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Şahin ET, Orhan E, Tutar V, Tutar H, Gündüz B. The Effect of Different Sensory Perturbations on Postural Control and Fall Risk in Benign Paroxysmal Positional Vertigo Patients. Am J Audiol 2024:1-8. [PMID: 39052352 DOI: 10.1044/2024_aja-23-00263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Benign paroxysmal positional vertigo (BPPV) patients may experience balance problems in various environmental conditions other than positional dizziness. Therefore, there is a need to investigate the postural control abilities and the ability to use sensory inputs in BPPV patients in different conditions. OBJECTIVE The aim of this study was to examine the postural control performance of middle-aged adult BPPV patients in easy and difficult balance tasks, the effect of vestibular stimulation on the maintenance of balance, and the risk of falling, by posturographic evaluation in various conditions. METHOD A total of 26 patients diagnosed with posterior canal BPPV and 26 controls were included in the study. Sensory Organization Test (SOT), Vestibular Stimulation Test (VST), and fall risk assessment (FRA) were applied to the participants, respectively. RESULTS Significant difference was observed in SOT medio-lateral (ML) plane in Conditions 2 and 5 (p < .05). A significant difference was observed in the vestibular score in the SOT ML plane. No significant difference was observed in VST test scores (p > .05). In the FRA test, a significant difference was observed in the energy and gain parameters in the anterio-posterior plane (p < .05). CONCLUSIONS The current study examined postural control abilities of patients with BPPV in extensive external conditions and in both planes, using various sensory perturbations and stimulation. It was thought that while BPPV patients were in the active phase of the disease, their postural control skills in the ML plane decreased and they might be at risk of falling.
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Affiliation(s)
- Esma Temiçin Şahin
- Faculty of Health Science, Department of Audiology, Gazi University, Ankara, Turkey
| | - Emre Orhan
- Faculty of Health Science, Department of Audiology, Gazi University, Ankara, Turkey
| | - Volkan Tutar
- Faculty of Health Science, Department of Audiology, Gazi University, Ankara, Turkey
| | - Hakan Tutar
- Faculty of Medicine, Department of Oto-Rhino-Laryngology, Gazi University, Ankara, Turkey
| | - Bülent Gündüz
- Faculty of Health Science, Department of Audiology, Gazi University, Ankara, Turkey
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Varghese SS, Varghese A, Kumar N. Adoption of the international classification of vestibular disorders criteria in cases of Benign positional paroxysmal vertigo: a single-center experience. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08794-8. [PMID: 38977478 DOI: 10.1007/s00405-024-08794-8] [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: 03/26/2024] [Accepted: 06/17/2024] [Indexed: 07/10/2024]
Abstract
INTRODUCTION Benign positional paroxysmal vertigo (BPPV) stands as the commonest cause for vertigo. It accounts for 20% of all cases of vertigo, even with its high prevalence rate it often goes underdiagnosed and undertreated. Development of the consensus document by the Bárány society's International Classification of Vestibular Disorders (ICVD)significantly facilitates the diagnosis of BPPV and its variants. This study assesses the utilisation of ICVD criteria for managing BPPV. METHODOLOGY This is a cross-sectional descriptive study conducted at a tertiary care hospital in Northern India spanning from November 1, 2022, to November 30, 2023. A total of 110 participants diagnosed with BPPV were enrolled consecutively. All participants underwent Dix-Hallpike and supine log roll positional maneuvers. Diagnosis was made based on the history and type of nystagmus seen, and classified as per the ICVD criteria. RESULTS Posterior semicircular canalolithiasis (pc-BPPV) accounted for 25.45% of cases and horizontal canal canalolithiasis (hc-BPPV) accounted for 20.91% of cases. Probable BPPV, spontaneously resolved (pBPPVsr) was diagnosed in 16.36% of participants and possible BPPV(pBPPV) was diagnosed in 18.18% of participants. Multiple canal BPPV (mc-BPPV) accounted for 17.27% of cases. One participant was diagnosed with horizontal canal cupulolithiasis and anterior canal canalolithiasis respectively. No participant was diagnosed with posterior canal cupulolithiasis. CONCLUSION The most common type of BPPV was pc-BPPV followed by hc-BPPV. The affected canal in possible BPPV, can be identified, and appropriate repositioning maneuvers are effective in treating them as well as aids in confirming the diagnosis. The diagnostic clarity provided by ICVD, aids in effective management of BPPV. More studies with larger sample size are required to further validate its clinical utility.
