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Arán-Tapia I, Soto-Varela A, Pérez-Muñuzuri V, Santos-Pérez S, Arán I, Muñuzuri AP. Numerical Simulations of the Epley Maneuver With Clinical Implications. Ear Hear 2024; 45:1033-1044. [PMID: 38439150 PMCID: PMC11175731 DOI: 10.1097/aud.0000000000001493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 01/23/2024] [Indexed: 03/06/2024]
Abstract
OBJECTIVES Canalith repositioning procedures to treat benign paroxysmal positional vertigo are often applied following standardized criteria, without considering the possible anatomical singularities of the membranous labyrinth for each individual. As a result, certain patients may become refractory to the treatment due to significant deviations from the ideal membranous labyrinth, that was considered when the maneuvers were designed. This study aims to understand the dynamics of the endolymphatic fluid and otoconia, within the membranous labyrinth geometry, which may contribute to the ineffectiveness of the Epley maneuver. Simultaneously, the study seeks to explore methods to avoid or reduce treatment failure. DESIGN We conducted a study on the Epley maneuver using numerical simulations based on a three-dimensional medical image reconstruction of the human left membranous labyrinth. A high-quality micro-computed tomography of a human temporal bone specimen was utilized for the image reconstruction, and a mathematical model for the endolymphatic fluid was developed and coupled with a spherical particle model representing otoconia inside the fluid. This allowed us to measure the position and time of each particle throughout all the steps of the maneuver, using equations that describe the physics behind benign paroxysmal positional vertigo. RESULTS Numerical simulations of the standard Epley maneuver applied to this membranous labyrinth model yielded unsatisfactory results, as otoconia do not reach the frontside of the utricle, which in this study is used as the measure of success. The resting times between subsequent steps indicated that longer intervals are required for smaller otoconia. Using different angles of rotation can prevent otoconia from entering the superior semicircular canal or the posterior ampulla. Steps 3, 4, and 5 exhibited a heightened susceptibility to failure, as otoconia could be accidentally displaced into these regions. CONCLUSIONS We demonstrate that modifying the Epley maneuver based on the numerical results obtained in the membranous labyrinth of the human specimen under study can have a significant effect on the success or failure of the treatment. The use of numerical simulations appears to be a useful tool for future canalith repositioning procedures that aim to personalize the treatment by modifying the rotation planes currently defined as the standard criteria.
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Affiliation(s)
- Ismael Arán-Tapia
- Group of Non-Linear Physics, Department of Physics, Campus Sur, University of Santiago de Compostela, Santiago de Compostela, Spain
- Galician Center for Mathematical Research and Technology, Santiago de Compostela, Spain
- Cross-disciplinary Research Center in Environmental Technologies (CRETUS), University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Andrés Soto-Varela
- Division of Neurotology, Department of Otorhinolaryngology, Complexo Hospitalario Universitario, Santiago de Compostela, Spain
- Department of Surgery and Medical-Surgical Specialities, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
- Health Research Institute of Santiago, Santiago de Compostela, Spain
| | - Vicente Pérez-Muñuzuri
- Group of Non-Linear Physics, Department of Physics, Campus Sur, University of Santiago de Compostela, Santiago de Compostela, Spain
- Cross-disciplinary Research Center in Environmental Technologies (CRETUS), University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Sofía Santos-Pérez
- Division of Neurotology, Department of Otorhinolaryngology, Complexo Hospitalario Universitario, Santiago de Compostela, Spain
- Department of Surgery and Medical-Surgical Specialities, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
- Health Research Institute of Santiago, Santiago de Compostela, Spain
| | - Ismael Arán
- Department of Otorhinolaryngology, Complexo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
| | - Alberto P. Muñuzuri
- Group of Non-Linear Physics, Department of Physics, Campus Sur, University of Santiago de Compostela, Santiago de Compostela, Spain
- Galician Center for Mathematical Research and Technology, Santiago de Compostela, Spain
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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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Tsai KL, Wang CT, Kuo CH, Cheng YY, Ma HI, Hung CH, Tsai YJ, Kao CL. The potential role of epigenetic modulations in BPPV maneuver exercises. Oncotarget 2018; 7:35522-35534. [PMID: 27203679 PMCID: PMC5094942 DOI: 10.18632/oncotarget.9446] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 05/10/2016] [Indexed: 11/25/2022] Open
Abstract
Benign paroxysmal positional vertigo (BPPV) is one of the most common complaints encountered in clinics and is strongly correlated with advanced age or, possibly, degeneration. Redistribution exercises are the most effective approaches to treat BPPV, and canalith repositioning procedure (CRP) cure most BPPV cases. However, the mechanisms through which the treatment modulates systemic molecules in BPPV patients remain largely unknown. In this study, we report that the miR-34a and Sirtuin 1 (SIRT1) genes correlated with the treatment effects of CRP in BPPV subjects. We found that miR-34a expression was largely inhibited and SIRT1 expression was significantly reversed after BPPV maneuver treatment. We also confirmed that the PPAR-γ, PGC-1 and FoxO gene expressions were decreased immediately after canalith repositioning procedure (CRP) for BPPV, and were largely increased after a complete cure of BPPV. Moreover, we observed that after a complete recovery of BPPV, the ROS concentrations, pro-inflammatory cytokine concentrations and p53 expression levels were attenuated. We conclude that BPPV treatment might involve some epigenetic regulations through the mediation of miR-34a, SIRT1 functions and repression of redox status.
