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Soylemez E, Bolat KB, Karakoc K, Can M, Basak H, Aydogan Z, Tokgoz-Yilmaz S. The Effect of Repositioning Maneuver Applied with the TRV Chair on Residual Dizziness after Benign Paroxysmal Positional Vertigo. Otol Neurotol 2023; 44:e596-e601. [PMID: 37550882 DOI: 10.1097/mao.0000000000003978] [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: 08/09/2023]
Abstract
OBJECTIVE This study aims to investigate the effect of TRV chair on residual dizziness (RD) after idiopathic posterior semicircular canal benign paroxysmal positional vertigo (BPPV) successfully treated with canalith repositioning maneuver (CRM). STUDY DESIGN Prospective case-control study. SETTING Hospital. PATIENTS Thirty-three patients with posterior canal BPPV were included in the study. These patients were divided into two identical groups. CRM was applied to the first group with a TRV chair (TRV group) and manually to the second group (manual group). INTERVENTIONS Dizziness Handicap Inventory (DHI), Beck Anxiety Inventory (BAI), and video head impulse test were applied to the patients. Patients in both groups were asked to report the RD developed after successful CRM daily by visual analog scale (VAS). RESULTS The TRV group's first-day RD rate was 94.1% with VAS, and the RD duration was 2.47 ± 1.77 (0-7) days. The manual group's first-day RD rate was 100%, and the RD duration was 3.38 ± 1.70 (1-7) days. There was no difference between the groups in terms of RD duration ( p > 0.05). Mean RD severity and severity in the first 3 days were lower in the TRV group compared with the manual group ( p < 0.05). There was no difference between the groups on other days ( p > 0.05). In addition, there was a positive correlation between RD and DHI and BPPV duration ( p < 0.05). CONCLUSION RD is a multifactorial symptom associated with how the repositioning maneuver is performed, BPPV duration, and DHI. Performing the repositioning maneuver with the TRV chair can reduce the severity of RD.
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Affiliation(s)
| | | | | | | | - Hazan Basak
- Department of Otorhinolaryngology, Faculty of Medicine, Ankara University, Ankara, Turkey
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Fu W, He F, Bai Y, Wang Y, Wei D, Shi Y, An X, Han J, Wang X. Assessment of residual dizziness after successful canalith repositioning maneuvre in benign paroxysmal positional vertigo patients: a questionnaire-based study. Eur Arch Otorhinolaryngol 2023; 280:137-141. [PMID: 35727415 DOI: 10.1007/s00405-022-07474-9] [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: 03/30/2022] [Accepted: 05/27/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The purpose of this study was to assess residual dizziness (RD) after successful canalith repositioning maneuvre (CRM) treatment in patients with benign paroxysmal positional vertigo (BPPV) using Dizziness Handicap Inventory (DHI) questionnaire and Visual Analog Scale (VAS). METHODS One hundred sixty BPPV patients after successful CRM treatment were recruited. All patients were divided into the residual dizziness (RD) group and without RD group. The DHI questionnaire and VAS before CRM and follow-up were asked to complete. For analysis of the improvement in symptom, we defined ∆DHI and ∆VAS as the difference between the baseline score and the follow-up score. RESULTS High incidence of RD was observed in the older patients (p < 0.001). The incidence of hypertension in the RD group was also significantly higher than that of the without RD group (p = 0.022). The ∆DHI-P, ∆DHI-E, ∆DHI-F, ∆DHI-T, and ∆VAS scores in the without RD group were significantly higher than that of the RD group (p < 0.001). When the cutoff point of the ∆DHI total scores was 17, the sensitivity was 64.86% and the specificity was 73.26% for diagnosing RD. When the cutoff point of the ∆VAS scores was 2.5, the sensitivity was 77.03% and the specificity was 81.40% for diagnosing RD. CONCLUSIONS RD is prone to occur in the older patients and ∆VAS exhibits higher sensitivity and specificity in assessing RD.