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Affiliation(s)
- Sunil Sam Varghese
- Department of E.N.T, Chrisitan medical college, Brown Road, Ludhiana, 141008, Punjab, India.
| | - Ashish Varghese
- Department of E.N.T, Bangalore Baptist Hospital, Bellary Road, Hebbal, Bengaluru, Karnataka, India
| | - Navneet Kumar
- Department of E.N.T, Chrisitan medical college, Brown Road, Ludhiana, 141008, Punjab, India
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Xing J, Yun Y, Zhang S, Yang P, Bai X, Zhang L, Zhang M. Rapid axial roll test outperforms alternative positional tests in identifying the affected ear in HSC-BPPV: an observational cohort study. Front Neurol 2024; 15:1432608. [PMID: 38962475 PMCID: PMC11220116 DOI: 10.3389/fneur.2024.1432608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 06/04/2024] [Indexed: 07/05/2024] Open
Abstract
Purpose To evaluate the utility of supine roll test (SRT) and alternative positional tests, such as head-shaking test (HST), seated supine positioning test (SSPT), bow and lean test (BLT), and rapid axial roll test (RART) in determining the affected semicircular canal of horizontal semicircular canal benign paroxysmal positional vertigo (HSC-BPPV). Methods In an observational cohort study, 553 patients diagnosed with HSC-BPPV were divided into five groups in terms of different positional tests received: SRT group (n = 110), HST+ SRT (n = 112), BLT + SRT (n = 114), SSPT+SRT (n = 108) and RART+SRT (n = 109). The same method was used for the last four groups: The patients were first subjected to different alternative positional tests and then to SRT, and the nystagmus was observed separately to determine the affected side. The primary outcomes compared included the accuracy and sensitivity of these tests in the determination of the affected semicircular canal in HSC-BPPV. Results Patients with nystagmus elicited by positional tests accounted for 84.99% (470/553). The elicitation rate of nystagmus of SRT was lowest, being 77.27% (85/110). The elicitation rate of nystagmus were higher in the test groups than in the control group, and RART+SRT group yielded the highest elicitation rate of nystagmus (95.41%, 104/109). Among the alternative positional tests, RART attained the highest elicitation rate of nystagmus (101/109, 92.66%). Comparison between alternative positional tests and SRT, RART and SRT showed obviously better agreement in determining the affected semicircular canal (85.45%, 96/109) and eliciting nystagmus (95.41%, Kappa = 0.642), but no difference was found in curative effect when the affected side was accurately determined (χ2 = 1.618, p = 0.655). Conclusion All alternative positional tests are helpful for eliciting nystagmus in patients with HSC-BPPV, and the significant advantages of RART include high-sensitivity in eliciting nystagmus and high accuracy in determining the affected semicircular canal, which provided objective support for the correct diagnosis of HSC-BPPV and the successful reduction of otolith.
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Affiliation(s)
- Juanli Xing
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi’an, China
| | - Yanning Yun
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi’an, China
| | - Shu Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
| | - Pan Yang
- Department of Neurology, Jingyang County Hospital, Xianyang, China
| | - Xiongxiong Bai
- Department of Thoracic Surgery, The First Affiliated Hospital of Xi’an Medical University, Xi’an, China
| | - Leyi Zhang
- Department of Humanity, University of Amsterdam, Amsterdam, North Holland, Netherlands
| | - Ming Zhang
- Department of Medical Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, Xi’an, China
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Zhou C, Ma C, Li Y, Zhou X, Shui L, Han C. Risk Factors and a Nomogram Model for Residual Symptoms of Cured Benign Paroxysmal Positional Vertigo. J Int Adv Otol 2023; 19:523-528. [PMID: 38088327 PMCID: PMC10765189 DOI: 10.5152/iao.2023.231127] [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: 03/08/2023] [Accepted: 08/06/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND We aimed to analyze the independent risk factors that affect the treatment outcomes of residual symptoms of cured benign paroxysmal positional vertigoand to construct a nomogram model. METHODS A total of 186 benign paroxysmal positional vertigo patients who were treated in our hospital from June 2019 to August 2021 were selected. According to whether there were residual symptoms, they were divided into a group with residual symptoms (n=82) and a group without residual symptoms (n = 104). The logistic regression model was used to analyze the independent risk factors affecting the treatment outcomes, and the results were incorporated into R software to establish a nomogram model for verification. RESULTS The incidence rate of residual symptoms in the 186 patients was 44.09% (82/186). Logistic regression analysis showed that age, course of disease, number of maneuvers, anxiety state, diabetes mellitus, and hypertension were independent risk factors affecting the treatment outcomes of residual symptoms after cured benign paroxysmal positional vertigo. The area under the receiver operating characteristic curve of the nomogram model was 0.938. The calibration curve was fitted well (χ2 = 8.165, P = .417). CONCLUSION The nomogram model constructed based on age, course of disease, number of maneuvers, anxiety state, diabetes mellitus, and hypertension had a high predictive value for the treatment outcomes of residual symptoms in benign paroxysmal positional vertigo patients.
