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Alfarghal M, Singh NK, Algarni MA, Jagadish N, Raveendran RK. Treatment efficacy of repositioning maneuvers in multiple canal benign paroxysmal positional vertigo: a systematic review and meta-analysis. Front Neurol 2023; 14:1288150. [PMID: 38020643 PMCID: PMC10658715 DOI: 10.3389/fneur.2023.1288150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Benign paroxysmal positional vertigo (BPPV) involving the posterior canal is more common than other canals; however, simultaneous involvement of multiple canals can be seen up to 20% of all BPPV cases. The diagnosis and management of multiple canal BPPV can be quite challenging due to the complexity of findings. Therefore, this systematic review and meta-analysis aimed at unveiling the most effective repositioning strategy for the treatment of multiple canal BPPV. Methods A literature search through PubMed, Scopus, and Web of Science databases was conducted using search terms such as BPPV, multiple canals, bilateral BPPV, repositioning maneuvers etc. After duplicate removal, the retained articles underwent various stages of elimination by two independent reviewers, and a third reviewer resolved the discrepancy between them. Results A total of 22 articles were included in the systematic review. These publications documented 5,196 patients diagnosed with BPPV, of which 513 had multiple canal BPPV. Of 295 individuals with multiple canal BPPV, 58.9% were effectively treated in 1 session, whereas 18.3 and 4.4% achieved a symptom-free state after two and three sessions, respectively. Failure of treatment using repositioning maneuvers was found in 18.4%. Possible implications This study offers insight into the real world of BPPV management in single and multiple canal BPPV. It is evident that repositioning maneuvers provide rapid and long-lasting relief of BPPV in most single canal BPPV patients; however, multiple canal BPPV often requires repeated treatment, and the risk of recurrence is higher in this variety than the single canal BPPV.
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Affiliation(s)
- Mohamad Alfarghal
- Otolaryngology-Head and Neck Section, Surgery Department, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | | | - Mohammed Abdullah Algarni
- Otolaryngology-Head and Neck Section, Surgery Department, King Abdulaziz Medical City, Jeddah, Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Nirmala Jagadish
- All India Institute of Speech and Hearing (AIISH), Mysore, India
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Kinne BL, Breuer RE, Fitkin OM, Kelly RL. Interventions for apogeotropic horizontal canal benign paroxysmal positional vertigo: a systematic review. PHYSICAL THERAPY REVIEWS 2023. [DOI: 10.1080/10833196.2022.2163082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Bonni Lynn Kinne
- Department of Physical Therapy & Athletic Training, Grand Valley State University, Grand Rapids, Michigan, USA
| | - Rachel Elizabeth Breuer
- Department of Physical Therapy & Athletic Training, Grand Valley State University, Grand Rapids, Michigan, USA
| | - Olivia Margeurite Fitkin
- Department of Physical Therapy & Athletic Training, Grand Valley State University, Grand Rapids, Michigan, USA
| | - Rebecca Lynn Kelly
- Department of Physical Therapy & Athletic Training, Grand Valley State University, Grand Rapids, Michigan, USA
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Ogawa Y, Inagaki T, Kondo T, Takeda A, Nagai N, Itani S, Otsuka K. The clinical outcome of the patients with horizontal semicircular canal variants of benign paroxysmal positional vertigo. Acta Otolaryngol 2022; 142:381-387. [PMID: 35491854 DOI: 10.1080/00016489.2022.2049363] [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: 12/16/2021] [Revised: 02/22/2022] [Accepted: 02/24/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Gufoni maneuver is known to be effective for horizontal canal benign positional vertigo (HC-BPPV), but there are some intractable patients that the treatment procedure does not work. OBJECTIVE The clinical outcomes of patients with HC-BPPV were investigated. We also investigated the characteristics of intractable patients which needed long time to the remission. METHODS Sixty-six patients with HC-BPPV receiving Gufoni maneuver at Tokyo Medical University Hachioji Medical Center were investigated. The patients were classified into geotropic DCPN group and apogeotropic DCPN group. The clinical outcomes in 2 groups were examined. RESULTS There were 48 patients with geotropic DCPN and 18 patients with apogeotropic DCPN. There were significant differences between the geotropic HC-BPPV and apogeotropic HC BPPV in the period to remission. There were 7 intractable patients and the average ages of these intractable patients were higher than other patients. CONCLUSION The patients with geotropic DCPN and the patients with the nystagmus conversion from apogeotropic to geotropic DCPN have tendency to easy to resolve, but in patients with apogeotropic type without nystagmus transformation have long time to resolve. The elderly patients whose nystagmus remains apogeotropic without nystagmus conversion have tendencies to become intractable.
