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Valsted SS, Larsen AT, Callesen HE, Hougaard DD. A Comparison of the Efficacy of Four Repositioning Maneuvers in the Treatment of Posterior Benign Paroxysmal Positional Vertigo. Am J Audiol 2024; 33:1008-1022. [PMID: 38900988 DOI: 10.1044/2024_aja-23-00177] [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: 06/22/2024] Open
Abstract
PURPOSE The purpose of the present review was to report the effectiveness of Epley maneuver compared to other manual repositioning maneuvers (RM) for treatment of posterior benign paroxysmal positional vertigo (P-BPPV). A systematic search of PubMed, Embase, and the Cochrane Library was conducted up until June 30, 2023. RESULTS Primary outcomes focused on complete resolution of vertiginous symptoms measured by either a Visual Analog Scale (VAS) or the Dix-Hallpike (DH) test. Secondary outcomes included conversion of a positive DH test to a negative DH test exclusively looking at positional nystagmus and assessment of side effects (cervical/back pain, posttreatment dizziness, and nausea). Both outcomes were assessed within a maximum of 4-week follow-up. Following systematic search and review, nine randomized controlled trials (RCTs; p = .413) were found. The studies reported on the effectiveness of the Epley maneuver compared to three other specific RM: Semont, Li, and Gans maneuvers. Results revealed a low to very low certainty of evidence. With the primary outcomes, Epley maneuver was superior to Gans maneuver 24-hr posttreatment but not after 1 week. No significant differences were found between the remaining maneuvers. CONCLUSIONS In summary, evidence of low to very low certainty indicates that Epley maneuver is comparable with Semont, Gans, and Li maneuvers for vertiginous symptoms in patients with P-BPPV. Further high-quality studies are needed.
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Affiliation(s)
- Sebastian Satkunasingam Valsted
- Department of Clinical Medicine, Aalborg University Hospital, Denmark
- Balance & Dizziness Center, Department of Otolaryngology, Head and Neck Surgery and Audiology, Aalborg University Hospital, Denmark
| | | | | | - Dan Dupont Hougaard
- Department of Clinical Medicine, Aalborg University Hospital, Denmark
- Balance & Dizziness Center, Department of Otolaryngology, Head and Neck Surgery and Audiology, Aalborg University Hospital, Denmark
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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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Yang TH, Chen CH, Cheng YF, Lin HC, Chen CS. Association of Peripheral Vestibular Disorder with Diabetes: A Population-Based Study. J Pers Med 2024; 14:768. [PMID: 39064022 PMCID: PMC11277599 DOI: 10.3390/jpm14070768] [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: 06/09/2024] [Revised: 07/15/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND This study aimed to investigate the association of peripheral vestibular disorders with type 1 and type 2 diabetes using a population-based dataset. METHODS The data for this study were obtained from Taiwan's Longitudinal Health Insurance Database 2010. The sample consisted of 150,916 patients who were newly diagnosed with peripheral vestibular disorders as cases and 452,748 propensity-score-matching controls without peripheral vestibular disorders. We utilized multivariate logistic regression models to quantitatively evaluate the association between peripheral vestibular disorders and diabetes while considering factors such as sex, age, geographic location, monthly income, urbanization level of the patient's residence, coronary heart disease, hypertension, and hyperlipidemia. RESULTS The chi-squared test indicates that diabetes was more common in the peripheral vestibular disorder group compared to controls (20.6% vs. 15.1%, p < 0.001). Of all sampled patients, the adjusted odds ratio for diabetes was 1.597 (95% CI = 1.570~1.623) for those with peripheral vestibular disorders when compared to controls, while patients with Ménière's disease, benign paroxysmal positional vertigo, unilateral vestibulopathy, and other peripheral vestibular disorders had respective adjusted odds ratios of diabetes at 1.566 (95% CI = 1.498~1.638), 1.677 (95% CI = 1.603~1.755), 1.592 (95% CI = 1.504~1.685), and 1.588 (95% CI = l.555~1.621) in comparison to controls. CONCLUSIONS Our research has revealed an association between diabetes and an increased susceptibility to peripheral vestibular disorders.
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Affiliation(s)
- Tzong-Hann Yang
- Department of Otorhinolaryngology, Taipei City Hospital, Taipei 100, Taiwan;
- Department of Speech, Language and Audiology, National Taipei University of Nursing and Health, Taipei 112, Taiwan
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan;
- Center of General Education, University of Taipei, Taipei 111, Taiwan
- Research Center of Data Science on Healthcare Industry, College of Management, Taipei Medical University, Taipei 110, Taiwan
| | - Chao-Hung Chen
- Department of Thoracic Surgery, Mackay Memorial Hospital, Taipei 104, Taiwan;
- Department of Medicine, MacKay Medical College, New Taipei City 252, Taiwan
| | - Yen-Fu Cheng
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan;
- Research Center of Data Science on Healthcare Industry, College of Management, Taipei Medical University, Taipei 110, Taiwan
- Department of Medical Research, Taipei Veterans General Hospital, Taipei 112, Taiwan
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Herng-Ching Lin
- School of Health Care Administration, College of Management, Taipei Medical University, Taipei 110, Taiwan
- Research Center of Sleep Medicine, Taipei Medical University Hospital, Taipei 110, Taiwan
| | - Chin-Shyan Chen
- Research Center of Data Science on Healthcare Industry, College of Management, Taipei Medical University, Taipei 110, Taiwan
- Department of Economics, National Taipei University, New Taipei City 237, Taiwan
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Çakır S, Sahin A, Gedik-Soyuyuce O, Gence Gumus Z, Sertdemir İ, Korkut N, Yalınay Dikmen P. Assessing the impact of migraine on benign paroxysmal positional vertigo symptoms and recovery. BMC Neurol 2024; 24:148. [PMID: 38698310 PMCID: PMC11064330 DOI: 10.1186/s12883-024-03606-2] [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: 10/08/2023] [Accepted: 03/18/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND During episodes of benign paroxysmal positional vertigo (BPPV), individuals with migraine, compared with individuals without migraine, may experience more severe vestibular symptoms because of their hyperexcitable brain structures, more adverse effects on quality of life, and worse recovery processes from BPPV. METHODS All patients with BPPV were assigned to the migraine group (MG, n = 64) and without migraine group (BPPV w/o MG, n = 64) and completed the Vertigo Symptom Scale (VSS), Vertigo Dizziness Imbalance Symptom Scale (VDI-SS), VDI Health-Related Quality of Life Scale (VDI-HRQoLS), Beck Anxiety Inventory (BAI), and Beck Depression Inventory (BDI) at the time of BPPV diagnosis (baseline) and on the one-month follow-up. Headache Impact Test-6 and Migraine Disability Assessment Scale were used for an assessment of headache. Motion sickness was evaluated based on the statement of each patient as present or absent. RESULTS Compared with the BPPV w/o MG, the MG had higher VSS scores at baseline [19.5 (10.7) vs. 11.3 (8.5); p < 0.001] and on one-month follow-up [10.9 (9.3) vs. 2.2 (2.7), p < 0.001]; experienced more severe dizziness and imbalance symptoms based on the VDI-SS at baseline (61.9% vs. 77.3%; p < 0.001) and after one month (78.9% vs. 93.7%, p < 0.001); and more significantly impaired quality of life according to the VDI-HRQoLS at baseline (77.4% vs. 91.8%, p < 0.001) and after one month (86.3% vs. 97.6%, p < 0.001). On the one-month follow-up, the subgroups of patients with moderate and severe scores of the BAI were higher in the MG (39.2%, n = 24) than in the BPPV w/o MG (21.8%, n = 14) and the number of patients who had normal scores of the BDI was lower in the MG than in the BPPV w/o MG (67.1% vs. 87.5%, p = 0.038). CONCLUSION Clinicians are advised to inquire about migraine when evaluating patients with BPPV because it may lead to more intricate and severe clinical presentation. Further studies will be elaborated the genuine nature of the causal relationship between migraine and BPPV.