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Affiliation(s)
- Changhua Zhou
- Department of Otolaryngology, Head and Neck Surgery, Dazhou Central Hospital, Dazhou, Sichuan, China
| | - Chongzhi Ma
- Department of Otorhinolaryngology, The 63600 Hospital of PLA, Lanzhou, Gansu, China
| | - Yueshan Li
- Department of Endocrinology and Metabolism, Dazhou Central Hospital, Dazhou, Sichuan, China
| | - Xiaoying Zhou
- Department of Otolaryngology, Head and Neck Surgery, Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Lijuan Shui
- Department of Otolaryngology, Head and Neck Surgery, Dazhou Central Hospital, Dazhou, Sichuan, China
| | - Chungeng Han
- Department of Neurology, Ningbo Yinzhou No. 2 Hospital, Ningbo, Zhejiang, China
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Song N, Wu Y, Li X, Wang Q, Ma X, Yang X. Geriatric benign paroxysmal positional vertigo: a single-center study. Braz J Otorhinolaryngol 2023; 89:101277. [PMID: 37331236 PMCID: PMC10300295 DOI: 10.1016/j.bjorl.2023.101277] [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: 10/27/2022] [Revised: 04/18/2023] [Accepted: 05/25/2023] [Indexed: 06/20/2023] Open
Abstract
OBJECTIVE To compare the clinical features, risk factors, distribution of Benign Paroxysmal Positional Vertigo (BPPV) subtypes, and effectiveness of canalith repositioning between geriatric and non-geriatric patients with BPPV. METHODS A total of 400 patients with BPPV were enrolled. Canalith repositioning was performed according to the semicircular canals involved. Patients were divided by age into a geriatric group (≥60 years) and a non-geriatric group (20-59 years). Clinical characteristics, potential age-related risk factors, distribution of subtypes, and effectiveness of canalith repositioning were compared between the groups. RESULTS Female sex was significantly more common in all age groups, with a peak female-to-male ratio of 5.1:1 in the group aged 50-59 years. There was a higher proportion of men in the geriatric group. A history of disease associated with atherosclerosis was significantly more common in the geriatric group (p < 0.05). Migraine was significantly more common in the non-geriatric group (p = 0.018), as was posterior canal BPPV. The horizontal canal BPPV (especially horizontal canal BPPV-cupulolithiasis), and multicanal BPPV subtypes were more common in the geriatric group, whereas anterior canal BPPV was more common in the non-geriatric group. Two canalith repositioning sessions were effective in 58.0% of the geriatric cases and in 72.6% of the non-geriatric cases (p = 0.002). There was a tendency for the effectiveness of canalith repositioning to decrease with increasing age. CONCLUSION BPPV was more common in women. However, the proportion of men with BPPV increased with age. Elderly patients often had a history of diseases associated with atherosclerosis (i.e., hypertension, diabetes, and hyperlipidemia). The horizontal canal BPPV (particularly horizontal canal BPPV-cupulolithiasis) and multicanal BPPV subtypes were more common and the anterior canal BPPV subtype was less common in elderly patients. The effectiveness of canalith repositioning may decrease with age. Therefore, older patients should receive more comprehensive medical treatment. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Ning Song
- Peking University Aerospace School of Clinical Medicine, Aerospace Center Hospital, Department of Neurology, Peking, China
| | - Yuexia Wu
- Peking University Aerospace School of Clinical Medicine, Aerospace Center Hospital, Department of Neurology, Peking, China
| | - Xiang Li
- Peking University Aerospace School of Clinical Medicine, Aerospace Center Hospital, Department of Neurology, Peking, China
| | - Qianqian Wang
- Peking University Aerospace School of Clinical Medicine, Aerospace Center Hospital, Department of Neurology, Peking, China
| | - Xinyan Ma
- Peking University Aerospace School of Clinical Medicine, Aerospace Center Hospital, Department of Neurology, Peking, China
| | - Xu Yang
- Peking University Aerospace School of Clinical Medicine, Aerospace Center Hospital, Department of Neurology, Peking, China.
