[Application of the dizziness handicap inventory in the patients with benign paroxysmal positional vertigo]

Older patients with persistent postural-perceptual dizziness exhibit fewer emotional disorders and lower vertigo scores

The clinical characteristics of persistent postural-perceptual dizziness (PPPD) vary according to patient age and inducing factors. We aimed to analyze the differences in the clinical characteristics of PPPD with different patient age groups and different etiologies. A total of 122 PPPD patients hospitalized in the vertigo ward of Nanjing Brain Hospital from December 2018 to July 2021 were enrolled. According to whether dizziness symptoms were secondary to organic diseases, PPPD patients were divided into the primary (p-) and secondary (s-) PPPD groups; subgroups were created according to age including youth group, middle-aged group, older adults group 1 and older adults 2. We collected detailed data from each patients, including scores on the Dizziness Handicap Inventory (DHI), mental state and other clinical data. The ratio of males to females was 1:2. The prevalence of emotional disorders in the middle-aged group was the highest (67.57%) and that in the older adults groups was lower (48.08% in older adults group 1 and 8.70% in older adults group 2, P = 0.000). The proportion of p-PPPD patients with emotional disorders was significantly higher than that of s-PPPD patients (53.48% vs. 30.56%, P = 0.028). The average total DHI score in the middle-aged group was significantly higher than that in older adults group 2 (52.86 vs. 35.04, P = 0.032), and the Beck anxiety score in the middle-aged group was higher than that in older adults group 2 (38.89 vs. 27.65, P = 0.000). The middle-aged group had the highest proportion of women, the highest proportion of patients with emotional disorders and the highest vertigo score. The proportion of patients with emotional disorders and the vertigo scores were lower in the older adults groups.

Risk factors for residual dizziness in patients with benign paroxysmal positional vertigo after successful repositioning: a systematic review and meta-analysis

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.

The Clinical Response Time of Epley Maneuvers for Treatment of BPPV: A Hospital Based Study

The Epley maneuver is one of the most effective canalith repositioning procedures for treatment of posterior canal benign paroxysmal positional vertigo. It was found that response to BPPV varies with various factors such as types, single versus multiple canals BPPV, single or repeated cycles of head maneuvers in each session and duration of follow up of patient. Furthermore, less uniform result exists after treatment of BPPV among studies. Hence, the present study was taken with aim to investigate "The clinical response time of Epley maneuvers in treatment of BPPV: A Hospital Based Study. A total of 132 patients were included in study with age ranging from 30 to 50 years These patient visited department of ENT from 2019 to 2020 with complaint of vertigo. The subjective balancing assessments along with Dix-Hallpike maneuver were done and dizziness handicap inventory were administrated for screening of BPPV. The patients, who were diagnosed as posterior canal BPPV, were treated with Canal repositioning procedure i.e. Epley's Maneuvers during the initial visit. In addition, the same maneuvers were repeated after 1 week of sequential sessions if the patient reported no benefit or partial benefit from first session until the patient became asymptomatic and Dix-Hallpike maneuver were negative. The total number of sessions of Epley maneuver required by each patient was recorded. The findings of present study suggested that 37.69% of cases with posterior canal BPPV were asymptomatic after first CRP session of Epleys maneuver whereas repeated sessions were required in 61.52% of cases of BPPV and 0.76% of cases showed no response to repeated CRP up to 6 months. BPPV involving posterior canals may be easily detected by position test with good response to Epley maneuver. Short-term and long term control of symptoms of unilateral posterior SCC through this easy and simple procedure can be achieved. This cost effective approach requires proper trained and committed professionals. The repeated session may be required as complete recovery may not be immediate. Sometimes partial response can be due to canal switching during BPPV Hence, it is necessary to counsel the patient regarding the importance of follow-up.