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Affiliation(s)
- Wei Fu
- Department of Geriatrics, Xijing Hospital, Air Force Medical University, No. 127, Changle West Road, Xi'an, 710032, Shaanxi, China
| | - Feng He
- Department of Neurology, Xijing Hospital, Air Force Medical University, No. 127, Changle West Road, Xi'an, 710032, Shaanxi, China
| | - Ya Bai
- Department of Neurology, Xijing Hospital, Air Force Medical University, No. 127, Changle West Road, Xi'an, 710032, Shaanxi, China
| | - Yuanyuan Wang
- Department of Neurology, Xijing Hospital, Air Force Medical University, No. 127, Changle West Road, Xi'an, 710032, Shaanxi, China
| | - Dong Wei
- Department of Neurology, Xijing Hospital, Air Force Medical University, No. 127, Changle West Road, Xi'an, 710032, Shaanxi, China
| | - Ying Shi
- Department of Neurology, Xijing Hospital, Air Force Medical University, No. 127, Changle West Road, Xi'an, 710032, Shaanxi, China
| | - Xinyue An
- Department of Neurology, Xijing Hospital, Air Force Medical University, No. 127, Changle West Road, Xi'an, 710032, Shaanxi, China
| | - Junliang Han
- Department of Neurology, Xijing Hospital, Air Force Medical University, No. 127, Changle West Road, Xi'an, 710032, Shaanxi, China
| | - Xiaoming Wang
- Department of Geriatrics, Xijing Hospital, Air Force Medical University, No. 127, Changle West Road, Xi'an, 710032, Shaanxi, China.
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Assessment of sensory organization testing in benign paroxysmal positional vertigo patients before and after repositioning manoeuvre. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2022; 73:210-218. [PMID: 35908814 DOI: 10.1016/j.otoeng.2021.04.002] [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: 12/01/2020] [Accepted: 04/26/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION AND OBJECTIVE Benign paroxysmal positioning vertigo is considered the most common disorder of the peripheral vestibular system. After successful physical manoeuvres for BPPV, a number of patients complain of non-positional sustained imbalance of variable duration called residual dizziness lasting for several days. The objective of this study was to compare the posturographic changes before and one week after successful repositioning manoeuvres in patients with idiopathic BPPV. MATERIALS AND METHODS This study was a case-control study, where the first group was composed of 20 patients with confirmed BPPV diagnosis regardless of the affected canal or pathology. Twenty age and gender matched normal subjects constituted the control group. The sensory organization test was performed before and one week after a repositioning manoeuvre in BPPV patients. RESULTS All 20 BPPV patients, except 6 who had no significant improvement of symptoms even after disappearance of classic vertigo and nystagmus, had substantial improvement in sensory scores after CRPs in the antero-posterior visual and vestibular scores and the medio-lateral visual and global scores. All antero-posterior and medio-lateral scores before and after CRPs, except for the AP preferential score, were considerably poorer in BPPV patients than healthy subjects. The 6 patients, who showed no improvement after CRPs, presented with a history of non-specific symptoms i.e., light-headedness or sense of floating. CONCLUSIONS Sensory organization test might have a role in the assessment of residual dizziness in patients with BPPV after CRPs.
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Wu Y, Han K, Han W, Fan Z, Zhou M, Lu X, Liu X, Li L, Du L. Low 25-Hydroxyvitamin D Levels Are Associated With Residual Dizziness After Successful Treatment of Benign Paroxysmal Positional Vertigo. Front Neurol 2022; 13:915239. [PMID: 35812091 PMCID: PMC9256914 DOI: 10.3389/fneur.2022.915239] [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: 04/07/2022] [Accepted: 05/23/2022] [Indexed: 11/24/2022] Open
Abstract
Objective: Vitamin D (Vit D) regulates calcium and phosphate metabolism and helps to maintain otolith organ function. Residual dizziness (RD) is one of the most common complications after the successful treatment of benign paroxysmal positional vertigo (BPPV). Various theories have been suggested to explain the cause of RD, and otolith organ disorder is the most evident cause of RD. This study aimed to investigate the association between serum levels of Vit D and the occurrence of RD after the successful treatment of BPPV. Methods A prospective study including patients who were diagnosed with de novo posterior semicircular canal-type BPPV (PC-BPPV) was conducted at our institution from May 2017 to May 2019. All the patients underwent canalith repositioning procedures and were followed up. Univariate and multivariate analyses were performed to investigate the relationship between serum 25-hydroxy vitamin D (25(OH)D) levels and RD occurrence after successful BPPV treatment. Results In total, 123 patients with PC-BPPV were enrolled, and 41.5% (51/123) experienced RD. The serum level of 25(OH)D was significantly lower in PC-BPPV patients with RD [median 16.2 ng/ml (IQR 12.9–22.1)] than in patients without RD [median 20.5 ng/ml (IQR 16.5–26.5)] (P = 0.001). In multivariate models comparing the prevalence of RD in the insufficient group [25(OH)D ≥ 20 to <30 ng/ml], deficient group [25(OH)D < 20 ng/ml] and normal group [25(OH)D ≥ 30 ng/ml], the 25(OH)D levels in the deficient group were associated with the occurrence of RD (odds ratio = 5.48, 95% confidence interval = 1.08–27.71; P = 0.04). Conclusion Low 25(OH)D levels are associated with the development of RD in patients with PC-BPPV after successful treatment. Further efforts to validate and elucidate the mechanism are needed.