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Pérez-Fernández N, Saez Coronado S, Zulueta-Santos C, Neria Serrano F, Rey-Martinez J, Blanco M, Manrique-Huarte R. A Paradoxical Clinical Coincidence: Benign Paroxysmal Positional Vertigo and Bilateral Vestibulopathy. J Clin Med 2023; 12:jcm12103413. [PMID: 37240519 DOI: 10.3390/jcm12103413] [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: 04/16/2023] [Revised: 04/30/2023] [Accepted: 05/02/2023] [Indexed: 05/28/2023] Open
Abstract
Benign paroxysmal positional vertigo (BPPV) and bilateral vestibulopathy (BVL) are two completely different forms of vestibular disorder that occasionally occur in the same patient. We conducted a retrospective review searching for that coincidence in our database of the patients seen over a 15-year period and found this disorder in 23 patients, that is 0.4%. More frequently they occurred sequentially (10/23) and BPPV was diagnosed first. Simultaneous presentation occurred in 9/23 patients. It was subsequently studied, but in a prospective manner, in patients with BPPV on all of whom a video head impulse test was performed to search for bilateral vestibular loss; we found it was slightly more frequent (6/405). Both disorders were treated accordingly, and it was found that the results follow the general trend in patients with only one of those disorders.
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Affiliation(s)
- Nicolás Pérez-Fernández
- Department of Otorhinolaryngology, Marquesado de Santa Marta 1, Clínica Universidad de Navarra, 28047 Madrid, Spain
- Department of Otorhinolaryngology, Clínica Universidad de Navarra, 31008 Pamplona, Spain
| | - Sara Saez Coronado
- Department of Otorhinolaryngology, Hospital Universitario de Móstoles, 28938 Madrid, Spain
| | - Cristina Zulueta-Santos
- Department of Otorhinolaryngology, Marquesado de Santa Marta 1, Clínica Universidad de Navarra, 28047 Madrid, Spain
| | - Fernando Neria Serrano
- Department of Otorhinolaryngology, Facultad de Medicina, Universidad Francisco de Vitoria, 28223 Madrid, Spain
| | - Jorge Rey-Martinez
- Department of Otorhinolaryngology, Hospital Universitario Donostia, 20014 San Sebastian, Spain
| | - Melisa Blanco
- Department of Otorhinolaryngology, Marquesado de Santa Marta 1, Clínica Universidad de Navarra, 28047 Madrid, Spain
| | - Raquel Manrique-Huarte
- Department of Otorhinolaryngology, Clínica Universidad de Navarra, 31008 Pamplona, Spain
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Wu J, Jiang CY, Bai YX, Xu Q, Sun XH, Pan H, Shu L, Liu JR, Chen W. Effect of the serum 25-hydroxyvitamin D level on risk for short-term residual dizziness after successful repositioning in benign paroxysmal positional vertigo stratified by sex and onset age. Front Neurol 2023; 14:1144958. [PMID: 37064183 PMCID: PMC10102369 DOI: 10.3389/fneur.2023.1144958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 03/08/2023] [Indexed: 04/03/2023] Open
Abstract
ObjectiveA low serum 25-hydroxyvitamin D (25(OH)D) level is relevant to both the occurrence and recurrence of benign paroxysmal positional vertigo (BPPV). However, whether it also contributes to residual dizziness (RD) after successful repositioning maneuvers is unknown. Therefore, this study aimed to explore the correlation between the serum 25(OH)D level and short-term RD severity in patients with BPPV after successful repositioning maneuvers.MethodsIn total, 251 patients with BPPV after successful repositioning were enrolled and prospectively followed up for 1 week (W1). Serum 25(OH)D values were detected by chemiluminescence immunoassay at enrollment (W0). In addition, we explored the relationship between 25(OH)D values at baseline and RD severity at W1 in different subgroups stratified by sex and onset age (early-onset, ≤50 years; late-onset, >50 years).ResultsThe serum 25(OH)D level of female patients was significantly lower than that of male patients (15.9 ± 6.8 vs. 19.8 ± 6.6 ng/ml, p < 0.001). Its level also decreased in early-onset patients compared to late-onset ones (15.3 ± 5.9 vs. 18.0 ± 7.3 ng/ml, p = 0.003). In addition, early-onset female patients had lower 25(OH)D values than late-onset female patients (14.0 ± 5.5 vs. 17.1 ± 7.2 ng/ml, p = 0.004). However, this difference was not observed between early- and late-onset male patients. Among early-onset female patients, the 25(OH)D values of the moderate-to-severe RD group were lower than those of the minor or no RD group (10.9 ± 3.3 vs. 14.7 ± 5.7 vs. 15.0 ± 5.9 ng/ml, p = 0.046). Multivariate analysis found that decreased 25(OH)D values were related to the occurrence of moderate-to-severe RD in early-onset female patients (OR = 0.801; p = 0.022). This effect did not exist in late-onset female or male patients with BPPV.ConclusionsAge and sex differences in serum 25(OH)D levels exist in patients with BPPV. A decreased 25(OH)D level in early-onset female patients may increase the odds of moderate-to-severe RD 1 week after successful repositioning maneuvers.