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Affiliation(s)
- Seda Çakır
- Department of Neurology, Acıbadem University School of Medicine, İçerenköy. Kayışdağı Cad. No: 32. Ataşehir, İstanbul, 34752, Turkey
| | - Aysenur Sahin
- Department of Neurology, Acıbadem University School of Medicine, İçerenköy. Kayışdağı Cad. No: 32. Ataşehir, İstanbul, 34752, Turkey
| | | | | | - İbrahim Sertdemir
- Department of Biostatistics and Bioinformatics, Acıbadem University, İstanbul, Turkey
| | - Nazım Korkut
- Department of Otorhinolaryngology, Acıbadem Maslak Hospital, İstanbul, Turkey
| | - Pınar Yalınay Dikmen
- Department of Neurology, Acıbadem University School of Medicine, İçerenköy. Kayışdağı Cad. No: 32. Ataşehir, İstanbul, 34752, Turkey.
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Ren Y, Li J, Xia F. Assessment of vitamin D deficiency in recurrent BPPV patients: A cross-sectional study. Am J Otolaryngol 2024; 45:104212. [PMID: 38176205 DOI: 10.1016/j.amjoto.2023.104212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 01/06/2024]
Abstract
PURPOSE This study aimed to investigate the vitamin D deficiency of patients with BPPV recurrence and to evaluate the differences of 25-hydroxy vitamin D (25(OH)D) and serum calcium levels among gender and age categories. METHODS This cross-sectional study enrolled patients with BPPV. The diagnosis of BPPV was based on positional nystagmus and vertigo induced by certain head positions (The Dix-Hallpike maneuver and head roll tests). All patients' age, serum 25(OH)D, calcium measurements and recurrence data were collected and analyzed. RESULTS The median of 25(OH)D was 15.32 (IQR 10.61, 20.90) ng/ml. The recurrent group showed lower 25(OH)D levels than that of non-recurrent group [13.28 (IQR 9.47, 17.57) ng/ml vs 16.21 (IQR 11.49, 21.13) ng/ml]. There were significant differences of 25(OH)D levels among age categories. The proportion of vitamin D deficiency in patients ≥60 years old was lower than that in the other two groups. CONCLUSION Our study suggested that BPPV patients had a decreased 25(OH)D level and a high incidence of vitamin D deficiency. The 25(OH)D level of recurrent BPPV patients was lower than that in non-recurrent ones. Among them, the elderly group (≥60 years) took the preponderance, which had the lowest incidence of vitamin D deficiency and the highest incidence of vitamin D sufficiency.
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Affiliation(s)
- Yuanyuan Ren
- Department of Otorhinolaryngology-Head & Neck Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jinlan Li
- Department of Otorhinolaryngology-Head & Neck Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Fei Xia
- Department of Otorhinolaryngology-Head & Neck Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
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Kasimu M, Tuersun M, Maimaitituerxun Y, Abulizi W, Li S, Fulati N. Abnormal Rhomboid Lip and Choroid Plexus Should be Valued in Microvascular Decompression for Vestibulocochlear Diseases. World Neurosurg 2024; 181:e607-e614. [PMID: 37898278 DOI: 10.1016/j.wneu.2023.10.099] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 10/22/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND Surgical outcomes for functional vestibulocochlear diseases vary, and the influencing factors are not fully understood. The role of a rhomboid lip (RL) and choroid plexus (CP) in microvascular decompression (MVD) of the vestibulocochlear nerve has not been studied. This study aims to evaluate the surgical efficacy of MVD for vestibulocochlear diseases, with and without addressing the RL and CP, to enhance our understanding of their etiology. METHODS A total of 15 patients who underwent MVD for the vestibulocochlear nerve between 2013 and 2022 were retrospectively identified and followed up. The patients were classified into 4 categories: vestibular paroxysmia (VP), benign positional paroxysmal vertigo (BPPV), and Meniere disease (MD). The fourth was a "tinnitus" group. The relief of symptoms, recurrence, satisfaction after surgery, available relevant imaging studies, and intraoperative observation data were evaluated. RESULTS Following MVD, 6 of the 7 patients in the VP group, the 1 patient in the BPPV group, and 1 of 2 patients in the MD group were completely relieved of vertigo. The seventh VP patient showed significant improvement. The 5 patients in the "tinnitus" group remained unchanged. Retrospectively, 4 patients from the VP, BPPV, and MD groups who underwent RL incision and CP excision were also free of vertigo, although vascular compression was not confirmed in these cases. CONCLUSIONS MVD is generally considered a useful treatment for VP and could also be effective in managing recurrent vertigo caused by BPPV and MD. Our results highlight the potential role of an abnormal RL and CP in the development of vertigo symptoms. Patients presenting with "tinnitus" require further investigation and might not be suitable for MVD.
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Affiliation(s)
- Maimaitijiang Kasimu
- Department of Functional Neurosurgery, Neurosurgery Centre, The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, China.
| | - Maidina Tuersun
- Department of Functional Neurosurgery, Neurosurgery Centre, The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, China
| | - Yiliyasijiang Maimaitituerxun
- Department of Functional Neurosurgery, Neurosurgery Centre, The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, China
| | - Wulamuaili Abulizi
- Department of Functional Neurosurgery, Neurosurgery Centre, The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, China
| | - Shu Li
- Department of Functional Neurosurgery, Neurosurgery Centre, The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, China
| | - Nijiati Fulati
- Department of Functional Neurosurgery, Neurosurgery Centre, The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, China
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Ciorba A, Tessari M, Natale E, Buzzi F, Baldazzi G, Cosacco A, Migliorelli A, Corazzi V, Bianchini C, Stomeo F, Pelucchi S, Zamboni P. Cerebral Outflow Discrepancies in Recurrent Benign Paroxysmal Positional Vertigo: Focus on Ultrasonographic Examination. Diagnostics (Basel) 2023; 13:diagnostics13111902. [PMID: 37296754 DOI: 10.3390/diagnostics13111902] [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: 04/03/2023] [Revised: 04/28/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023] Open
Abstract
This prospective pilot study aimed to evaluate whether cerebral inflow and outflow abnormalities assessed by ultrasonographic examination could be associated with recurrent benign paroxysmal positional vertigo (BPPV). Twenty-four patients with recurrent BPPV, affected by at least two episodes, and diagnosed according to American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) criteria, evaluated at our University Hospital, between 1 February 2020 and 30 November 2021, have been included. At the ultrasonographic examination, 22 of 24 patients (92%) reported one or more alterations of the extracranial venous circulation, among those considered for the diagnosis of chronic cerebrospinal venous insufficiency (CCSVI), although none of the studied patients were found to have alterations in the arterial circulation. The present study confirms the presence of alterations of the extracranial venous circulation in recurrent BPPV; these anomalies (such as stenosis, blockages or regurgitation of flow, or abnormal valves, as per the CCSVI) could cause a disruption in the venous inner ear drainage, hampering the inner ear microcirculation and then possibly causing recurrent otolith detachment.
