervous system lesions.
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Affiliation(s)
- Helen S. Cohen
- Bobby R. Alford Department of Otolaryngology – Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, United States of America
| | - Christopher Cox
- Department of Epidemiology, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Gayle Springer
- Department of Epidemiology, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Howard J. Hoffman
- Epidemiology and Statistics Program, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Mary A. Young
- Division of Infectious Diseases, Department of Medicine, Georgetown University Medical Center, Washington, D. C., United States of America
| | - Joseph B. Margolick
- Department of Molecular Microbiology and Immunology, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Michael W. Plankey
- Division of Infectious Diseases, Department of Medicine, Georgetown University Medical Center, Washington, D. C., United States of America
- * E-mail:
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Dan-Goor E, Samra M. Benign paroxysmal positional vertigo after use of noise-canceling headphones. Am J Otolaryngol 2012; 33:364-6. [PMID: 21978648 DOI: 10.1016/j.amjoto.2011.08.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Accepted: 08/16/2011] [Indexed: 11/16/2022]
Abstract
Benign paroxysmal positional vertigo (BPPV) is a common cause of vertigo. We describe a case of a woman presenting acutely with a severe episode of disabling positional vertigo. Although she had no known etiologic risk factors, this attack followed 12 hours of continuously wearing digital noise-canceling headphones. This is the first such reported association between BPPV and the use of this gadget. We also provide a short review of BPPV and speculate on the possible pathogenic mechanisms involved.
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Burston A, Mossman S, Weatherall M. Are there diurnal variations in the results of the Dix–Hallpike manoeuvre? J Clin Neurosci 2012; 19:415-7. [DOI: 10.1016/j.jocn.2011.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2010] [Accepted: 08/23/2011] [Indexed: 11/29/2022]
Affiliation(s)
- Anne Burston
- Capital and Coast Health District Health Board, Wellington Hospital, Newtown, Wellington, New Zealand
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Al Saif AA, Alem HB, Alsenany S. Efficiency of the Deep Head Hanging Maneuver for Anterior Canal Benign Paroxysmal Positional Vertigo. J Phys Ther Sci 2012. [DOI: 10.1589/jpts.24.1191] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Amer A. Al Saif
- Department of Physical Therapy, Faculty of Applied Medical Science, King Abdulaziz University
| | | | - Samira Alsenany
- Nursing Department, Faculty of Applied Medical Science, King Abdulaziz University
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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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Heidenreich KD, Kerber KA, Carender WJ, Basura GJ, Telian SA. Persistent positional nystagmus. Laryngoscope 2011; 121:1818-20. [DOI: 10.1002/lary.21848] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Casani AP, Cerchiai N, Dallan I, Sellari-Franceschini S. Anterior canal lithiasis: diagnosis and treatment. Otolaryngol Head Neck Surg 2011; 144:412-8. [PMID: 21493205 DOI: 10.1177/0194599810393879] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To describe the clinical and oculographic features in patients with anterior semicircular canal benign paroxysmal positional vertigo and to determine the efficacy of a canalith repositioning procedure for its management. STUDY DESIGN Case series with chart review of patients presenting positional vertigo and positional downbeating nystagmus during a 2-year period. SETTING Outpatients' tertiary referral center for balance disorders. SUBJECTS AND METHODS Eighteen patients suffering from positional vertigo and presenting positional downbeating nystagmus were treated with a maneuver based on a modification of the procedure proposed by Crevits. MEAN OUTCOME MEASURE disappearance of positional downbeating nystagmus. RESULTS Positional downbeating nystagmus was elicited unilaterally with the Dix-Hallpike maneuver in 6 cases. In 4 patients, it was triggered by both left and right Dix-Hallpike tests. In 8 patients, the positional nystagmus was elicited by a straight head-hanging maneuver. The positional nystagmus was purely downbeating in 12 patients. In the remaining, a torsional component was detected. After the treatment, only 1 patient showed positional nystagmus at 30 days. CONCLUSION In anterior canal benign paroxysmal positional vertigo, the presence of a positional downbeating nystagmus in response to positional tests is key for diagnosis. In a significant number of patients, the affected side may not be detected because of the inconstant presence of a torsional component. Treatment with a simplified maneuver based on Crevits's technique can be considered an effective method for the treatment of anterior canal lithiasis, especially when the affected side cannot be detected clearly.
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Affiliation(s)
- Augusto Pietro Casani
- Department of Neuroscience, Otorhinolaryngology Unit, University of Pisa, Pisa, Italy.
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Teggi R, Giordano L, Bondi S, Fabiano B, Bussi M. Residual dizziness after successful repositioning maneuvers for idiopathic benign paroxysmal positional vertigo in the elderly. Eur Arch Otorhinolaryngol 2010; 268:507-11. [DOI: 10.1007/s00405-010-1422-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2009] [Accepted: 10/26/2010] [Indexed: 01/31/2023]
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Dan-Goor E, Eden JCP, Wilson SJ, Dangoor J, Wilson BR. Benign paroxysmal positional vertigo after decompression sickness: a first case report and review of the literature. Am J Otolaryngol 2010; 31:476-8. [PMID: 20015792 DOI: 10.1016/j.amjoto.2009.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2009] [Accepted: 07/06/2009] [Indexed: 11/15/2022]
Abstract
Benign paroxysmal positional vertigo is a common cause of vertigo. We describe a previously unreported case of this clinical entity in a young, fit recreational water diver, having experienced decompression illness. Full recovery occurred after hyperbaric recompression therapy, and he remained symptom free on 6-week follow-up. We review the literature and discuss the pathogenesis of benign paroxysmal positional vertigo, proposing that semicircular canal nitrogen bubble formation could have been the primary etiological event leading to this condition.
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Affiliation(s)
- Eric Dan-Goor
- The London Diving Chamber and Department of Hyperbaric Medicine, The Hospital of St John & St Elizabeth, London, England.
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Korres S, Riga M, Sandris V, Danielides V, Sismanis A. Canalithiasis of the anterior semicircular canal (ASC): treatment options based on the possible underlying pathogenetic mechanisms. Int J Audiol 2010; 49:606-12. [PMID: 20553103 DOI: 10.3109/14992021003753490] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Benign paroxysmal positional vertigo (BPPV) of the anterior semicircular canal (ASC) is an uncommon disorder currently diagnosed with the Dix-Hallpike (D-H) examination. According to the literature, nystagmus and vertigo may be more pronounced when the affected ear is either up or down. In some patients, both right and left D-H tests can trigger nystagmus with the same direction. The proposed treatment options with the addition of a different manoeuvre applied by the authors of the present study in cases of ASC lithiasis, seem to present a respective variety regarding the position of the affected ASC during the procedure of canalith repositioning. The aim of this study is to analyse the mechanisms underlying both the proposed treatment options and the clinical findings in the D-H examination. The results of this analysis stimulate further investigation, since they probably imply that repositioning manoeuvres might vary in their effectiveness when applied to different clinical subgroups of ASC BPPV.
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Affiliation(s)
- Stavros Korres
- ENT Department, Hippokration Hospital, University of Athens, Greece
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