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Affiliation(s)
- Kun-Ling Tsai
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chia-To Wang
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital; Taipei, Taiwan.,Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chia-Hua Kuo
- Department of Sports Sciences, University of Taipei, Taipei, Taiwan
| | - Yuan-Yang Cheng
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Physical Medicine and Rehabilitation, School of Medicine National Yang-Ming University, Taipei, Taiwan
| | - Hsin-I Ma
- Department of Neurological Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Ching-Hsia Hung
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Ju Tsai
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chung-Lan Kao
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital; Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, School of Medicine National Yang-Ming University, Taipei, Taiwan
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Yang CJ, Lee JW, Kim SJ, Lee CW, Park HJ. Development of a murine model of traumatic benign paroxysmal positional vertigo: a preliminary study. Acta Otolaryngol 2017; 137:29-34. [PMID: 27564837 DOI: 10.1080/00016489.2016.1217043] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
CONCLUSION The results showed a gradual detachment of otoconia in the utricle after a single event of head vibration, possibly explaining the frequent recurrence of BPPV attacks and persistent dizziness after trauma. OBJECTIVES This study developed a murine model of traumatic BPPV and observed the changes in otoconia detachment over time. METHODS Six-week-old CBA mice were used in this study. Otoconia detachment was induced by vibrating the head for 2 min. Utricles of mice were harvested from different groups: before the head vibration and 1 day, 1 week, 1 month, and 3 months after vibration application. Using scanning electron microscopy and ImageJ software, the percentage of the intact area of otoconia in the utricle was calculated. Hearing thresholds were compared among the groups. RESULTS The mean (± SD) percentages of the intact area of otoconia in the utricle were 98.1% ± 1.7% before the vibration and 93.6% ± 1.7%, 88.9% ± 5.3%, 78.2% ± 20.9%, and 38.9% ± 24.1% at 1 day, 1 week, 1 month, and 3 months after the vibration, respectively. The percentage decreased significantly over time after the vibration (p < .001). The hearing thresholds were not different among the groups.
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Impact of postmaneuver sleep position on recurrence of benign paroxysmal positional vertigo. PLoS One 2013; 8:e83566. [PMID: 24367602 PMCID: PMC3867465 DOI: 10.1371/journal.pone.0083566] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 11/12/2013] [Indexed: 11/19/2022] Open
Abstract
Background The necessity of postural restriction to patients suffering from benign paroxysmal positional vertigo is controversial. Objective To investigate the impact of the sleep position after the repositioning maneuver on BPPV recurrence. Methods 150 unilateral BPPV patients who were treated by repositioning maneuver were distributed into two groups. The patients in group A were instructed to sleep in a semi-sitting position at an angle of approximately 30 degrees and refrain from sleeping on their BPPV affected side for one week. The patients in group B were told to sleep in any preferred position. The comparison of recurrence rates according to different actual sleep positions in one week and one month was performed. Results There was a statistically significant correlation between the sleeping side and the side affected by BPPV. Without instructions on postural restriction, most patients (82.9%, 73/88) avoided sleeping on their affected side. The patients sleeping on their affected side had a higher recurrence rate (35.3%) than ones sleeping in other positions in the first week after the repositioning maneuver (p<0.05, Chi-square test and Fisher's exact test). The patients sleeping randomly in following 3 weeks had a lower recurrence rate than ones sleeping in other position (p<0.05, Fisher's exact test). Conclusions BPPV patients had a poor compliance to postural instructions. The habitual sleep side was associated with the side affected by BPPV. The patients sleeping on their affected side had a higher recurrence rate than those sleeping in other positions in first week after the repositioning maneuver.
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Detection of human utricular otoconia degeneration in vital specimen and implications for benign paroxysmal positional vertigo. Eur Arch Otorhinolaryngol 2013; 271:3133-8. [DOI: 10.1007/s00405-013-2784-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 10/12/2013] [Indexed: 11/25/2022]
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Toupet M, Ferrary E, Bozorg Grayeli A. Effect of repositioning maneuver type and postmaneuver restrictions on vertigo and dizziness in benign positional paroxysmal vertigo. ScientificWorldJournal 2012; 2012:162123. [PMID: 22973168 PMCID: PMC3438743 DOI: 10.1100/2012/162123] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 07/02/2012] [Indexed: 12/03/2022] Open
Abstract
Introduction. To compare the efficiency of Epley (Ep) and Sémont-Toupet (ST) repositioning maneuvers and to evaluate postmaneuver restriction effect on short-term vertigo and dizziness after repositioning maneuvers by an analog visual scale (VAS) in benign positional paroxysmal vertigo (BPPV). Material and Methods. 226 consecutive adult patients with posterior canal BPPV were included. Patients were randomized into 2 different maneuver sequence groups (n = 113): 2 ST then 1 Ep or 2 Ep then 1 ST. Each group of sequence was randomized into 2 subgroups: with or without postmaneuver restrictions. Vertigo and dizziness were assessed from days 0 to 5 by VAS. Results. There was no difference between vertigo scores between Ep and ST groups. Dizziness scores were higher in Ep group during the first 3 days but became similar to those of ST group at days 4 and 5. ST maneuvers induced liberatory signs more frequently than Ep (58% versus 42% resp., P < 0.01, Fisher's test). After repositioning maneuvers, VAS scores decreased similarly in patients with and without liberatory signs. Postmaneuver restrictions did not influence VAS scores. Conclusion. Even if ST showed a higher rate of liberatory signs than Ep in this series, VAS scores were not influenced by these signs.
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Affiliation(s)
- Michel Toupet
- Centre d'Explorations Fonctionnelles Oto-Neurologiques, Institut de Recherche en Oto-Neurologie-IRON, 75015 Paris, France
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