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Affiliation(s)
- Jing Wu
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chun-Yan Jiang
- Department of Neurology, Huangpu Branch, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying-Xia Bai
- Department of Neurology, Huangpu Branch, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qian Xu
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xu-Hong Sun
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hui Pan
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liang Shu
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jian-Ren Liu
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Jian-Ren Liu
| | - Wei Chen
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Wei Chen
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Wan Y, Li Y, Zhou L, Ma R, Sun J. Significance of subtype-determining questionnaire in efficient diagnosis and treatment of BPPV. Acta Otolaryngol 2023; 143:106-112. [PMID: 36662151 DOI: 10.1080/00016489.2023.2166987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Rapid recognition of benign paroxysmal positional vertigo (BPPV) matters in many ways, questionnaires evolve as a new alternative for diagnosis. A subtype-determining questionnaire is a more advanced but rarely studied type. OBJECTIVE To explore the practicability of a subtype-determining questionnaire in facilitating diagnosis and treatment of BPPV. METHODS A BPPV subtype-determining questionnaire was applied to vertiginous patients. All patients underwent the positional test, performed by one technician, who was either informed or uninformed about questionnaire results randomly. In the informed group, the technician checked the canal indicated by the questionnaire straightforwardly; in the uninformed group, she performed the conventional positional test. Diagnostic parameters of the questionnaire and disparities between the 2 groups were investigated. RESULTS The accuracy, sensitivity, specificity of question 1-3 for diagnosing BPPV is 74.4%, 90.9%, 66.6% respectively. Question 4 shows an accuracy of 80.7% in determining BPPV subtype, question 5 yields an accuracy of 78.7% in ascertaining the affected side, question 6 exhibits an accuracy of 87.2% in deciding canalithiasis or cupulolithiasis. Both examination and treatment time were shorter in the informed group (p < .05). CONCLUSION This subtype-determining questionnaire has appealing diagnostic ability. It provides valuable information that's conducive to fast diagnosis and efficient treatment of BPPV.
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Affiliation(s)
- Yichen Wan
- Department of Otolaryngology Head Neck Surgery, Peking University International Hospital, Beijing, China
| | - Yingxuan Li
- Department of Otolaryngology Head Neck Surgery, Peking University International Hospital, Beijing, China
| | - Lihong Zhou
- Department of Otolaryngology Head Neck Surgery, Peking University International Hospital, Beijing, China
| | - Rui Ma
- Department of Otolaryngology Head Neck Surgery, Peking University International Hospital, Beijing, China
| | - Jianjun Sun
- Department of Otolaryngology Head Neck Surgery, Peking University International Hospital, Beijing, China
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Onal M, Aygun A, Colpan B, Karakayaoglu H, Onal O. Correlation between nystagmus intensity and vestibular-ocular reflex gain in benign paroxysmal positional vertigo: A prospective, clinical study. J Vestib Res 2023; 33:115-125. [PMID: 36776086 DOI: 10.3233/ves-220106] [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] [Indexed: 02/10/2023]
Abstract
BACKGROUND Video head impulse test (vHIT) and videonystagmography (VNG) provide significant benefits in evaluating benign paroxysmal positional vertigo (BPPV) and determining the semicircular canal localization of the otoconia. OBJECTIVE This study aimed to investigate the relationship between vestibular-ocular reflex (VOR) gains measured via vHIT and the slow-phase velocity (SPV) of nystagmus in patients with the posterior semicircular canal (PSCC)-BPPV. METHODS Sixty-two patients were included in this study and divided into the study (n = 32, patients with isolated PSCC-BPPV) and control (n = 30, age- and sex-matched healthy individuals) groups. While VOR gains were measured with vHIT in both groups and compared between groups, the SPV values of nystagmus observed during the Dix-Hallpike maneuver in the study group were recorded using VNG and compared with the VOR gains of the study group. RESULTS There were significant differences in posterior canal VOR gains between the study and control groups (p < 0.001 and p < 0.01, respectively). Although the affected PSCC had decreased VOR gains versus the control group, it was still within the normal range. However, there was no significant relationship between the VOR gains of the affected PSCC and the SPV of the nystagmus. CONCLUSIONS vHIT can help detect semicircular canal dysfunction in patients with PSCC-BPPV. The SPV values of nystagmus on VNG during the Dix-Hallpike maneuver do not correlate with the level of VOR gain.