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Affiliation(s)
- Andrea Ciorba
- ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44124 Ferrara, Italy
| | - Mirko Tessari
- Vascular Diseases Centre, University Hospital of Ferrara, 44124 Ferrara, Italy
| | - Erennio Natale
- ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44124 Ferrara, Italy
| | - Fabio Buzzi
- ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44124 Ferrara, Italy
| | - Giulia Baldazzi
- Vascular Diseases Centre, University Hospital of Ferrara, 44124 Ferrara, Italy
| | - Alessio Cosacco
- Vascular Diseases Centre, University Hospital of Ferrara, 44124 Ferrara, Italy
| | - Andrea Migliorelli
- ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44124 Ferrara, Italy
| | - Virginia Corazzi
- ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44124 Ferrara, Italy
| | - Chiara Bianchini
- ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44124 Ferrara, Italy
| | - Francesco Stomeo
- ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44124 Ferrara, Italy
| | - Stefano Pelucchi
- ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44124 Ferrara, Italy
| | - Paolo Zamboni
- Vascular Diseases Centre, University Hospital of Ferrara, 44124 Ferrara, Italy
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Evaluation of a questionnaire as a screening tool for benign paroxysmal position vertigo. Eur Arch Otorhinolaryngol 2023; 280:1919-1926. [PMID: 36422670 DOI: 10.1007/s00405-022-07744-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 11/07/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the value of a questionnaire as a screening tool for benign paroxysmal position vertigo (BPPV). STUDY DESIGN Retrospective chart review. SETTING Tertiary care centers. METHODS A total of 520 vertigo adults completed the questionnaire before the diagnosis was confirmed. After vestibular function examination and other diagnostic examination, the diagnosis of all participants was confirmed by experts. By validating valuable items from the questionnaire with 47 items, a new questionnaire of 5 items was formed to quickly diagnose BPPV. The internal consistency of the new questionnaire and validity were evaluated. The correlation between the score obtained from the new questionnaire and diagnosis was investigated. The mean score was also compared between groups with and without BPPV and diagnostic precision measures were calculated. RESULTS 520 vertigo participants answered all the question completely and BPPV was identified in 138 participants (26.5%). The responses to questionnaire revealed preferable reproducibility (r = 0.898, P < 0.05) and internal consistency (Cronbach's α = 0.702) as well as the validity (Kaiser-Meyer-Olkin, KMO = 0.731). The higher the individual score, the more likely to be BPPV (B = 2.082; P < 0.05). The mean score of answers was greater in the group with a clinical diagnosis of BPPV compared to those without BPPV (F = 58.459, P < 0.05). The sensitivity of the screening tool was 92.8% and specificity was 88.5%, with an area under the ROC curve of 0.946 (95% confidence interval 0.926-0.965; P < 0.05). CONCLUSION The questionnaire proved to be of great value to screen for individuals with possible BPPV.
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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: 3] [Impact Index Per Article: 3.0] [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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Shu Y, Liao N, Fang F, Shi Q, Yan N, Hu Y. The relationship between psychological conditions and recurrence of benign paroxysmal positional vertigo: a retrospective cohort study. BMC Neurol 2023; 23:137. [PMID: 37004007 PMCID: PMC10064541 DOI: 10.1186/s12883-023-03169-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 03/16/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Psychological conditions have been found to be associated with an increased risk of incident benign paroxysmal positional vertigo (BPPV). However, much less is known on whether and how psychological conditions such as anxiety, insomnia and obsessive-compulsive disorder (OCD) affect the recurrence of BPPV. METHODS A retrospective cohort study of 2,612 outpatients and inpatients diagnosed with BPPV between September 2012 and August 2020. BPPV recurrence was followed up until February 2021. The Cox proportional hazard regression was used to analyze the association between psychological conditions and the risk of the first recurrence. Poisson regression was applied to analyze the association between psychological conditions and the number of recurrences in patients with at least one relapse. RESULTS During the follow-up, 391 patients had at least one BPPV recurrence. Female BPPV patients were more likely than male patients to experience relapses than male patients, but the characteristics of BPPV recurrence (number of recurrences and duration between recurrences) did not differ between men and women. After adjustment for sex, age and comorbidities, a heightened risk of first BPPV recurrence was found to be associated with anxiety (hazard ratio [HR]: 1.30, 95% confidence interval [CI]: 1.01, 1.68) and OCD (HR: 2.15, 95% CI: 1.31, 3.52). An increased risk of first BPPV recurrence associated with insomnia was only observed in male patients (HR: 2.22, 95% CI: 1.24, 3.98) but not in female patients (HR: 0.91, 95% CI: 0.63, 1.31). None of these psychological conditions were associated with the number of recurrences in patients who experienced recurrence. CONCLUSIONS The presence of anxiety and OCD increased the risk of first BPPV recurrence, as well as insomnia for male patients. These psychological conditions were not associated with the number of BPPV recurrences. Diagnosis and treatment of these psychological conditions could be a useful strategy to prevent the recurrence of BPPV.
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Affiliation(s)
- Yuexin Shu
- School of Public Health, Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Nannan Liao
- University-Town Hospital of Chongqing Medical University, Chongqing, 401331, People's Republic of China
| | - Fang Fang
- University-Town Hospital of Chongqing Medical University, Chongqing, 401331, People's Republic of China
| | - Qiuling Shi
- School of Public Health, Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Ning Yan
- University-Town Hospital of Chongqing Medical University, Chongqing, 401331, People's Republic of China.
| | - Yaoyue Hu
- School of Public Health, Chongqing Medical University, Chongqing, 400016, People's Republic of China.
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Cobb LH, Bailey VO, Liu YF, Teixido MT, Rizk HG. Relationship of vitamin D levels with clinical presentation and recurrence of BPPV in a Southeastern United States institution. Auris Nasus Larynx 2023; 50:70-80. [PMID: 35659787 DOI: 10.1016/j.anl.2022.05.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 05/17/2022] [Accepted: 05/19/2022] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To examine the relationship of 25hydroxyvitamin D serum levels with BPPV incidence and recurrence rates. METHODS A retrospective cross-sectional, case-controlled study with follow-up phone survey was performed on patients diagnosed with BPPV between 05/2017-05/2020, who had available 25hydroxyvitamin D serology. Patients were seen at a multidisciplinary, vestibular-focused, neurotology clinic at a tertiary referral center. Controls consisted of subjects from the National Health and Nutrition Examination Survey (NHANES), and a locoregional age, sex, and race-matched group of patients from our institution. RESULTS Our BPPV cohort consisted of 173 patients (mean age 66.2 ± 11.8 years), who were predominately female (75.7%) and Caucasian (76.3%). Almost all age subgroups (BPPV, NHANES, and locoregional groups) ≤60 years old had insufficient levels of vitamin D. However, the overall BPPV cohort had a significantly higher vitamin D level than the NHANES control (31.4 ± 16.5 v. 26.0 ± 11.2 ng/mL, d=0.474 [0.323, 0.626]). There was no significant difference when compared to the overall locoregional control (31.4 ± 20.5 ng/mL). Migraines were significantly correlated to increased BPPV recurrence rates on univariate (beta=0.927, p=0.037, 95% CI: [0.057, 1.798]) and multiple regression analyses (beta=0.231, 95% CI: [0.024, 2.029], p=0.045). Furthermore, patients with BPPV recurrences had significantly lower levels of vitamin D at initial presentation when compared to patients with no recurrences (29.0 ± 12.0 v. 37.6 ± 18.3 ng/mL, d=0.571[0.139,1.001]). CONCLUSION Many BPPV patients in our cohort had insufficient vitamin D levels, and patients with BPPV recurrences had insufficient and significantly lower vitamin D levels than those without. As a readily available and affordable supplement, vitamin D may be used as an adjunct treatment but prospective studies should be done to confirm if it can prevent or reduce recurrence.
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Affiliation(s)
- Leah H Cobb
- Department of Otolaryngology; Medical University of South Carolina, Charleston, SC, USA
| | - Victoria O Bailey
- Department of Otolaryngology; Medical University of South Carolina, Charleston, SC, USA
| | - Yuan F Liu
- Department of Otolaryngology, Head and Neck Surgery, Loma Linda University Health, Loma Linda, CA, USA
| | - Michael T Teixido
- Department of Otolaryngology, University of Pennsylvania, Philadelphia, PA, USA
| | - Habib G Rizk
- Department of Otolaryngology; Medical University of South Carolina, Charleston, SC, USA.