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Affiliation(s)
- Yasuo Ogawa
- Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University Hachioji Medical Center, Hachioji-shi, Tokyo
| | - Taro Inagaki
- Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Nishi-Shinjyu, Tokyo
| | - Takahito Kondo
- Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University Hachioji Medical Center, Hachioji-shi, Tokyo
| | - Atsuo Takeda
- Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University Hachioji Medical Center, Hachioji-shi, Tokyo
| | - Noriko Nagai
- Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Nishi-Shinjyu, Tokyo
| | - Shigeto Itani
- Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Nishi-Shinjyu, Tokyo
| | - Koji Otsuka
- Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Nishi-Shinjyu, Tokyo
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Ramos BF, Cal R, Mangabeira Albernaz PL, Zuma e Maia F. Practical approach for lateral canal benign paroxysmal positional vertigo. J Neurol Sci 2022; 434:120180. [DOI: 10.1016/j.jns.2022.120180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 01/25/2022] [Accepted: 01/30/2022] [Indexed: 11/29/2022]
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Ramos BF, Cal R, Albernaz PLM, Zuma e Maia F. The role of the reversed nystagmus during Zuma maneuver in patients treated for geotropic lateral canal benign paroxysmal positional vertigo. J Neurol Sci 2022; 434:120160. [DOI: 10.1016/j.jns.2022.120160] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/23/2021] [Accepted: 01/13/2022] [Indexed: 11/28/2022]
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Kinne BL, Harless MG, Lauzon KA, Wamhoff JR. Roll maneuvers versus side-lying maneuvers for geotropic horizontal canal BPPV: a systematic review. PHYSICAL THERAPY REVIEWS 2021. [DOI: 10.1080/10833196.2021.1978778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Bonni Lynn Kinne
- Department of Physical Therapy, Grand Valley State University, Grand Rapids, MI, USA
| | - Mikaela Grace Harless
- Department of Physical Therapy, Grand Valley State University, Grand Rapids, MI, USA
| | - Kyra Ann Lauzon
- Department of Physical Therapy, Grand Valley State University, Grand Rapids, MI, USA
| | - Jill Renee Wamhoff
- Department of Physical Therapy, Grand Valley State University, Grand Rapids, MI, USA
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Zuma e Maia F, Ramos BF, Cal R, Brock CM, Mangabeira Albernaz PL, Strupp M. Management of Lateral Semicircular Canal Benign Paroxysmal Positional Vertigo. Front Neurol 2020; 11:1040. [PMID: 33041982 PMCID: PMC7522363 DOI: 10.3389/fneur.2020.01040] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 08/10/2020] [Indexed: 11/23/2022] Open
Abstract
Benign paroxysmal positional vertigo (BPPV) is the most common cause of peripheral vestibular vertigo. It is caused by free-floating otoconia moving freely in one of the semicircular canals (canalolithiasis) or by otoliths adhered to the cupula (cupulolithiasis). The posterior canal is the most common canal affected, followed by the lateral canal. Diagnosis of the side affected is critical for successful treatment; therefore, suppressing visual fixation is essential to examination of these patients' eye movement. On the basis of our experience, we have adopted the Zuma maneuver and the modified Zuma maneuver for both apogeotropic and geotropic variants of lateral canal BPPV. Knowledge of the anatomy and pathophysiologic mechanisms of the semicircular canals is essential for correct management of these patients. Hence, using a single maneuver and its modification may facilitate daily neurotological practice.