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Affiliation(s)
- Merih Onal
- Selcuk University Faculty of Medicine, Department of Otorhinolaryngology, Konya, Turkey
| | - Ahmet Aygun
- Selcuk University Faculty of Medicine, Department of Otorhinolaryngology, Subdepartment of Audiometry, Konya, Turkey
| | - Bahar Colpan
- Selcuk University Faculty of Medicine, Department of Otorhinolaryngology, Konya, Turkey
| | - Harun Karakayaoglu
- Selcuk University Faculty of Medicine, Department of Otorhinolaryngology, Konya, Turkey
| | - Ozkan Onal
- Cleveland Clinic Main Hospital, Anesthesiology Institute, Outcomes Research Consortium, Cleveland, Ohio, USA
- Selcuk University Faculty of Medicine, Department of Anesthesiology and Reanimation, Konya, Turkey
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Helminski JO. Case report: Atypical patterns of nystagmus suggest posterior canal cupulolithiasis and short-arm canalithiasis. Front Neurol 2022; 13:982191. [PMID: 36299265 PMCID: PMC9588913 DOI: 10.3389/fneur.2022.982191] [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: 06/30/2022] [Accepted: 07/26/2022] [Indexed: 12/03/2022] Open
Abstract
Background Atypical posterior canal (PC) positional nystagmus may be due to the changes in cupular response dynamics from cupulolithiasis (cu), canalithiasis of the short arm (ca-sa), or a partial/complete obstruction—jam. Factors that change the dynamics are the position of the head in the pitch plane, individual variability in the location of the PC attachment to the utricle and the position of the cupula within the ampulla, and the location of debris within the short arm and on the cupula. The clinical presentation of PC-BPPV-cu is DBN with torsion towards the contralateral side in the DH positions and SHHP or no nystagmus in the ipsilateral DH position and no nystagmus upon return to sitting from each position. The clinical presentation of PC-BPPV-ca-sa is no nystagmus in the DH position and upbeat nystagmus (UBN) with torsion lateralized to the involved side upon return to sitting from each position. Case description A 68-year-old woman, diagnosed with BPPV, presented with DBN associated with vertigo in both DH positions and without nystagmus or symptoms on sitting up. In the straight head hanging position (SHHP), the findings of a transient burst of UBN with left torsion associated with vertigo suggested ipsicanal conversion from the left PC-BPPV-cu to canalithiasis. Treatment included a modified canalith repositioning procedure (CRP), which resulted in complete resolution. BPPV recurred 17 days later. Clinical presentation of BPPV included no nystagmus/symptoms in both the contralateral DH position and SHHP, DBN in the ipsilateral DH position without symptoms, and UBN with left torsion associated with severe truncal retropulsion and nausea on sitting up from provoking position. The findings suggested the left PC-BPPV-cu-sa and PC-BPPV-ca-sa. Treatment included neck extension, a modified CRP, and demi-Semont before complete resolution. Conclusion An understanding of the biomechanics of the vestibular system is necessary to differentially diagnose atypical PC-BPPV. DH test (DHT) findings suggest that PC-BPPV-cu presents with DBN or no nystagmus in one or two DH positions and sometimes SHHP and without nystagmus or no reversal/reversal of nystagmus on sitting up. The findings suggest PC-BPPV-ca-sa has no nystagmus in DH positions or DBN in the ipsilateral DH position and UBN with torsion lateralized to the involved side on sitting up.
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Wang W, Yan S, Zhang S, Han R, Li D, Liu Y, Zhang T, Liu S, Wu Y, Li Y, Yang X, Gu P. Clinical Application of Different Vertical Position Tests for Posterior Canal-Benign Paroxysmal Positional Vertigo-Cupulolithiasis. Front Neurol 2022; 13:930542. [PMID: 35903115 PMCID: PMC9315446 DOI: 10.3389/fneur.2022.930542] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundPosterior canal-benign paroxysmal positional vertigo-cupulolithiasis (PC-BPPV-cu) is a new and controversial type of benign paroxysmal positional vertigo (BPPV). At present, there are few relevant clinical studies as to whether the Half Dix-Hallpike test (Half D-HT) induces more obvious nystagmus than the Dix Hallpike test (D-HT) and straight head hanging test (SHH) in patients with PC-BPPV-cu.ObjectivesTo investigate the clinical characteristics of PC-BPPV-cu, and analyze the diagnostic significance of the Dix-Hallpike test (D-HT), Half D-HT, and straight head hanging (SHH) test in these patients.MethodsA total of 46 patients with PC-BPPV-cu were enrolled, and divided into two groups (N = 23): a group A (induction order: D-HT, Half D-HT, SHH) and a group B (induction order: Half D-HT, D-HT, SHH).ResultsAmong 46 patients with PC-BPPV-cu, the bilateral and unilateral abnormality rates of the disease side were 5 cases and 41 cases, respectively. There were significant differences in the proportion of torsional-upbeating nystagmus and upbeating nystagmus among the three headhanging positions in 46 patients with PC-BPPV-cu (P < 0.001). The slow phase velocity (SPV) of induced nystagmus at half D-HT supine position was slower than D-HT supine position (P < 0.05) and SHH supine position (P < 0.05). The nystagmus latency of D-HT supine position was significantly shorter than half D-HT (P < 0.05) and SHH (P < 0.05). PC-BPPV-cu patients were accompanied by 53.5% semicircular canal paresis, 69.6% audiological abnormalities, 76% cervical vestibular evoked myogenic potential (cVEMP), and 75% video head impulse test (vHIT) abnormalities, the concordance rates of the four detection methods were similar (χ2 = 0.243, P = 0.970).ConclusionsThe Half D-HT is simple and feasible, but might have a risk of false-negative diagnoses of the torsional-upbeating nystagmus and upbeating nystagmus. The D-HT is still a classic induction method for PC-BPPV-cu. The two complement each other and may aid in the diagnosis of PC-BPPV-cu patients. Future clinical applications of Half D-HT require extensive research to determine its diagnostic efficacy.