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12
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Zhao C, Yang Q, Song J. Dynamic changes of otolith organ function before and after repositioning in patients with benign paroxysmal positional vertigo detected by virtual reality auxiliary technology: A cohort study. Front Neurol 2022; 13:1007992. [PMID: 36425796 PMCID: PMC9679621 DOI: 10.3389/fneur.2022.1007992] [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: 07/31/2022] [Accepted: 10/17/2022] [Indexed: 11/11/2022] Open
Abstract
Objectives To dynamically investigate otolith function in patients with benign paroxysmal positional vertigo (BPPV) before, after, and 1 month after repositioning, and explore the possible compensation mechanisms. Methods Thirty-six patients confirmed with BPPV (canal lithiasis) treated in our hospital between August 2020 and March 2021, as well as 36 health controls matched for age and gender (normal control group, NC group) were enrolled. For NC group, the virtual reality (VR) auxiliary static subjective visual vertical (SVV), subjective visual horizontal (SVH), and SVV of dynamic unilateral centrifugation (DUC), were measured at inclusion. For the BPPV group, visual analog scale (VAS) was used to assess the vertigo degree, while static SVV, SVH, and DUC were performed before, after, and 1 month after repositioning. First, we compare the deviations of SVV0/SVH0° when the subject's head is in the positive position, and SVV of DUC between BPPV and NC groups before repositioning, after which we compared the deviations in SVV45, SVV90, SVH45, SVH90°, and SVV of DUC between the affected and unaffected sides before repositioning. Finally, paired t-test was used to compare the VAS score, deviations in static SVV0, SVV45, SVV90, SVH0, SVH45, and SVH90°, and deviations in SVV of DUC before, after, and 1 month after repositioning. (Here, 0, 45, and 90° refer to the angle which the center axis of head deviates from the gravity line.) Results SVV0 SVH0°, and SVV of DUC at 120 and 180°/s 0 significantly differed between BPPV and NC group before repositioning. The deviations in SVV45, SVV90, SVH45, SVH90°, and SVV of DUC at 120°/s-2 and 180°/s-4.5 did not significantly differ between bilateral sides in BPPV patients before repositioning. The deviation in SVH90° was significantly lower after repositioning than before. The deviation in SVH45° was significantly higher 1 month after repositioning than before. The deviation angle of SVV of DUC at 180°/s-0 was significantly lower after repositioning than before. The vertigo VAS score of patient with BPPV continued to decrease after repositioning. Conclusion Before repositioning, the otolithic organ function of BPPV patients was obviously impaired, with no significant difference between the healthy and affected ear. After repositioning, there was a transient recovery of otolithic organ dysfunction followed by a sustained decline to similar levels to before repositioning.
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13
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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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Analysis of Bone Mineral Density and Bithermal Caloric Test Results in Unilateral Idiopathic Benign Paroxysmal Positional Vertigo Patients. Otol Neurotol 2022; 43:e780-e786. [PMID: 35763493 DOI: 10.1097/mao.0000000000003565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Benign paroxysmal positional vertigo (BPPV) is the most frequently diagnosed type of peripheral vestibular vertigo. Studies have reported a possible association between BPPV and osteoporosis; however, there is still a lack of evidence. This study aimed to investigate the characteristics of bone mineral density (BMD) and bithermal caloric test results in patients with unilateral posterior canal idiopathic benign paroxysmal positional vertigo (pc-iBPPV). METHODS BMD was measured in 65pc-iBPPV menopausal female patients and 65 healthy controls using dual-energy xray absorptiometry and then compared the T-score of BMD between the two groups. The bithermal caloric test was also performed with video nystagmography and the relationship between canal paresis, directional preponderance, T-score, and recurrence were analyzed. RESULTS Lower T-scores were observed in pc-iBPPV patients compared with the normal subjects. Among 65 pc-iBPPV patients, free recurrence was observed in 38 (58.5%), single recurrence was noted in 14 (21.5%), and multiple recurrences were seen in 13 (20%) patients. The proportion of positive T-score and CP value increased with the pc-BPPV recurrence frequency. Statistically, a significant difference was found only in T-score, indicating that recurrence was raised with a decrement of T-score. The proportion of positive CP values tended to increase as BMD decreased. CONCLUSION The decrement of BMD might be one of the pathogeneses in patients with unilateral pc-iBPPV and associated with multiple recurrences. Moreover, positive CP value cannot be regarded as a predictive factor for recurrence; however, there is a clear association between CP and BMD.
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15
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Fan Z, Hu Z, Han W, Lu X, Liu X, Zhou M, Yan W, Wu Y. High Serum Levels of Otolin-1 in Patients With Benign Paroxysmal Positional Vertigo Predict Recurrence. Front Neurol 2022; 13:841677. [PMID: 35359660 PMCID: PMC8963966 DOI: 10.3389/fneur.2022.841677] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/27/2022] [Indexed: 11/17/2022] Open
Abstract
Background Otolin-1 is an inner ear-specific protein that is exclusively expressed in otoconia and vestibule and cochlea cells. Recent investigations reported that otolin-1 can cross the blood-labyrinthine barrier and that the levels in serum well-reflected otolith status. Serum otolin-1 levels in patients with benign paroxysmal positional vertigo (BPPV) are significantly elevated compared with healthy controls. We aimed to explore whether otolin-1 can also serve as a biomarker for predicting BPPV recurrence. Method Patients at our institution with new-onset of idiopathic BPPV between May, 2017 and May, 2018 were recruited and followed up for 2 years. All demographic data of the patients were collected, and serum levels of otolin-1 and other laboratory indicators were measured and compared according to the recurrence status. Results A total of 74 patients, who met the inclusion criteria were enrolled in this study, of which 27 (36.5%) patients had suffered one or more episodes of recurrence after undergoing canal repositioning treatments during the study. The serum levels of otolin-1 in patients with recurrent BPPV were significantly higher than those in patients without recurrent BPPV (363.9 vs. 309.8 pg/ml, p = 0.001). In multivariate analysis comparing the second to fourth quartiles (Q2–Q4) against the first quartile (Q1) of otolin-1, the level of otolin-1 in Q4 could significantly predict BPPV recurrence, and the odds ratio (OR) was elevated by approximately 812% (OR = 9.12; 95% confidence interval [CI]: 1.44–57.9; p = 0.019). Conclusion High serum levels of otolin-1 were associated with an increased risk of BPPV recurrence, and further investigation is required to confirm this association and clarify the exact mechanism.
