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Maas BDPJ, Hacarlioglugil E, van Leeuwen RB, Kamphuis S, Schermer TR, van Benthem PPG, Bruintjes TD. Risk Factors for Recurrence of Benign Paroxysmal Positional Vertigo: A Prospective Study. Otol Neurotol 2024; 45:932-938. [PMID: 39142315 DOI: 10.1097/mao.0000000000004287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
OBJECTIVES Benign paroxysmal positional vertigo (BPPV) can be treated successfully in most cases. However, recurrences are common. We aimed to prospectively investigate demographic and clinical risk factors for BPPV recurrence. Our second aim was to investigate whether seasonality affects recurrences. METHODS We recruited adult Dutch patients presenting at our dizziness clinic with a diagnosis of definite or possible BPPV for a prospective observational study with 1-year follow-up. Factors collected from patient history and questionnaires were age, sex, ethnicity, previous treatment for BPPV, duration of BPPV symptoms, number of treatment sessions for the initial BPPV episode, the affected canal, recent head trauma, and a history of vestibular neuritis, Menière's disease, (vestibular) migraine, gout, diabetes mellitus, and chronic renal failure. Factors derived from blood samples were uric acid, glycated hemoglobin, and 25-hydroxyvitamin D. RESULTS We included 139 subjects with a mean age of 65 (SD, 13) years, of whom 70% was female. A total of 48 subjects (34.5%) suffered from at least one recurrence during the 1-year follow-up. Independent risk factors for recurrence of BPPV were "multiple treatment sessions for the initial BPPV episode" (incidence rate ratio, 1.74; 95% confidence interval 1.06-2.85; p = 0.027) and history of gout (incidence rate ratio, 1.90; 95% confidence interval, 1.01-3.57; p = 0.045). CONCLUSION One-third of patients presenting in a tertiary dizziness clinic develop at least one recurrence of BPPV within 1 year. Multiple treatment sessions and a history of gout are independent risk factors for recurrence.
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Affiliation(s)
| | | | | | - Stephan Kamphuis
- Department of Clinical Chemistry and Haematology, Eurofins Gelre, the Netherlands
| | | | - Peter Paul G van Benthem
- Department of Otorhinolaryngology-Head and Neck Surgery, Leiden University Medical Center, Leiden, the Netherlands
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Kong TH, Jung SY, Seo YJ, Shim DB. Vitamin D supplementation in preventing the recurrence of benign paroxysmal positional vertigo. Laryngoscope Investig Otolaryngol 2024; 9:e1225. [PMID: 38384364 PMCID: PMC10880126 DOI: 10.1002/lio2.1225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/06/2023] [Accepted: 02/03/2024] [Indexed: 02/23/2024] Open
Abstract
Objective To evaluate the effect of vitamin D supplementation on the recurrence rate of benign paroxysmal positional vertigo (BPPV). Methods A single-center, prospective, double-blind, placebo-controlled, parallel-group randomized controlled trial was conducted between November 2018 and May 2020. After successful treatment with canalith repositioning maneuvers, patients diagnosed with BPPV were randomized to either the vitamin D (n = 20) or placebo (n = 18) group. Only patients with serum vitamin D levels <20 ng mL-1 were included. The vitamin D group received 7000 IU of vitamin D weekly for a year, while the placebo group received a matching placebo drug. The final endpoint was the BPPV recurrence rate and correlation with serum vitamin D levels after 6 and 12 months in both groups. Results Among 38 patients, 37 were followed up for 6 months and 30 for 12 months. Significantly higher serum vitamin D levels were observed in the vitamin D group compared to the placebo group at both the 6-month and 1-year follow-ups (p < .001 at each timepoint). The recurrence rate was lower in the vitamin D group than in the placebo group after 6 months (p = .008) and 1 year (p = .003). Conclusion Vitamin D supplementation, in the absence of calcium, may be beneficial for patients prone to recurrent BPPV episodes, particularly when serum vitamin D levels are suboptimal (PRE20181024-001, Clinical Research Information Service, South Korea). Level of Evidence 1b.