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Affiliation(s)
- Francisco Zuma e Maia
- Department of Otorhinolaryngology and INSCER, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Bernardo Faria Ramos
- Department of Otorhinolaryngology, Federal University of Espirito Santo, Vitoria, Brazil
| | - Renato Cal
- Department of Otorhinolaryngology, University Center of Para (CESUPA), Belem, Brazil
| | - Camila Martins Brock
- Department of Otorhinolaryngology, Pontifical Catholic University of Rio Grande do Sul (PUC-RS), Porto Alegre, Brazil
| | | | - Michael Strupp
- Ludwig Maximilians University, Munich, Germany
- Department of Neurology and German Center for Vertigo and Balance Munich, Munich, Germany
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Dai Q, Chen Q, Yin L, Zheng H, Liu SX, Duan M. The long-term follow-up of 61 horizontal canal BPPV after Gufoni and Barbecue maneuver: a prospective study. Acta Otolaryngol 2020; 140:463-466. [PMID: 32049574 DOI: 10.1080/00016489.2020.1725114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Background: Horizontal canal BPPV (HC-BPPV) has a higher recurrence rate than PC-BPPV. Which maneuver is better for its prognosis is still uncertain.Objective: To compare the long-term recurrence rate after Gufoni and Barbecue maneuver.Materials and methods: We prospectively collected 61 cases of HC-BPPV which were initially diagnosed in our hospital from the first episode, and had already ruled out other diseases. Roll them into Gufoni group and Barbecue group alternatively. After the maneuver, we followed them up until December 2016. Mean follow-up time was 49.25 months.Results: The recurrence rate is 18.0% in the first year, 14.8% after the first year, and 31.1% overall. There is no statistically significant difference between Gufoni group and Barbecue group (p > .05). Age is statistically significant as a risk factor of recurrence (p<.05).Conclusions and significance: Barbecue maneuver is as good as Gufoni maneuver. The recurrence rate is only related to age. We suggest the disease relapsed within the 1st year as recurrence rather than a new disease.
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Affiliation(s)
- Qingqing Dai
- Department of Otolaryngology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
- Department of Otolaryngology Head and Neck, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden
- Department of Clinical Science, Intervention and Technology, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden
| | - Qiurong Chen
- Department of Otolaryngology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Li Yin
- Department of Medicine Epidemiology and Biostatistics, Karolinska University, Stockholm, Sweden
| | - Hong Zheng
- Department of Otolaryngology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Shi-Xi Liu
- Department of Otolaryngology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Maoli Duan
- Department of Otolaryngology Head and Neck, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden
- Department of Clinical Science, Intervention and Technology, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden
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Zhu M, Yu F, Zhou F, Wang H, Jiao Y, Wang M, Huang L, Liang Z. Benign paroxysmal positional vertigo associated with Meniere's disease. J Vestib Res 2019; 28:359-364. [PMID: 30149485 DOI: 10.3233/ves-180638] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE We studied the clinical features of benign paroxysmal positional vertigo (BPPV) associated with Meniere's disease. METHODS The medical records of 120 patients with BPPV was retrospectively analyzed. Complete otolaryngological, audiological, and neurotological evaluation results were available for all patients, including nystagmography. All patients were diagnosed using the Dix-Hallpike test or roll test and treated with the canalith repositioning procedure. The outcomes were compared among the three groups. RESULTS A series of 120 BPPV cases. Results showed that Group A and Group B based on the following features: unilateral semicircular canal BPPV occurred more often than bilateral BPPV and the posterior semicircular canal was the most common canal involved. Additionally, Meniere's disease patients with multiple semicircular canal BPPV required repeated canalith repositioning procedures and had a higher recurrence rate. CONCLUSION A lower treatment success rate and a higher recurrence rate were found in the BPPV patients with Meniere's disease compared with the patients without Meniere's disease. The recurrence rate was highest in the patients with multiple semicircular canal BPPV with Meniere's disease.