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Affiliation(s)
- Zhenyi Fan
- Department of Neurology, Hwa Mei Hospital, University of Chinese Academy of Science, Ningbo, China.,Ningbo Institute of Life and Health Industry, University of Chinese Academy of Science, Ningbo, China
| | - Zhizhou Hu
- Department of Neurology, Longyan First Affiliated Hospital, Fujian Medical University, Longyan, China
| | - Weiwei Han
- Ningbo Institute of Life and Health Industry, University of Chinese Academy of Science, Ningbo, China.,Department of Rehabilitation, Hwa Mei Hospital, University of Chinese Academy of Science, Ningbo, China
| | - Xiaoxiong Lu
- Department of Neurology, Hwa Mei Hospital, University of Chinese Academy of Science, Ningbo, China.,Ningbo Institute of Life and Health Industry, University of Chinese Academy of Science, Ningbo, China
| | - Xiaoxia Liu
- Department of Neurology, Hwa Mei Hospital, University of Chinese Academy of Science, Ningbo, China.,Ningbo Institute of Life and Health Industry, University of Chinese Academy of Science, Ningbo, China
| | - Min Zhou
- Department of Neurology, Hwa Mei Hospital, University of Chinese Academy of Science, Ningbo, China.,Ningbo Institute of Life and Health Industry, University of Chinese Academy of Science, Ningbo, China
| | - Wang Yan
- Department of Neurology, Hwa Mei Hospital, University of Chinese Academy of Science, Ningbo, China.,Ningbo Institute of Life and Health Industry, University of Chinese Academy of Science, Ningbo, China
| | - Yunqin Wu
- Department of Neurology, Hwa Mei Hospital, University of Chinese Academy of Science, Ningbo, China.,Ningbo Institute of Life and Health Industry, University of Chinese Academy of Science, Ningbo, China
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16
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Li D, Cheng D, Yang W, Chen T, Zhang D, Ren J, Zhao Y. Current Therapies in Patients With Posterior Semicircular Canal BPPV, a Systematic Review and Network Meta-analysis. Otol Neurotol 2022; 43:421-428. [PMID: 34999620 DOI: 10.1097/mao.0000000000003464] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To compare the efficacy of different treatments for posterior semicircular canal benign paroxysmal positional vertigo (PC-BPPV) by using direct and indirect evidence from existing randomized data. METHODS Randomized case-control studies that compared the efficacy of various nonsurgical treatments in PC-BPPV patients at 1 week and 1 month of follow-up were comprehensively screened. Bayesian network meta-analysis was performed to evaluate direct and indirect treatment comparisons. We further conducted subgroup pairwise meta-analysis to explore the inconsistency between comparisons of the Epley versus a sham maneuver and the Epley versus the Semont maneuver. RESULTS A total of 41 parallel, randomized controlled studies were included. The Epley with vestibular rehabilitation (EVR), Epley, Semont and Hybrid maneuvers were effective in eliminating nystagmus during a Dix-Hallpike test at 1 week of follow-up (odds ratios [ORs]: 11.41-23.8, 95% credible interval [CrI]: excluding null), among which EVR showed the best efficacy (the surface area under the cumulative ranking curves [SUCRA] = 77.5%). However, at 1 month of follow-up, only the Semont (rank first, SUCRA = 76.1%) and Epley maneuvers (rank second, SUCRA = 65.3%) were effective in eliminating nystagmus during a Dix-Hallpike test. In the pairwise subgroup meta-analysis, for patients younger than 55 years of age, the efficacy of the Epley maneuver was comparable to that of the Semont maneuver [rate ratio (RR): 0.99, 95% confidence interval (CI): 0.93-1.05]; for patients with a longer duration before treatment, the effect of the Epley maneuver was equivalent to that of a sham maneuver (RR: 1.07, 95% CI: 0.90-1.29). CONCLUSION Among the 12 types of PC-BPPV treatments, the Epley, Semont, EVR, and Hybrid maneuvers were effective in eliminating nystagmus during a Dix-Hallpike test for PC-BPPV at 1 week of follow-up, whereas only the Epley and Semont maneuvers were effective at 1 month of follow-up. The duration before treatments and the age of patients might contribute to the efficacy of treatments.
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Affiliation(s)
- Daibo Li
- Department of Oto-Rhino-Laryngology
- Department of Otorhinolaryngology, Head and Neck Surgery, Meishan Municipal People's Hospital, Dongpo Road, Meishan, Sichuan
| | | | - Wenjie Yang
- Center of Biostatistics, Design, Measurement and Evaluation, West China Hospital, Sichuan University, Chengdu, China
| | - Ting Chen
- Department of Otorhinolaryngology, Head and Neck Surgery, Meishan Municipal People's Hospital, Dongpo Road, Meishan, Sichuan
| | - Di Zhang
- Department of Otorhinolaryngology, Head and Neck Surgery, Meishan Municipal People's Hospital, Dongpo Road, Meishan, Sichuan
| | - Jianjun Ren
- Department of Oto-Rhino-Laryngology
- West China Biomedical Big Data Center, West China Hospital
- Med-X Center for Informatics, Sichuan University
| | - Yu Zhao
- Department of Oto-Rhino-Laryngology
- West China Biomedical Big Data Center, West China Hospital
- Med-X Center for Informatics, Sichuan University
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17
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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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18
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Laurent G, Vereeck L, Verbecque E, Herssens N, Casters L, Spildooren J. Effect of age on treatment outcomes in benign paroxysmal positional vertigo: A systematic review. J Am Geriatr Soc 2021; 70:281-293. [PMID: 34698378 DOI: 10.1111/jgs.17485] [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: 03/01/2021] [Revised: 08/20/2021] [Accepted: 08/28/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Benign paroxysmal positional vertigo (BPPV) can lead to an increased fall risk in older adults. Therefore, we examined the influence of age on the effectiveness of canalith-repositioning procedures (CRPs) for the treatment of BPPV. METHODS Pubmed, Web of Science, and the bibliographies of selected articles were searched for studies conducted before September 2020 that examined the effectiveness of treatments for BPPV in various age groups. Meta-analyses were performed to compare treatment effectiveness and recurrence rates for younger and older adults. Odds ratios were calculated in a random-effects model. Mean differences were calculated using a fixed-effects model. A significance level of p < 0.05 (95% confidence interval) was set. The risk of bias and the methodological quality of all included articles were examined. RESULTS Forty-five studies were retrieved after full-text screening, of which 29 studies were included for a qualitative review. The remaining 16 studies were eligible for inclusion in the meta-analysis (3267 participants with BPPV). The success rate of a single CRP was higher in the younger group (72.5% vs. 67%, p < 0.001). An average of 1.4 and 1.5 CRPs was needed for complete recovery in the younger and older groups, respectively (p = 0.02). However, global treatment success did not differ between these groups (97.5% vs. 94.6%, p = 0.41). The recurrence rate was higher in the older population (23.2% vs. 18.6%, p = 0.007). CONCLUSIONS Although more CRPs are needed, the rate of complete recovery in older adults is similar to that observed in younger adults.
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Affiliation(s)
- Gwen Laurent
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Luc Vereeck
- Department of Rehabilitation Sciences and Physiotherapy/MOVANT, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Evi Verbecque
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium.,Department of Rehabilitation Sciences and Physiotherapy/MOVANT, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Nolan Herssens
- Department of Rehabilitation Sciences and Physiotherapy/MOVANT, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.,Department of Rehabilitation Sciences, Gent university, Ghent, Belgium
| | - Laura Casters
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Joke Spildooren
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
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Teggi R, Guidetti R, Gatti O, Guidetti G. Recurrence of benign paroxysmal positional vertigo: experience in 3042 patients. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2021; 41:461-466. [PMID: 34734582 PMCID: PMC8569667 DOI: 10.14639/0392-100x-n1233] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 05/10/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Benign paroxysmal positional vertigo (BPPV) is a disorder of the inner ear with a high rate of recurrence. Vascular disorders, migraine and autoimmune disorders have been considered facilitating factors for relapsing episodes. Our aim was to assess the role of vascular disorders, migraine and anti-thyroid antibodies in patients with recurrences. METHODS We retrospectively analysed records of 3042 patients treated for BPPV without other lifetime vertigo. Clinical data included previous vascular disorders of the central nervous system, heart disorders, migraine and recent head trauma. The presence of anti-thyroid autoantibodies was assessed in all patients. RESULTS Mean age of the first BPPV was 52.8 ± 14.5 years; there were 2339 females (76.9%), while 2048 (67.3%) of patients presented recurrences within two years of follow-up. Previous disorders of the central nervous system, presence of anti-thyroid antibodies, head trauma and migraine showed an association with recurrences. Above all, in subjects having the first BPPV while aged between 40 and 60 years, anti-thyroid antibodies were predictive for recurrences. CONCLUSIONS Our data are consistent with the hypothesis that anti-thyroid autoantibodies may play a role in recurrences in subjects with initial manifestations between 40 and 60 years.