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Affiliation(s)
- Yunqin Wu
- Department of Neurology, Hwa Mei Hospital, University of Chinese Academy of Science, Ningbo, China
| | - Kun Han
- Department of Neurology, Hwa Mei Hospital, University of Chinese Academy of Science, Ningbo, China
| | - Weiwei Han
- Department of Rehabilitation, Hwa Mei Hospital, University of Chinese Academy of Science, Ningbo, China
| | - Zhenyi Fan
- Department of Neurology, Hwa Mei Hospital, University of Chinese Academy of Science, Ningbo, China
| | - Min Zhou
- Department of Neurology, 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
| | - Xiaoxia Liu
- Department of Neurology, Hwa Mei Hospital, University of Chinese Academy of Science, Ningbo, China
| | - Li Li
- Department of Neurology, Hwa Mei Hospital, University of Chinese Academy of Science, Ningbo, China
| | - Liwen Du
- Department of Emergency, Hwa Mei Hospital, University of Chinese Academy of Science, Ningbo, China
- *Correspondence: Liwen Du
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Ke Y, Ma X, Jing Y, Diao T, Yu L. Risk factors for residual dizziness in patients with benign paroxysmal positional vertigo after successful repositioning: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2022; 279:3237-3256. [PMID: 35218384 DOI: 10.1007/s00405-022-07288-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 01/24/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To investigate the risk factors for residual dizziness (RD) in patients with benign paroxysmal positional vertigo (BPPV) after successful repositioning. METHODS Searches were performed in PubMed, Embase, Cochrane library, Web of Science, Chinese National Knowledge Infrastructure, and Sino Med up to March 7, 2021 and references of relevant articles were screened. Data from eligible studies were meta-analyzed using Stata version 16.0 and Review Manager 5.4. RESULTS In this systematic review and meta-analysis of 4487 patients from 31 studies, the prevalence of RD was 43.0% (95% CI 39.0-48.0%). Age (MD 4.17; 95% CI 2.13-6.21, P = 0.000), female gender (OR = 1.28, 95% CI 1.11-1.47, P = 0.001), secondary BPPV (OR 1.88; 95% CI 1.27-2.77, P = 0.001), a longer duration of BPPV before treatment (MD 3.45; 95% CI 1.87-5.02, P = 0.000), abnormal ocular vestibular evoked myogenic potential (OVEMP, OR 4.34; 95% CI 2.78-6.78, P = 0.000), abnormal cervical vestibular evoked myogenic potential (CVEMP, OR 2.48; 95% CI 1.54-3.99, P = 0.000), higher Dizziness Handicap Index (DHI) score before treatment (MD 10.88; 95% CI 5.96-15.80, P = 0.000), anxiety (OR 9.58; 95% CI 6.32-14.52, P = 0.000), osteopenia (OR = 4.40, 95% CI 2.17-8.96, P = 0.000), onset in winter (OR 7.27; 95% CI 2.38-22.24, P = 0.001) and with a history of BPPV (OR 1.79; 95% CI 1.06-3.04, P = 0.03) are the risk factors for RD in patients with BPPV after successful repositioning. The affected side, location or type of semicircular involvement, hyperlipidemia, diabetes, hypertension, heart disease, migraine, sleep disorders, canalolithiasis/cupulolithiasis, the number of times the canalith repositioning procedures (CRPs) were performed and number of vertigo attacks did not correlate with the occurrence of RD. CONCLUSIONS Despite successful treatment, nearly half of the BPPV patients developed RD. RD seems to be a syndrome caused by multiple factors. The pathogenesis of most factors can be explained by psychological and/or physical disorders. Early recognition of these risk factors contributes to the prevention and treatment of RD.
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Affiliation(s)
- Yujie Ke
- Department of Otorhinolaryngology, Peking University People's Hospital, Beijing, China
| | - Xin Ma
- Department of Otorhinolaryngology, Peking University People's Hospital, Beijing, China
| | - Yuanyuan Jing
- Department of Otorhinolaryngology, Peking University People's Hospital, Beijing, China
| | - Tongxiang Diao
- Department of Otorhinolaryngology, Peking University People's Hospital, Beijing, China
| | - Lisheng Yu
- Department of Otorhinolaryngology, Peking University People's Hospital, Beijing, China.