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Affiliation(s)
- Wenting Wang
- Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Shuangmei Yan
- Department of Vertigo Center, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Sai Zhang
- Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Rui Han
- Department of Vertigo Center, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Dong Li
- Department of Vertigo Center, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yihan Liu
- Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ting Zhang
- Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Shaona Liu
- Department of Vertigo Center, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yuexia Wu
- Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ya Li
- Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xu Yang
- Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China
- *Correspondence: Xu Yang
| | - Ping Gu
- Department of Neurology, The First Hospital of Hebei Medical University, Shijiazhuang, China
- Department of Vertigo Center, The First Hospital of Hebei Medical University, Shijiazhuang, China
- Brain Aging and Cognitive Neuroscience Laboratory of Hebei Province, Shijiazhuang, China
- Ping Gu
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Imai T, Inohara H. Benign paroxysmal positional vertigo. Auris Nasus Larynx 2022; 49:737-747. [DOI: 10.1016/j.anl.2022.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/11/2022] [Accepted: 03/04/2022] [Indexed: 10/18/2022]
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Onset and resolution failure of recurrent benign paroxysmal positional vertigo: the role of cervical range of motion. Eur Arch Otorhinolaryngol 2022; 279:2183-2192. [DOI: 10.1007/s00405-021-07226-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 12/17/2021] [Indexed: 11/03/2022]
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Guseva AL, Doronina OM, Kryukov AI. [Diagnosis and rehabilitation of anterior canal benign paroxysmal positional vertigo]. Vestn Otorinolaringol 2022; 87:12-18. [PMID: 36404685 DOI: 10.17116/otorino20228705112] [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] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To assess clinical symptoms and rehabilitation of anterior canal benign paroxysmal positional vertigo (aBPPV) in comparison to horizontal canal BPPV (hBPPV) and posterior canal BPPV (pBPPV). PATIENTS AND METHODS The study included 22 patients with aBPPV, 450 patients with pBPPV and 88 patients with hBPPV from total 640 patients with definite BPPV. Rehabilitation of BPPV included different manual repositioning maneuvers. In case of unsuccessful reposition during the visit the patients practiced various home-based repositioning maneuvers and underwent reposition in multipositional mechanical chair. Clinical symptoms and repositioning process in patients with aBPPV were compared to patients with hBPPV and pBPPV, nystagmus was analyzed in aBPPV during the rehabilitation. RESULTS ABPPV is a rare type of otolithiasis (3.4% of all BPPVcases). aBPPV typically has no association with middle and inner ear pathology and head trauma. Clinical symptoms in aBPPV are equal to pBPPV and less severe than in hBPPV. In aBPPV cases dominates cupulolithiasis type of canal involvement, which leads to treatment resistance and complex rehabilitation process, which includes repeat visits, multiple repeat maneuvers by specialist, home-based treatment and use of multipositional mechanical chair. Residual dizziness with duration more than a week after successful reposition occurs more often in patients with aBPPV compared to hBPPV and pBPPV cases. In aBPPV cases atypical change of nystagmus could be observed which could be due to canal switch from anterior to posterior canals, primary location of otoliths in common crus of vertical canals or masking chronic otolithiasis of anterior short arm of posterior canal.