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Affiliation(s)
- Roberto Teggi
- Division of Otolaryngology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Omar Gatti
- Division of Otolaryngology, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Risk Factors for Recurrence of Benign Paroxysmal Positional Vertigo. A Clinical Review. J Clin Med 2021; 10:jcm10194372. [PMID: 34640391 PMCID: PMC8509726 DOI: 10.3390/jcm10194372] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/17/2021] [Accepted: 09/23/2021] [Indexed: 12/04/2022] Open
Abstract
Benign paroxysmal positional vertigo (BPPV) is one of the most common peripheral vestibular dysfunctions encountered in clinical practice. Although the treatment of BPPV is relatively successful, many patients develop recurrence after treatment. Our purpose is to evaluate the mean recurrence rate and risk factors of BPPV after treatment. A review of the literature on the risk factors of BPPV recurrence was performed. A thorough search was conducted using electronic databases, namely Pubmed, CINAHL, Academic Search Complete and Scopus for studies published from 2000 to 2020. Thirty studies were included in this review with 13,358 participants. The recurrence rate of BPPV ranged from 13.7% to 48% for studies with follow-up <1 year, and from 13.3% to 65% for studies with follow-up ≥2 years. Pathophysiologic mechanisms and implication of each of the following risk factors in the recurrence of BPPV were described: advanced age, female gender, Meniere’s disease, trauma, osteopenia or osteoporosis, vitamin D deficiency, diabetes mellitus, hypertension, hyperlipidemia, cardiovascular disease, migraine, bilateral/multicanal BPPV, cervical osteoarthrosis and sleep disorders. Patients with hyperlipidemia and hypertension had the highest recurrence rates of BPPV, 67.80% and 55.89%, respectively, indicating that vascular comorbidities increase the risk of BPPV recurrence. In addition, more than half of patients (53.48%) with diabetes mellitus and BPPV experienced recurrence of BPPV. Knowledge and awareness of risk factors for recurrence of BPPV are essential for the assessment and long-term prognosis of patients. Identification of these relapse risk factors may enhance the ability of clinicians to accurately counsel patients regarding BPPV and associated comorbidities.
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21
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Recurrence Rate and Risk Factors of Recurrence in Benign Paroxysmal Positional Vertigo: a Single-Center Long-Term Prospective Study With a Large Cohort. Ear Hear 2021; 43:234-241. [PMID: 34320525 DOI: 10.1097/aud.0000000000001093] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to assess the long-term recurrence rate and correlations between recurrence and potential risk factors in patients with benign paroxysmal positional vertigo (BPPV). DESIGN A total of 548 consecutive patients who demonstrated typical posterior or horizontal BPPV between January 2010 and December 2012 were included in this prospective study. All patients were contacted by phone every 6 months for 5 years and were asked to revisit the clinic when they experienced positional vertigo to be reexamined for recurrence. Recurrence of BPPV was defined as having positional vertigo and nystagmus confirmed following a symptom-free period of at least 7 days after complete resolution. We assessed the 5-year recurrence rate of BPPV, and the time point of recurrence in all patients as well as the risk factors of BPPV recurrence, including the clinical characteristics, therapeutic results of BPPV, and various comorbidities. RESULTS Among the 548 patients, 121 (22.1 %) had at least one recurrence. Of these, 78 patients (54.5%) had only one recurrence within 5 years, while 43 (45.5%) patients experienced two or more recurrences. A recurrence occurred within 1 year in 82 patients (67.8%). The Cox proportional hazard ratio analysis found that head trauma (p = 0.015), Meniere's disease (p = 0.016), the number of canalith repositioning procedures performed (p = 0.037), and the number of previous vertigo attacks (p = 0.038) were significant risk factors of BPPV recurrence as opposed to hypertension or hyperlipidemia. CONCLUSIONS The recurrence rate of BPPV was 22.1% at 5 years after the initial treatment. About 70% of recurred patients had a recurrence within 1 year. Head trauma, ipsilateral Meniere's disease, the number of canalith repositioning procedures performed, and the number of previous vertigo attacks were significant risk factors of BPPV recurrence.
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22
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Single Cycle Versus Multiple Cycles of Canalith Repositioning Procedure for Treatment of Posterior Canal Benign Paroxysmal Positional Vertigo: A Randomized Controlled Trial. Otol Neurotol 2021; 42:121-128. [PMID: 32947492 DOI: 10.1097/mao.0000000000002894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare the treatment outcomes and complications of single cycle versus multiple cycles of the canalith repositioning procedure (CRP). STUDY DESIGN Randomized controlled trial. SETTING Academic tertiary referral center; Chiang Mai University, Thailand. PATIENTS One hundred and forty-three adults who had unilateral posterior canal benign paroxysmal positional vertigo (BPPV). INTERVENTION Therapeutic. Patients received either a single cycle or multiple cycles of the CRP in one session. MAIN OUTCOME MEASURES Rate of negative Dix-Hallpike test (DHT), rate of symptom improvement, dizziness handicap inventory score (DHI), and rate of complications. RESULTS At the 1st week and the 4th week recall visits after CRP the treatment outcomes between the single-CRP group and the multiple-CRP group showed no significant difference. The outcomes included: 1) rate of negative DHT (1st week: 76.9 and 76.7%, 4th week: 89.5 and 88.2%); 2) rate of complete recovery or improved symptoms (1st week: 92.3 and 91.7%; 4th week: 96.5 and 98.0%); 3) DHI scores (1st week: 22 and 28; 4th week: 6 and 10); and 4) complication rate (1st week: 12.5 and 20%; 4th week: 20 and 0%. Rate of complications in the single-CRP group (6.9%) during the 1st treatment was lower than in the multiple-CRP groups (21.1%) (p-value = 0.013). CONCLUSION A single cycle of CRP is as effective as multiple cycle CRP, with a lower incidence of complication and a decrease in the time for treatment. Single-cycle CRP is a more advantageous treatment for unilateral posterior canal BPPV. CLINICALTRIALS. GOV IDENTIFIER NCT02701218.
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Hilton DB, Luryi AL, Bojrab DI, Babu SC, Hong RS, Bojrab DI, Santiago Rivera OJ, Schutt CA. Comparison of associated comorbid conditions in patients with benign paroxysmal positional vertigo with or without migraine history: A large single institution study. Am J Otolaryngol 2020; 41:102650. [PMID: 32702572 DOI: 10.1016/j.amjoto.2020.102650] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 06/30/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE In the largest reported United States (U.S.) cohort of benign paroxysmal positional vertigo (BPPV), does the presence or absence of migraine correlate with increased associations of other factors? MATERIALS & METHODS A retrospective chart review from a single U.S. neurotology center. Adult patients with BPPV from 2003 to 2017 classified into two groups: 1) with migraine; 2) without migraine. RESULTS The prevalence of self-reported migraine history in a BPPV-positive population (n = 1481) was 25.8% (n = 382). Among those with BPPV and migraine, 88.5% were female, 8.1% had diabetes, 22.5% had prior history of BPPV, 8.9% had Meniere's disease and recurrence rate was 38.3%. No statistically significant differences between recurrence or resolution rates between the two groups were demonstrated (p > 0.05). Adjusted logistic regression model found that women and those with a prior history of BPPV had significantly higher odds of having both BPPV and migraine conditions compared to their counterparts. In contrast, older age and diabetes were associated with significantly lower odds of concomitant BPPV and migraine. CONCLUSIONS The prevalence of migraine among the study sample was 25.8%. Female gender, prior history of BPPV, younger age, and lack of diabetes were independently associated with the concurrent comorbidity of BPPV and migraine. These data further substantiate previously reported rates (from smaller studies); and, demonstrate that recurrence and resolution rates are not worse in those with BPPV and migraine compared to the general BPPV population. Findings support an association between migraine and BPPV and enhances one's ability to accurately counsel patients regarding these diseases.