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Affiliation(s)
- Meichan Zhu
- Department of Otorhinolaryngology, Guangzhou Otolarynology - Head and Neck Surgery Hospital (Guangzhou Twelfth People's Hospital), Guangzhou, Guangdong, China
| | - Feng Yu
- Department of Otorhinolaryngology, Guangzhou Otolarynology - Head and Neck Surgery Hospital (Guangzhou Twelfth People's Hospital), Guangzhou, Guangdong, China
| | - Feng Zhou
- Department of Otorhinolaryngology, Guangzhou Otolarynology - Head and Neck Surgery Hospital (Guangzhou Twelfth People's Hospital), Guangzhou, Guangdong, China
| | - Haitao Wang
- Department of Otorhinolaryngology, Guangzhou Otolarynology - Head and Neck Surgery Hospital (Guangzhou Twelfth People's Hospital), Guangzhou, Guangdong, China
| | - Yuenong Jiao
- Department of Otorhinolaryngology, Guangzhou Otolarynology - Head and Neck Surgery Hospital (Guangzhou Twelfth People's Hospital), Guangzhou, Guangdong, China
| | - Meng Wang
- Department of Otorhinolaryngology, Guangzhou Otolarynology - Head and Neck Surgery Hospital (Guangzhou Twelfth People's Hospital), Guangzhou, Guangdong, China
| | - Lifen Huang
- Department of Otorhinolaryngology, Guangzhou Otolarynology - Head and Neck Surgery Hospital (Guangzhou Twelfth People's Hospital), Guangzhou, Guangdong, China
| | - Zijian Liang
- Department of Otorhinolaryngology, Guangzhou Otolarynology - Head and Neck Surgery Hospital (Guangzhou Twelfth People's Hospital), Guangzhou, Guangdong, China
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You P, Instrum R, Parnes L. Benign paroxysmal positional vertigo. Laryngoscope Investig Otolaryngol 2018; 4:116-123. [PMID: 30828628 PMCID: PMC6383320 DOI: 10.1002/lio2.230] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/11/2018] [Accepted: 10/24/2018] [Indexed: 11/11/2022] Open
Abstract
Objectives Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular end‐organ disease. This article aims to summarize research findings and key discoveries of BPPV. The pathophysiology, diagnosis, nonsurgical, and surgical management are discussed. Methods A comprehensive review of the literature regarding BPPV up through June 2018 was performed. Results BPPV is typified by sudden, brief episodes of vertigo precipitated by specific head movements. While often self‐limited, BPPV can have a considerable impact on quality of life. The diagnosis can be established with a Dix‐Hallpike maneuver for the posterior and anterior canals, or supine roll test for the horizontal canal, and typically does not require additional ancillary testing. Understanding the pathophysiology of both canalithiasis and cupulolithiasis has allowed for the development of various repositioning techniques. Of these, the particle repositioning maneuver is an effective way to treat posterior canal BPPV, the most common variant. Options for operative intervention are available for intractable cases or patients with severe and frequent recurrences. Conclusions A diagnosis of BPPV can be made through clinical history along with diagnostic maneuvers. BPPV is generally amenable to in‐office repositioning techniques. For a small subset of patients with intractable BPPV, canal occlusion can be considered. Level of Evidence N/A
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Affiliation(s)
- Peng You
- Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry Western University, London Health Sciences Centre London Ontario Canada
| | - Ryan Instrum
- Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry Western University, London Health Sciences Centre London Ontario Canada
| | - Lorne Parnes
- Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry Western University, London Health Sciences Centre London Ontario Canada
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Pérez-Vázquez P, Franco-Gutiérrez V, Soto-Varela A, Amor-Dorado JC, Martín-Sanz E, Oliva-Domínguez M, Lopez-Escamez JA. Practice Guidelines for the Diagnosis and Management of Benign Paroxysmal Positional Vertigo Otoneurology Committee of Spanish Otorhinolaryngology and Head and Neck Surgery Consensus Document. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.otoeng.2018.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Pollak L, Huna-Baron R, Osherov M, Roni M. In whom does horizontal canal BPPV recur? Am J Otolaryngol 2018; 39:410-412. [PMID: 29650422 DOI: 10.1016/j.amjoto.2018.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 04/03/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE The objective of this study is to examine the rate of horizontal canal BPPV recurrence of the same type and search for predisposing factors.
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Affiliation(s)
- L Pollak
- Department of Neurology, Barzilai Medical Center, Ashkelon, Israel affiliated to Ben Gurion University of the Negev, Beer Sheva, Israel.
| | - R Huna-Baron
- Goldschleger Eye Institute, Sheba Medical Center, Ramat Gan, Israel affiliated to Sackler Faculty of Medicine Tel Aviv University, Israel
| | - Michael Osherov
- Department of Neurology, Barzilai Medical Center, Ashkelon, Israel affiliated to Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Milo Roni
- Department of Neurology, Barzilai Medical Center, Ashkelon, Israel affiliated to Ben Gurion University of the Negev, Beer Sheva, Israel
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Pérez-Vázquez P, Franco-Gutiérrez V. Treatment of benign paroxysmal positional vertigo. A clinical review. J Otol 2017; 12:165-173. [PMID: 29937852 PMCID: PMC6002633 DOI: 10.1016/j.joto.2017.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 08/04/2017] [Accepted: 08/07/2017] [Indexed: 11/12/2022] Open
Abstract
Benign paroxysmal positional vertigo (BPPV) is the most frequent episodic vestibular disorder. It is due to otolith rests that are free into the canals or attached to the cupulas. Well over 90% of patients can be successfully treated with manoeuvres that move the particles back to the utriculus. Among the great variety of procedures that have been described, the manoeuvres that are supported by evidenced-based studies or extensive series are commented in this review. Some topics regarding BPPV treatment, such as controlling the accuracy of the procedures or the utility of post-manoeuvre restrictions are also discussed.