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Affiliation(s)
- A L Guseva
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - O M Doronina
- Pirogov Russian National Research Medical University, Moscow, Russia
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - A I Kryukov
- Pirogov Russian National Research Medical University, Moscow, Russia
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
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Lemos J, Strupp M. Central positional nystagmus: an update. J Neurol 2021; 269:1851-1860. [PMID: 34669008 DOI: 10.1007/s00415-021-10852-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/10/2021] [Accepted: 10/13/2021] [Indexed: 12/25/2022]
Abstract
Clinically, central positional nystagmus (CPN) is often suspected when atypical forms of its peripheral counterpart, i.e., benign paroxysmal positional vertigo (BPPV), are observed, namely a linear horizontal nystagmus as in horizontal canal BPPV or a downwardly and torsionally beating nystagmus as in anterior canal BPPV. Pathophysiologically, CPN is caused by cerebellar and/or brainstem dysfunction. Recent work has provided further insights into the different clinical phenotypes and the underlying pathomechanisms. We performed a PubMed review focused on the findings on CPN using the key words "Central Positional Nystagmus", "Central Positional Vertigo", "Positional Nystagmus" OR "Positioning Nystagmus" OR "Positional Vertigo" OR "Positioning Vertigo" AND "Central" from January 2015 to August 2021. CPN may account for up to 12% of patients with positional nystagmus. Clinical data on CPN are mostly based on case reports or small retrospective case series. CPN is frequently associated with cerebellar and/or brainstem structural lesions, namely stroke, tumours or demyelination, or diffuse involvement of these structures due to degenerative or autoimmune/paraneoplastic diseases; it is also found in patients with vestibular migraine. CPN can be paroxysmal or persistent. The direction of the nystagmus is often downward in head-hanging or apogeotropic in lateral supine positions; combinations of both forms also occur. Clinically it is important to note that CPN is often associated with other central, often cerebellar ocular motor or other neurological signs; typically, it is not improved by the therapeutic liberatory manoeuvres for BPPV. These additional features are also important for the diagnosis, in particular if no structural lesions are found. Pathophysiologically, CPN is believed to reflect an abnormal integration of semicircular canal-related signals by the cerebellar nodulus, uvula and/or tonsil, ultimately providing an erroneous estimation of the head tilt and/or eye position coordinates. The natural course of CPN remains, so far, largely unknown. Symptomatic treatment of CPN consists of pharmacotherapy, e.g., with 4-aminopyridine, and causative treatment of the underlying disease if known. CPN is an important differential diagnosis to BPPV and a clinically relevant entity with heterogenous clinical presentations and various pathomechanisms and etiologies. In particular, studies on the natural course and treatment of CPN are needed.
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Affiliation(s)
- João Lemos
- Department of Neurology. Coimbra University and Hospital Centre, Portugal and Faculty of Medicine, Coimbra University, Praceta Professor Mota Pinto, 3000-075, Coimbra, Portugal.
| | - Michael Strupp
- Department of Neurology and German Center for Vertigo and Balance Disorders, Hospital of the Ludwig Maximilians University Munich, Munich, Germany
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García-Muñoz C, Cortés-Vega MD, Hernández-Rodríguez JC, Palomo-Carrión R, Martín-Valero R, Casuso-Holgado MJ. Epley manoeuvre for posterior semicircular canal benign paroxysmal positional vertigo in people with multiple sclerosis: protocol of a randomised controlled trial. BMJ Open 2021; 11:e046510. [PMID: 33737443 PMCID: PMC7978251 DOI: 10.1136/bmjopen-2020-046510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Vestibular disorders in multiple sclerosis (MS) could have central or peripheral origin. Although the central aetiology is the most expected in MS, peripheral damage is also significant in this disease. The most prevalent effect of vestibular peripheral damage is benign paroxysmal positional vertigo (BPPV). Impairments of the posterior semicircular canals represent 60%-90% of cases of BPPV. The standard gold treatment for this syndrome is the Epley manoeuvre (EM), the effectiveness of which has been poorly studied in patients with MS. Only one retrospective research study and a case study have reported encouraging results for EM with regard to resolution of posterior semicircular canal BPPV. The aim of this future randomised controlled trial (RCT) is to assess the effectiveness of EM for BPPV in participants with MS compared with a sham manoeuvre. METHODS AND ANALYSIS The current protocol describes an RCT with two-arm, parallel-group design. Randomisation, concealed allocation and double-blinding will be conducted to reduce possible bias. Participants and evaluators will be blinded to group allocation. At least 80 participants who meet all eligibility criteria will be recruited. Participants will have the EM or sham manoeuvre performed within the experimental or control group, respectively. The primary outcome of the study is changes in the Dix Hallpike test. The secondary outcome will be changes in self-perceived scales: Dizziness Handicap Inventory and Vestibular Disorders Activities of Daily Living Scale. The sample will be evaluated at baseline, immediately after the intervention and 48 hours postintervention. ETHICS AND DISSEMINATION The study was approved by the Andalusian Review Board and Ethics Committee of Virgen Macarena-Virgen del Rocio Hospitals (ID 0107-N-20, 23 July 2020). The results of the research will be disseminated by the investigators to peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04578262.
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Affiliation(s)
| | | | | | - Rocio Palomo-Carrión
- Department of Nursery, Physiotherapy and Occupational Therapy, Universidad de Castilla-La Mancha, Toledo, Spain
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