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Affiliation(s)
- Daniel B Hilton
- Department of Surgery, McLaren Health Care/Oakland - Michigan State University, Pontiac, MI, United States
| | - Alexander L Luryi
- Department of Neurotology, Michigan Ear Institute, St. John Providence Hospital and Medical Centers, Farmington, MI, United States.
| | - Dennis I Bojrab
- Department of Neurotology, Michigan Ear Institute, St. John Providence Hospital and Medical Centers, Farmington, MI, United States.
| | - Seilesh C Babu
- Department of Neurotology, Michigan Ear Institute, St. John Providence Hospital and Medical Centers, Farmington, MI, United States
| | - Robert S Hong
- Department of Neurotology, Michigan Ear Institute, St. John Providence Hospital and Medical Centers, Farmington, MI, United States
| | - Dennis I Bojrab
- Department of Neurotology, Michigan Ear Institute, St. John Providence Hospital and Medical Centers, Farmington, MI, United States
| | - Olga J Santiago Rivera
- Research Faculty, McLaren Health Care/Oakland - Michigan State University, Pontiac, MI, United States.
| | - Christopher A Schutt
- Department of Neurotology, Michigan Ear Institute, St. John Providence Hospital and Medical Centers, Farmington, MI, United States.
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Chen J, Zhang S, Cui K, Liu C. Risk factors for benign paroxysmal positional vertigo recurrence: a systematic review and meta-analysis. J Neurol 2020; 268:4117-4127. [DOI: 10.1007/s00415-020-10175-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/15/2020] [Accepted: 08/18/2020] [Indexed: 12/17/2022]
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Li S, Wang Z, Liu Y, Cao J, Zheng H, Jing Y, Han L, Ma X, Xia R, Yu L. Risk Factors for the Recurrence of Benign Paroxysmal Positional Vertigo: A Systematic Review and Meta-Analysis. EAR, NOSE & THROAT JOURNAL 2020; 101:NP112-NP134. [PMID: 32776833 DOI: 10.1177/0145561320943362] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Benign paroxysmal positional vertigo (BPPV) has a high recurrence rate, but the risk factor-associated recurrence are elusive. METHODS Searches were performed in PubMed, Embase, Cochrane library, Web of science, Chinese National Knowledge Infrastructure, and Sino Med up to November 3, 2019. The effect size was analyzed by odds ratio and 95% CI. Data from eligible studies were meta-analyzed using Stata version 15.0. RESULTS Our search resulted in a total of 4076 hits. Twenty-four outcomes of sixty articles were included in the meta-analysis. Risk factors for the recurrence of BPPV included female gender, age (≥65years), hyperlipidemia, diabetes, hypertension, migraine, cervical spondylosis, osteopenia/osteoporosis, head trauma, otitis media, abnormal vestibular evoked myogenic potential, and long use of computers. No significant differences were found in side, type of the involved semicircular canals, smoking, alcohol consumption, stroke, ear surgery, duration of vertigo before treatment, the times of repositioning, Meniere disease, sleep disorders, hypercholesterolemia, and 25-hydroxy vitamin D. CONCLUSION These findings strengthen clinical awareness of early warning to identify patients with potential relapse risk of BPPV and clinicians should counsel patients regarding the importance of follow-up after diagnosis of BPPV.
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Affiliation(s)
- Shichang Li
- Department of Otorhinolaryngology Head and neck surgery, 71185Peking University People's Hospital, Beijing, China
| | - Zijing Wang
- Department of Otorhinolaryngology Head and neck surgery, 71185Peking University People's Hospital, Beijing, China
| | - Yan Liu
- Department of Otorhinolaryngology Head and neck surgery, 71185Peking University People's Hospital, Beijing, China
| | - Jie Cao
- Department of Otorhinolaryngology Head and neck surgery, 71185Peking University People's Hospital, Beijing, China
| | - Hongwei Zheng
- Department of Otorhinolaryngology Head and neck surgery, 71185Peking University People's Hospital, Beijing, China
| | - Yuanyuan Jing
- Department of Otorhinolaryngology Head and neck surgery, 71185Peking University People's Hospital, Beijing, China
| | - Lin Han
- Department of Otorhinolaryngology Head and neck surgery, 71185Peking University People's Hospital, Beijing, China
| | - Xin Ma
- Department of Otorhinolaryngology Head and neck surgery, 71185Peking University People's Hospital, Beijing, China
| | - Ruiming Xia
- Department of Otorhinolaryngology Head and neck surgery, 71185Peking University People's Hospital, Beijing, China
| | - Lisheng Yu
- Department of Otorhinolaryngology Head and neck surgery, 71185Peking University People's Hospital, Beijing, China
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Chen J, Zhao W, Yue X, Zhang P. Risk Factors for the Occurrence of Benign Paroxysmal Positional Vertigo: A Systematic Review and Meta-Analysis. Front Neurol 2020; 11:506. [PMID: 32655479 PMCID: PMC7324663 DOI: 10.3389/fneur.2020.00506] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 05/07/2020] [Indexed: 01/05/2023] Open
Abstract
Background and Purpose: The lifetime prevalence of benign paroxysmal positional vertigo (BPPV) is high, especially in the elderly. Patients with BPPV are more susceptible to ischemic stroke, dementia, and fractures, severely reducing quality of life of patients. Many studies have analyzed risk factors for the occurrence of BPPV. However, the results of these studies are not identical. We performed this meta-analysis to determine potential risk factors associated with the occurrence of BPPV. Methods: PubMed, EMBASE, and the Cochrane Library (January 2000 through March 2020) were systematically searched for eligible studies analyzing risk factors for the occurrence of BPPV. Reference lists of eligible studies were also reviewed. We selected observational studies in English with a control group and sufficient data. Pooled odds ratios (ORs) or the mean differences (MDs) and 95% confidence intervals (CIs) were calculated to measure the impacts of all potential risk factors. Heterogeneity among studies was evaluated using the Q-test and I2 statistics. We used the random-effect model or the fixed-effect model according to the heterogeneity among the included studies. Results: We eventually included 19 studies published between 2006 and 2019, including 2,618 patients with BPPV and 11,668 participants without BPPV in total. In this meta-analysis, the occurrence of BPPV was significantly associated with female gender (OR = 1.18; 95% CI, 1.05–1.32; P = 0.004), serum vitamin D level (MD = −2.12; 95% CI, −3.85 to −0.38; P = 0.02), osteoporosis (OR = 2.49; 95% CI, 1.39–4.46; P = 0.002), migraine (OR = 4.40; 95% CI, 2.67–7.25; P < 0.00001), head trauma (OR = 3.42; 95% CI, 1.21–9.70; P = 0.02), and total cholesterol level (MD = 0.32; 95% CI, 0.02–0.62; P = 0.03). Conclusion: Female gender, vitamin D deficiency, osteoporosis, migraine, head trauma, and high TC level were risk factors for the occurrence of BPPV. However, the effects of other risk factors on BPPV occurrence need further investigations.