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Affiliation(s)
- Tae Hoon Kong
- Department of Otorhinolaryngology ‐ Head and Neck SurgeryYonsei University Wonju College of MedicineWonju‐siGangwon‐doKorea
- Department of Medical Informatics and StatisticsYonsei University Wonju College of MedicineWonju‐siGangwon‐doKorea
| | - Su Young Jung
- Department of Otorhinolaryngology, Myongji HospitalHanyang University College of MedicineWonju‐siGangwon‐doKorea
| | - Young Joon Seo
- Department of Otorhinolaryngology ‐ Head and Neck SurgeryYonsei University Wonju College of MedicineWonju‐siGangwon‐doKorea
- Department of Medical Informatics and StatisticsYonsei University Wonju College of MedicineWonju‐siGangwon‐doKorea
| | - Dae Bo Shim
- Department of Otorhinolaryngology, Myongji HospitalHanyang University College of MedicineWonju‐siGangwon‐doKorea
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Bukurov B, Nenezic D, Pot D, Radivojevic N, Ivosevic T, Jotic A. Adoption of clinical practice guidelines in cases of benign paroxysmal positional vertigo. Eur Arch Otorhinolaryngol 2023; 280:4477-4483. [PMID: 37103580 PMCID: PMC10133903 DOI: 10.1007/s00405-023-07981-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/11/2023] [Indexed: 04/28/2023]
Abstract
PURPOSE Despite being one of the most common types of the peripheral vertigo encountered in clinical practice, benign paroxysmal positional vertigo (BPPV) remains underdiagnosed and undertreated, even in affluent health care systems. The publication of fully updated clinical practice guidelines significantly facilitated the diagnosis and treatment of BPPV. This study evaluates the adoption of the guidelines in our clinical setting and reviews further recommendations for quality-of-care improvement. METHODS This retrospective cross-sectional survey included a total of 1155 adult patients diagnosed with BPPV at the biggest tertiary care center in the country during a 5-year period (2017-2021). The data for the first three years (2017-2020) and 919 patients were collected in full, and for the remaining 236 patients (2020-2021) only partially due to the disturbance in referrals caused by COVID-19 pandemic. RESULTS The familiarity with and adherence to the published clinical guidelines by physicians judged by patients' charts and our health care database were overall unsatisfactory. The adherence varied from 0 to 40.5% in our sample. The recommendations for making the diagnosis and for repositioning procedure as first-line therapy were followed in only 20-30% of cases. CONCLUSION There are large opportunities for improvement in quality of care of BPPV patients. Apart from constant and systematic education at the primary health care level, the health care system may need to adopt more advanced measures of ensuring better adherence to guidelines and subsequent reduction in medical costs.
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Affiliation(s)
- Bojana Bukurov
- Faculty of Medicine, University of Belgrade, Dr Subotica 8, 11000, Belgrade, Serbia.
- Clinic for Otorhinolaryngology and Maxillofacial Surgery, University Clinical Center of Serbia, Pasterova 2, 11000, Belgrade, Serbia.