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Tang H, Li W. Advances in the diagnosis and treatment of benign paroxysmal positional vertigo. Exp Ther Med 2017; 14:2424-2430. [PMID: 28962176 PMCID: PMC5609213 DOI: 10.3892/etm.2017.4837] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 05/19/2017] [Indexed: 12/03/2022] Open
Abstract
Benign paroxysmal positional vertigo (BPPV) (otolith disease) is the most common neurological and position change related vertigo, accounting for 17-20% of peripheral vertigo. BPPV occur in the elderly. The high incidence age for BPPC was 50 to 70 years and mostly in female. According to the different parts of the lesions, it is divided into anterior canal BPPV (AC-BPPV), posterior canal BPPV (PC-BPPV), horizontal canal BPPV (HC-BPPV). Studies have shown that the incidence of PC-BPPV was 86.36%, the incidence of HC-BPPV was 11.37%, the incidence rate of AC-BPPV was 2.27%. Treatment for PC-BPPV includes manual reduction, drug treatment, psychological treatment, and surgical treatment. Repositioning is the preferred method for the treatment of PC-BPPV with high effective rate and low risk. The mechanism is through the different changes of head position to make the otolith back to utricle. Many manual reduction methods have been reported in clinical treatment of PC-BPPV. With the increasing emphasis on the BPPV, a variety of new methods are being developed and designed.
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Affiliation(s)
- Hengyong Tang
- Department of Neurology, Fengcheng Hospital in Fengxian District, Shanghai, P.R. China
| | - Wei Li
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai, P.R. China
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Practice Guidelines for the Diagnosis and Management of Benign Paroxysmal Positional Vertigo Otoneurology Committee of Spanish Otorhinolaryngology and Head and Neck Surgery Consensus Document. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2017; 69:345-366. [PMID: 28826856 DOI: 10.1016/j.otorri.2017.05.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 05/04/2017] [Indexed: 11/21/2022]
Abstract
Benign Paroxysmal Positional Vertigo is the most frequent episodic vestibular disorder. The purpose of this guide, requested by the committee on otoneurology of the Spanish Society of Otolaryngology and Head and Neck Surgery, is to supply a consensus document providing practical guidance for the management of BPPV. It is based on the Barany Society criteria for the diagnosis of BPPV. This guideline provides recommendations on each variant of BPPV, with a description of the different diagnostic tests and the therapeutic manoeuvres. For this purpose, we have selected the tests and manoeuvres supported by evidence-based studies or extensive series. Finally, we have also included a chapter on differential diagnosis and a section relating to general aspects in the management of BPPV.
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Li J, Guo P, Tian S, Li K, Zhang H. Quick repositioning maneuver for horizontal semicircular canal benign paroxysmal positional vertigo. J Otol 2015; 10:115-117. [PMID: 29937793 PMCID: PMC6002574 DOI: 10.1016/j.joto.2015.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 11/13/2015] [Accepted: 11/16/2015] [Indexed: 11/23/2022] Open
Abstract
Objective To investigate the efficacy of quick repositioning maneuver for horizontal semicircular canal benign paroxysmal positional vertigo (H-BPPV). Methods Clinical data of 67 patients with H-BPPV who underwent quick repositioning maneuver in our hospital from July 2009 to November 2014 were retrospectively analyzed. The maneuver involved rotating the patient in the axial plane for 180° from the involved side towards contralateral side as quickly as possible. Results Complete symptom resolution was achieved in 61 patients (91.0%) at one week and in 64 patients (95.5%) at 3 months post-treatment. During the repositioning maneuver process, there were no obvious untoward responses except transient nausea with or without vomiting in a few patients. Conclusion The results indicate that the quick repositioning maneuver is an easy and effective alternative treatment in the management of H-BPPV.