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Recovery of Regular Daily Physical Activities Prevents Residual Dizziness after Canalith Repositioning Procedures. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19010490. [PMID: 35010750 PMCID: PMC8744883 DOI: 10.3390/ijerph19010490] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 12/20/2021] [Accepted: 12/30/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Residual dizziness is a disorder of unknown pathophysiology, which may occur after repositioning procedures for benign paroxysmal positional vertigo. This study evaluates the relationship between regular daily physical activity and the development of residual dizziness after treatment for benign paroxysmal positional vertigo. STUDY DESIGN Prospective observational cohort study. SETTING Academic university hospital. METHODS Seventy-one patients admitted with benign paroxysmal positional vertigo involving the posterior semicircular canal were managed with Epley's procedure. Three days after successful treatment, the patients underwent a telephone interview to investigate vertigo relapse. If the patients no longer complained of vertigo, they were asked about symptoms consistent with residual dizziness. Subsequently, they were asked about the recovery of physical activities they regularly performed prior to the onset of vertigo. RESULTS Sixty-nine patients (age: 57.79 ± 15.05) were enrolled: five (7.24%) reported vertigo relapse whereas twenty-one of sixty-four non-relapsed patients (32.81%) reported residual dizziness. A significant difference in the incidence of residual dizziness was observed considering the patients' age (p = 0.0003). Of the non-relapsed patients, 46 (71.88%) recovered their regular dynamic daily activities after treatment and 9 (19.57%) reported residual dizziness, while 12 of the 18 patients (66.67%) who did not resume daily activity reported residual symptoms (p = 0.0003). A logistic regression analysis showed a significant association between daily activity resumption and lack of residual dizziness (OR: 14.01, 95% CI limits 3.14-62.47; p = 0.001). CONCLUSIONS Regardless of age, the resumption of regular daily physical activities is associated with a lack of residual dizziness.
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Assal S, Morsy HM, Almagassbi NM, Eldeeb M. Assessment of sensory organization testing in benign paroxysmal positional vertigo patients before and after repositioning manoeuvre. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2021; 73:S0001-6519(21)00086-8. [PMID: 34456028 DOI: 10.1016/j.otorri.2021.04.007] [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: 12/01/2020] [Revised: 04/23/2021] [Accepted: 04/26/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION AND OBJECTIVE Benign paroxysmal positioning vertigo is considered the most common disorder of the peripheral vestibular system. After successful physical manoeuvres for BPPV, a number of patients complain of non-positional sustained imbalance of variable duration called residual dizziness lasting for several days. The objective of this study was to compare the posturographic changes before and one week after successful repositioning manoeuvres in patients with idiopathic BPPV. MATERIALS AND METHODS This study was a case-control study, where the first group was composed of 20 patients with confirmed BPPV diagnosis regardless of the affected canal or pathology. Twenty age and gender matched normal subjects constituted the control group. The sensory organization test was performed before and one week after a repositioning manoeuvre in BPPV patients. RESULTS All 20 BPPV patients, except 6 who had no significant improvement of symptoms even after disappearance of classic vertigo and nystagmus, had substantial improvement in sensory scores after CRPs in the antero-posterior visual and vestibular scores and the medio-lateral visual and global scores. All antero-posterior and medio-lateral scores before and after CRPs, except for the AP preferential score, were considerably poorer in BPPV patients than healthy subjects. The 6 patients, who showed no improvement after CRPs, presented with a history of non-specific symptoms i.e., light-headedness or sense of floating. CONCLUSIONS Sensory organization test might have a role in the assessment of residual dizziness in patients with BPPV after CRPs.
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Affiliation(s)
- Samir Assal
- Department of Otorhinolaryngology, Audio-vestibular Medicine Unit, Faculty of Medicine, Alexandria University, Egypt
| | - Hebatollah Mohamed Morsy
- Department of Otorhinolaryngology, Audio-vestibular Medicine Unit, Faculty of Medicine, Alexandria University, Egypt
| | - Naima Muftah Almagassbi
- Department of Otorhinolaryngology, Audio-vestibular Medicine Unit, Faculty of Medicine, Alexandria University, Egypt
| | - Mirhan Eldeeb
- Department of Otorhinolaryngology, Audio-vestibular Medicine Unit, Faculty of Medicine, Alexandria University, Egypt.
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