| | - Dragana Nenezic
- Clinic for Otorhinolaryngology and Maxillofacial Surgery, University Clinical Center of Serbia, Pasterova 2, 11000, Belgrade, Serbia
| | - Danilo Pot
- Hospital for Otorhinolaryngology, Clinical Center of Montenegro, Podgorica, Montenegro
| | - Nemanja Radivojevic
- Clinic for Otorhinolaryngology and Maxillofacial Surgery, University Clinical Center of Serbia, Pasterova 2, 11000, Belgrade, Serbia
| | - Tjasa Ivosevic
- Faculty of Medicine, University of Belgrade, Dr Subotica 8, 11000, Belgrade, Serbia
- Centre for Anesthesiology and Resuscitation, University Clinical Center of Serbia, Belgrade, Serbia
| | - Ana Jotic
- Faculty of Medicine, University of Belgrade, Dr Subotica 8, 11000, Belgrade, Serbia
- Clinic for Otorhinolaryngology and Maxillofacial Surgery, University Clinical Center of Serbia, Pasterova 2, 11000, Belgrade, Serbia
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Casani AP, Gufoni M. Recurring benign paroxysmal positional vertigo after successful canalith repositioning manoeuvers. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2023; 43:S61-S66. [PMID: 37698102 PMCID: PMC10159632 DOI: 10.14639/0392-100x-suppl.1-43-2023-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 01/08/2023] [Indexed: 09/13/2023]
Abstract
Benign baroxysmal positional vertigo (BPPV) represents the most common peripheral vestibular dysfunction encountered in clinical practice. Although canalith repositioning procedures (CRPs) are a relatively successful treatment for BPPV, many patients suffer from recurrences. Several studies have demonstrated that various pathological conditions (diabetes, hypertension, endolymphatic hydrops, low vitamin D levels) as well as delayed BPPV treatment using CRP, multiple canal involvement may be associated with recurrence of BPPV. We evaluated the history of 1,428 patients (558 males and 870 females, age range 10-92 years) suffering from BPPV. Of 1,428 cases, 820 (77%) did not relapse in the following 20 years. Mean age and gender did not differ significantly between groups with and without recurrence. Regarding risk factors for BPPV recurrence, age, female gender, migraine, hypertension, diabetes mellitus, hyperlipidaemia, osteoporosis, vascular diseases, and vitamin D deficiency may be associated with recurrent BPPV and should be kept in mind. Osteoporosis, vitamin D deficiency as well as thyroid dysfunction should be evaluated in postmenopausal women. Treatment of these comorbidities may help to reduce the risk of BPPV recurrence.
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Affiliation(s)
- Augusto Pietro Casani
- Department of Medicine and Surgery, ENT Section, Pisa University Hospital, Pisa, Italy
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Incidence of idiopathic benign paroxysmal positional vertigo subtype by hospital visit type: experience of a single tertiary referral centre. J Laryngol Otol 2023; 137:57-60. [PMID: 35942983 DOI: 10.1017/s0022215121003923] [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: 01/14/2023]
Abstract
OBJECTIVE To investigate the incidence of benign paroxysmal positional vertigo subtype by hospital visit type (i.e. out-patient department vs emergency room), in a single tertiary referral centre. METHODS A total of 772 consecutive patients with benign paroxysmal positional vertigo were included. Using head-roll and Dix-Hallpike tests, benign paroxysmal positional vertigo subtype was determined as canalolithiasis posterior semicircular canal benign paroxysmal positional vertigo, geotropic horizontal semicircular canal benign paroxysmal positional vertigo or apogeotropic benign paroxysmal positional vertigo. RESULTS The posterior semicircular canal benign paroxysmal positional vertigo patients who were evaluated via the out-patient department outnumbered those evaluated via the emergency room, while those with horizontal semicircular canal benign paroxysmal positional vertigo who were evaluated via the emergency room outnumbered those evaluated via the out-patient department. CONCLUSION A significantly higher proportion of patients who visited the emergency room had horizontal semicircular canal benign paroxysmal positional vertigo than posterior semicircular canal benign paroxysmal positional vertigo. These results suggest that the true incidence of horizontal semicircular canal benign paroxysmal positional vertigo might be higher than previously reported.