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Affiliation(s)
- Jinrang Li
- Department of Otorhinolaryngology Head Neck Surgery, Navy General Hospital, Beijing, 100048, China
| | - Pengfei Guo
- Department of Otorhinolaryngology Head Neck Surgery, Navy General Hospital, Beijing, 100048, China
| | - Shiyu Tian
- Department of Otorhinolaryngology Head Neck Surgery, Navy General Hospital, Beijing, 100048, China
| | - Keliang Li
- Department of Otorhinolaryngology Head Neck Surgery, Navy General Hospital, Beijing, 100048, China
| | - Hao Zhang
- Department of Otorhinolaryngology Head Neck Surgery, Navy General Hospital, Beijing, 100048, China
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Efficacy of Computer-Controlled and Modified Roll Maneuver for Treatment of Geotropic Lateral Canal Benign Paroxysmal Positional Vertigo. Otol Neurotol 2015; 36:1412-6. [PMID: 26134939 DOI: 10.1097/mao.0000000000000813] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the short-term efficacy of computer-controlled and modified roll maneuver (CMRM) versus conventional roll maneuver (RM) for treatment of geotropic lateral canal benign paroxysmal positional vertigo (BPPV). STUDY DESIGN Prospective case-controlled study. SETTING Academic hospital. PATIENTS One hundred consecutive patients diagnosed as having unilateral idiopathic geotropic lateral canal BPPV with a duration of symptoms of less than 2 weeks. INTERVENTIONS Fifty-two patients (aged 32-80 yr; mean, 55.9 yr; 18 men and 34 women) were treated with CMRM that was composed of three sequential 360-degree rotations and 48 patients (aged 30-71 yr; mean, 52.4 yr; 20 men and 28 women) treated with RM that consisted of one 360-degree rotation. MAIN OUTCOME MEASURES Resolution of vertigo on the supine roll test at 48 hours after initial maneuver and the number of maneuvers required for final resolution of vertigo were main outcome measures to assess the efficacy of treatment. RESULTS On the supine roll test at 48-hour follow-up after initial maneuver, 44 (84.6%) of 52 CMRM-treated patients and 23 (54.2%) of 48 RM-treated patients had resolution of vertigo (p < 0.01). All patients obtained final resolution of vertigo with a maximum of five maneuvers in each group, but the CMRM group had less mean number of maneuvers required for final resolution of vertigo compared with the RM group (1.23 ± 0.39 versus 1.63 ± 0.68, p < 0.05). No significant adverse effects and complications occurred aside from two patients with conversion into posterior canal BPPV in each treatment. CONCLUSION The CMRM consisting of three sequential 360-degree rotations for geotropic lateral canal BPPV has a higher initial success rate compared with the conventional RM consisting of one 360-degree rotation.
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Jung I, Kim JS. Approach to dizziness in the emergency department. Clin Exp Emerg Med 2015; 2:75-88. [PMID: 27752577 PMCID: PMC5052860 DOI: 10.15441/ceem.15.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 04/21/2014] [Accepted: 04/21/2014] [Indexed: 02/07/2023] Open
Abstract
Acute dizziness/vertigo is among the most common causes for visiting the emergency department. The traditional approach to dizziness starts with categorizing dizziness into four types: vertigo, presyncope, disequilibrium, and nonspecific dizziness. However, a recently proposed approach begins with classifying dizziness/vertigo as acute prolonged spontaneous dizziness/vertigo, recurrent spontaneous dizziness/vertigo, recurrent positional vertigo, or chronic persistent dizziness and imbalance. Vestibular neuritis and stroke are key disorders causing acute prolonged spontaneous dizziness/vertigo, but the diagnosis of isolated vascular vertigo has increased by virtue of developments in clinical neurotology and neuroimaging. However, a well-organized bedside examination appears more sensitive than brain imaging in diagnosing strokes presenting with acute dizziness/vertigo. A detailed history is vital to diagnose recurrent spontaneous dizziness/vertigo since confirmatory diagnostic tests are usually unavailable. Isolated positional vertigo is usually caused by benign paroxysmal positional vertigo, which can be treated at the bedside. In recent years, marked progress has occurred in the evaluation/management of acute dizziness/vertigo. However, even with developments in imaging technology, the diagnosis of acute dizziness/vertigo largely relies on bedside examination.