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Affiliation(s)
- Jinbao Chen
- Department of Pediatrics, The First Clinic College of Xinxiang Medical University, Xinxiang, China
| | - Weisong Zhao
- Department of Pediatrics, The First Clinic College of Xinxiang Medical University, Xinxiang, China
| | - Xuejing Yue
- School of Basic Medicine, Xinxiang Medical University, Xinxiang, China
| | - Ping Zhang
- Department of Neurology, The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
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Lou Y, Cai M, Xu L, Wang Y, Zhuang L, Liu X. Efficacy of BPPV diagnosis and treatment system for benign paroxysmal positional vertigo. Am J Otolaryngol 2020; 41:102412. [PMID: 32057490 DOI: 10.1016/j.amjoto.2020.102412] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/28/2020] [Accepted: 02/02/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To evaluate the efficacy of automatic benign paroxysmal positional vertigo (BPPV) diagnosis and treatment system for BPPV compared with the manual repositioning group. METHODS Two hundred thirty patients diagnosed as idiopathic BPPV who were admitted from August 2018 to July 2019 in Zhejiang Hospital were included. Among them, 150 patients of posterior semicircular canal BPPV(pc-BPPV), 53 patients of horizontal semicircular canal BPPV(hc-BPPV), and 27 patients of horizontal semicircular canal calculus (hc-BPPV-cu) were randomly treated with BPPV diagnosis and treatment system(the experimental group) or manual repositioning (the control group). Resolution of vertigo and nystagmus on the Dix-Hallpike and Roll test on day 3,day 7,day 14 and day 28 follow-up after first treatment was the main outcome measure to assess the efficacy of treatment. RESULTS At 3-day and 7-day follow-up after treatment with BPPV diagnosis and treatment system, 79%, 91%had complete resolution of vertigo and nystagmus, the effective rate in the experimental group were significantly higher than those in the control group, the differences were statistically significant(P < .05). On day 14, the effective rate in the experimental group (96%) was slightly higher than that in the control group(91%), but there was no significant difference between the two groups. And at 28-day after the first treatment, the effective rate was 100% in the experimental group and the control group. The repositioning efficiency of pc-BPPV (the first, second, third treatment), hc-BPPV (the first, second, third treatment), hc-BPPV-cu(the first, second treatment) in the experimental group were higher than the control group, and the secondary reposition of pc-BPPV in the experimental group was significantly higher than the control group(96%vs.84%; P < .05). While for the hc-BPPV-cu patients, the effective rate of the third treatment in the experimental group was slightly lower than that of the control group, but the differences were not statistically significant. CONCLUSIONS BPPV diagnosis and treatment system is effective for the treatment of BPPV, with a better effective rate than those treated with manual maneuver, and is safe and easy to perform on patients.
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Singh JM, Corser WD, Monsell EM. Cardiovascular Risk Factors and Benign Paroxysmal Positional Vertigo in Community Otolaryngology-Head and Neck Surgery. Otolaryngol Head Neck Surg 2020; 162:283-289. [PMID: 32013711 DOI: 10.1177/0194599820902116] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Cardiovascular risk factors have been associated with benign paroxysmal positional vertigo (BPPV), possibly causing degeneration of the utricular epithelium and subepithelium, but supportive evidence is mixed. This is the first study to examine the association between cardiovascular risk factors and BPPV as they present in the community practice of comprehensive otolaryngology-head and neck surgery. STUDY DESIGN Cross-sectional case-matched case-control series. SETTING A community practice of otolaryngology-head and neck surgery with 3 clinical offices and a socioeconomically diverse patient population. SUBJECTS AND METHODS Clinical data were collected retrospectively from the electronic health records of a continuous 4-year series of 628 patients with BPPV and age- and sex-matched controls. RESULTS There were no statistically significant associations found between BPPV and diabetes, hypertension, dyslipidemia, or body mass index in the study population in pairwise comparisons or multivariable modeling. CONCLUSION This study suggests that BPPV as encountered in a community ear, nose, and throat practice is not generally associated with cardiovascular risk factors. The possibility that these or other cardiovascular risk factors may be causative in some cases cannot be excluded, though most cases of BPPV appear to be caused primarily by shedding of otoconia from the utricle that is idiopathic or at least in part by unconfirmed noncardiovascular factors.
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Affiliation(s)
- Jeffrey M Singh
- McLaren Health System, Pontiac, Michigan, USA.,College of Osteopathic Medicine, Statewide Campus System, School of Medicine, Michigan State University, East Lansing, Michigan, USA
| | - William D Corser
- College of Osteopathic Medicine, Statewide Campus System, School of Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Edwin M Monsell
- McLaren Health System, Pontiac, Michigan, USA.,Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Wayne State University, Detroit, Michigan, USA
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Ding L, Lin T, Zhou X, Han J, Xu A. Analysis of related factors of recurrence in horizontal semicircular canal benign paroxysmal positional vertigo: a pilot study. Acta Otolaryngol 2020; 140:8-13. [PMID: 31782327 DOI: 10.1080/00016489.2019.1685129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Whether the abnormal caloric test (C-test) affects recurrence rate in horizontal semicircular canal benign paroxysmal positional vertigo (HSC-BPPV) with residual dizziness (RD) is not clear.Objectives: 1) Analyze the association of the cycles of canalith repositioning procedure (CRP), C-test and RD after CRP and 2) determine which affects the recurrence rate in idiopathic HSC-BPPV.Materials and methods: Eighty-four patients with HSC-BPPV (canal type) were included in this work. The cycles of CRP, C-test, the RD after CRP and HSC-BPPV recurrence rate were recorded. Depending on the times of CRP and patients who presented dizziness after treatment, patients were divided into four groups, the relationship between abnormal C-test and RD was analyzed. The outcomes of recurrence rate were compared between groups, respectively.Results: (1) The abnormal C-test prevalence among the HSC-BPPV patients with RD was 36% while in no RD group was 14.7%. The difference was statistically significant (p = .045). (2) The recurrence rate was 11.8% in no RD group but in RD group the rate was higher (32%, p = .039). When patients combined with abnormal C-test, the recurrence rate was significantly higher (77.8% vs. 20%) (p = .033).Conclusions: A weak correlation between RD and abnormal C-test is noted. Presence of RD and abnormal C-test in patients with HSC-BPPV predicts a higher recurrence rate.
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Affiliation(s)
- Ling Ding
- Department of Otorhinolaryngology-Head and Neck Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Shandong, PR China
| | - Tao Lin
- Shandong Provincial ENT Hospital, Affiliated to Shandong University, Shandong, PR China
| | - Xuanchen Zhou
- Department of Otorhinolaryngology-Head and Neck Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Shandong, PR China
| | - Jie Han
- Department of Otorhinolaryngology-Head and Neck Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Shandong, PR China
| | - Anting Xu
- Department of Otorhinolaryngology & Head and Neck Surgery, The Second Hospital of Shandong University, Shandong ,PR China
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Causes of Persistent Positional Vertigo Following Posterior Semicircular Canal Occlusion for Benign Paroxysmal Positional Vertigo. Otol Neurotol 2018; 39:e1078-e1083. [PMID: 30239433 DOI: 10.1097/mao.0000000000001990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To report causes of persistent recalcitrant positional vertigo (PRPV) after posterior semicircular canal occlusion (PSCO) for benign paroxysmal positional vertigo (BPPV). STUDY DESIGN Retrospective chart review. SETTING Single high-volume otology practice. PATIENTS Patients diagnosed with BPPV from 2007 to 2017. INTERVENTION PSCO and follow-up care including diagnostic and particle repositioning maneuvers for recurrent BPPV. MAIN OUTCOME MEASURES PRPV, defined as recalcitrant positional vertigo for any reason following PSCO. RESULTS Twenty seven PSCO operations were performed in 26 patients. Twenty five patients (96.2%) had resolution of the Dix-Hallpike test in the operated ear. Eleven patients (42.3%) developed BPPV postoperatively, three (11.5%) in the operated ear and eight (30.8%) in the contralateral ear. Five of eight patients (62.5%) who developed contralateral BPPV had unilateral BPPV preoperatively. Eight patients (30.8%) developed BPPV at least twice after surgery or did not resolve, qualifying as PRPV, and all but one of these events occurred in the nonsurgical ear. No instances of cerebrospinal fluid leak, postoperative infection, facial palsy, clinically significant hearing loss, or death occurred. CONCLUSIONS PSCO is a safe and effective option for recalcitrant BPPV. However, 30.8% of patients, including patients with initially unilateral BPPV, had recalcitrant positional vertigo postoperatively, usually due to contralateral BPPV. Patients considering PSCO should be counseled regarding this risk to ensure realistic expectations.
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