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Lee DH, Shin JE, Jung T, Kim CH. Change in Diagnosis of Benign Paroxysmal Positional Vertigo During COVID-19 Pandemic. Int J Gen Med 2022; 15:7029-7037. [PMID: 36090705 PMCID: PMC9462836 DOI: 10.2147/ijgm.s378822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/31/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose The present study investigated the impact of coronavirus disease 2019 (COVID-19) pandemic on benign paroxysmal positional vertigo (BPPV). Patients and Methods The medical records of BPPV patients who were evaluated in the outpatient department (OPD) and emergency room (ER) during (435 patients) and before (517 patients) the COVID-19 pandemic were retrospectively reviewed. Dix-Hallpike and supine head-roll tests were used to classify the subtype of BPPV as posterior semicircular canal (PSCC), geotropic lateral semicircular canal (geotropic LSCC), or apogeotropic lateral semicircular canal (apogeotropic LSCC) BPPV. Results More patients with PSCC BPPV were diagnosed at the OPD compared with those who were diagnosed at the ER both before and during the COVID-19 pandemic; however, more patients with LSCC BPPV were diagnosed at the ER compared with those who were diagnosed at the OPD during the same periods. The mean time interval between vertigo onset and initial evaluation was remarkably longer during the pandemic in patients with PSCC BPPV. Conclusion This study demonstrated that the incidences of BPPV subtypes according to hospital visit type were not significantly different before and during the COVID-19 pandemic. Because hospital visits were delayed in patients with PSCC BPPV during the COVID-19 pandemic, telemedicine or e-health could be suitable alternatives to face-to-face medical care for these patients.
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Affiliation(s)
- Dong-Han Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Jung Eun Shin
- Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Taesik Jung
- Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Chang-Hee Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea
- Correspondence: Chang-Hee Kim, Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, 120-1 Neungdong-ro (Hwayang-dong), Gwangjin-gu, Seoul, 05030, Republic of Korea, Tel +82-2-2030-7666, Fax +82-2-2030-5299, Email
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Hougaard DD, Valsted SH, Bruun NH, Bech MW, Talebnasab MH. Seven years of experience with treatment of benign paroxysmal positional vertigo with a mechanical rotational chair. Front Neurol 2022; 13:981216. [PMID: 36090886 PMCID: PMC9453247 DOI: 10.3389/fneur.2022.981216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/05/2022] [Indexed: 11/16/2022] Open
Abstract
Background Throughout the last decade, several mechanical rotational chairs have been developed for diagnostics and treatment of patients with a typical case history of benign paroxysmal positional vertigo. Sparse evidence, however, exists in terms of diagnostic accuracy and treatment efficiency with these mechanical rotational chairs. Also, recommendations for optimal use of these chairs are yet to be determined. Objective Primary objective was to evaluate overall treatment of benign paroxysmal positional vertigo with a mechanical rotational chair and secondary objectives included description of patient- and BPPV characteristics, determination of subjective and objective outcomes, as well as analyzation of recurrence- and recurrence-related risk factors following successful treatment. Methods Retrospective cohort study with 635 patients diagnosed with benign paroxysmal positional vertigo and treated by means of a mechanical rotational chair during a 7-year period from 2014 to 2021 at a tertiary University hospital. Patient- and disease-specific characteristics, treatment and recurrence data were collected through reviewing of patient records. Results The mean number of required treatments was 2.7 when accounting for a six percent treatment failure rate (defined as a need of more than 10 treatments), and 3.7 when not. Bilateral mono-canal affection required 3.8 treatments, unilateral multi-canal 3.5 treatments, and the combination of bilateral and multi-canal affection 5.2 treatments. All these scenarios were associated with significantly higher numbers of required treatments when compared to unilateral mono-canal affection, which required 1.9 treatments. The overall recurrence rate was 25.4 percent. Conclusion A mechanical rotational chair provides successful treatment of benign paroxysmal positional vertigo. Mechanical rotational chairs should primarily be reserved for the treatment of retractable and atypical benign paroxysmal positional vertigo patients. Many aspects of the optimal use of these chairs still require elaborative assessment.
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Affiliation(s)
- Dan Dupont Hougaard
- Balance and Dizziness Center, Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- *Correspondence: Dan Dupont Hougaard
| | - Sebastian Hygum Valsted
- Balance and Dizziness Center, Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Niels Henrik Bruun
- Unit of Clinical Biostatistics and Bioinformatics, Aalborg University Hospital, Aalborg, Denmark
| | - Mathias Winther Bech
- Balance and Dizziness Center, Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Michel Heide Talebnasab
- Balance and Dizziness Center, Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Aalborg University Hospital, Aalborg, Denmark
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