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Affiliation(s)
- Ileok Jung
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Ji-Soo Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Song CI, Kang BC, Yoo MH, Chung JW, Yoon TH, Park HJ. Management of 210 patients with benign paroxysmal positional vertigo: AMC protocol and outcomes. Acta Otolaryngol 2015; 135:422-8. [PMID: 25678222 DOI: 10.3109/00016489.2014.993089] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Benign paroxysmal positional vertigo (BPPV) could be treated with specific maneuvers for the involved canals. Management on a daily basis gave earlier relief than weekly treatment, especially in apogeotropic BPPV. Apogeotropic and multi-canal BPPVs were related to the increased numbers of follow-ups and trauma was related to the increased recurrence. OBJECTIVE We aimed to report the short-term outcomes of our protocol for BPPV and evaluate the factors influencing the results and recurrence. METHODS In 210 BPPV patients, posterior semicircular canal (PSCC), geotropic and apogeotropic lateral canal BPPVs were treated with the Epley maneuver, barbecue maneuver, and barbecue maneuver after head-shaking. The total number of follow-ups needed to have no provoked nystagmus, success rates at 1 week and 1 month, and factors for repeated maneuvers or recurrence were identified. RESULTS Apogeotropic and multi-canal BPPV needed more follow-ups than PSCC BPPV. Multi-canal BPPV showed a significantly lower 1-week success rate than other types. Anterior and multi-canal BPPV showed significantly lower 1-month success rates than other types. The 1-week success rates for PSCC and geotropic and apogeotropic BPPV in patients followed up on a daily basis were higher than those in patients with weekly follow-up and the difference was significant only in apogeotropic BPPV. The overall 1-year recurrence rate was 16% and higher recurrence rate was related to trauma.
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Affiliation(s)
- Chan Il Song
- Department of Otorhinolaryngology-Head and Neck Surgery, Jeju National University School of Medicine , Jeju , Korea
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Oron Y, Cohen-Atsmoni S, Len A, Roth Y. Treatment of horizontal canal BPPV: Pathophysiology, available maneuvers, and recommended treatment. Laryngoscope 2015; 125:1959-64. [DOI: 10.1002/lary.25138] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/22/2014] [Accepted: 12/15/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Yahav Oron
- Department of Otolaryngology-Head and Neck Surgery and Tel-Aviv University Sackler School of Medicine; The Edith Wolfson Medical Center; Holon Israel
| | - Smadar Cohen-Atsmoni
- Department of Otolaryngology-Head and Neck Surgery and Tel-Aviv University Sackler School of Medicine; The Edith Wolfson Medical Center; Holon Israel
| | - Assaf Len
- Department of Otolaryngology-Head and Neck Surgery and Tel-Aviv University Sackler School of Medicine; The Edith Wolfson Medical Center; Holon Israel
| | - Yehudah Roth
- Department of Otolaryngology-Head and Neck Surgery and Tel-Aviv University Sackler School of Medicine; The Edith Wolfson Medical Center; Holon Israel
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van den Broek EMJM, van der Zaag-Loonen HJ, Bruintjes TD. Systematic Review: Efficacy of Gufoni Maneuver for Treatment of Lateral Canal Benign Paroxysmal Positional Vertigo with Geotropic Nystagmus. Otolaryngol Head Neck Surg 2014; 150:933-8. [PMID: 24627409 DOI: 10.1177/0194599814525919] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 02/07/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE In this rapid systematic review, we studied the efficacy of the Gufoni maneuver for the treatment of lateral canal benign paroxysmal positional vertigo (BPPV) with geotropic nystagmus. METHODS A comprehensive search, including PubMed, Embase, Web of Science, and Cochrane as data sources, resulted in 44 original papers for randomized trials that compared the Gufoni maneuver with other maneuvers (date of search: April 23, 2013). Three studies (389 patients) remained after screening of title, abstract, and full text. RESULTS After method assessment, 2 of these 3 studies were considered to have a low risk of bias and a high level of validity. The third study did not properly report the treatment allocation and blinding; moreover, outcome data were incomplete. The first 2 studies compared the Gufoni maneuver with a sham maneuver (and the barbecue roll in one study). The third study compared the Gufoni maneuver with a treatment with vestibular suppressants and with the barbecue roll (plus forced prolonged positioning). All 3 studies reported short-term results. Midterm results (1 month) were reported in 2 studies. CONCLUSION AND RECOMMENDATION Given the variety in the comparative treatments and follow-up duration, all 3 studies showed that the Gufoni maneuver was more effective than the sham maneuver or treatment with vestibular suppressants. All agreed that the maneuver was easy to perform, which made it suitable for older, immobile, and obese patients. However, there were insufficient data to establish the relative efficacy of the Gufoni maneuver compared with other maneuvers.
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Apogeotropic variant of lateral semicircular canal benign paroxysmal positional vertigo: is there a correlation between clinical findings, underlying pathophysiologic mechanisms and the effectiveness of repositioning maneuvers? Otol Neurotol 2014; 34:1155-64. [PMID: 23512075 DOI: 10.1097/mao.0b013e318280db3a] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The apogeotropic variant of horizontal semicircular canal (h-SCC) benign paroxysmal positional vertigo (BPPV) is attributed to canalithiasis of the anterior arm or cupulolithiasis. This study is an attempt to distinguish the most effective maneuvers for each case, by investigating any correlation, between the clinical findings or the treatment options and the possible location of the displaced debris. DATA SOURCES A review of the literature (1990-2012) was conducted via the PubMed database with the search terms "apogeotropic nystagmus and benign paroxysmal positional vertigo." STUDY SELECTION Articles on central nervous system lesions were excluded. DATA EXTRACTION The studies included in the analysis provided detailed diagnostic and therapeutic protocols, supported by the resolution of the signs and symptoms through repositioning maneuvers. DATA SYNTHESIS Descriptive statistics were used to summarize the findings. Intergroup and intragroup comparisons were performed through Pearson's χ or Fischer's exact test. CONCLUSION Protocols vary considerably among studies. Nystagmus from seated to supine position is the best studied secondary clinical sign and possibly a clinical indication of cupulolithiasis. In patients with symmetrical responses in the head yaw test, no significant differences can be detected in the occurrence of secondary signs of lateralization compared to patients with asymmetrical responses. The Gufoni maneuver seems to be effective in all pathophysiologic types of apogeotropic h-SCC BPPV. The Barbeque and Vannucchi-Asprella maneuvers mainly target at lithiasis of the anterior ampullary arm. The results of this analysis may imply that different clinical subgroups of h-SCC BPPV may regard to different pathophysiologic and therapeutical mechanisms.
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The Significance of 180-Degree Head Rotation in Supine Roll Test for Horizontal Canal Benign Paroxysmal Positional Vertigo. Otol Neurotol 2013; 34:736-42. [DOI: 10.1097/mao.0b013e31827de2d1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Balatsouras DG, Ganelis P, Aspris A, Economou NC, Moukos A, Koukoutsis G. Benign paroxysmal positional vertigo associated with Meniere's disease: epidemiological, pathophysiologic, clinical, and therapeutic aspects. Ann Otol Rhinol Laryngol 2012; 121:682-8. [PMID: 23130545 DOI: 10.1177/000348941212101011] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES We studied the demographic, pathogenetic, and clinical features of benign paroxysmal positional vertigo (BPPV) associated with Meniere's disease. METHODS The medical records of patients with BPPV associated with Meniere's disease were reviewed. In all patients, results of a complete otolaryngological, audiological, and neurotologic evaluation, including nystagmography, were available. Patients with idiopathic BPPV were used as a control group. RESULTS Twenty-nine patients with both disorders were found and were compared with 233 patients with idiopathic BPPV. The patients with BPPV associated with Meniere's disease presented the following features, in which they differed from the patients with idiopathic BPPV: 1) a higher percentage of female patients; 2) a longer duration of symptoms; 3) common involvement of the horizontal semicircular canal; 4) a greater incidence of canal paresis; and 5) more therapeutic sessions needed for cure and a higher rate of recurrence. CONCLUSIONS The BPPV associated with Meniere's disease differs from idiopathic BPPV in regard to several epidemiological and clinical features, may follow a different course, and responds less effectively to treatment.
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Kheradmand A, Zee DS. The bedside examination of the vestibulo-ocular reflex (VOR): an update. Rev Neurol (Paris) 2012; 168:710-9. [PMID: 22981296 PMCID: PMC4066458 DOI: 10.1016/j.neurol.2012.07.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 07/17/2012] [Indexed: 10/27/2022]
Abstract
Diagnosing dizzy patients remains a daunting challenge to the clinician in spite of modern imaging and increasingly sophisticated electrophysiological testing. Here we review the major bedside tests of the vestibulo-ocular reflex and how, when combined with a proper examination of the other eye movement systems, one can arrive at an accurate vestibular diagnosis.
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Affiliation(s)
- A Kheradmand
- Departments of Neurology, The Johns Hopkins Hospital, Oculomotor Lab, Path 2-210, 600 N. Wolfe street, Baltimore, MD 21287, USA.
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