Minimal Stimulus Strategy in Benign Paroxysmal Positional Vertigo: Its Application in a Resource Limited Setting.

Efficacy of canalith repositioning maneuvers for benign paroxysmal positional vertigo

Patients with benign paroxysmal positional vertigo (BPPV) occasionally experience severe dizziness, could not maintain the sitting posture, and then fall onto or off the examination table when they return to the sitting position, which is the last step of the barbecue maneuver and Epley maneuver (EM); down-beating nystagmus is also observed. This study aims to investigate the clinical characteristics and significance of these findings. We retrospectively reviewed video data showing nystagmus and medical records of adult patients diagnosed with canalolithiasis of the horizontal canal and the posterior canal (PC) BPPV who underwent barbecue maneuver and EM, respectively, in outpatient clinics from April 2014 to March 2019. This study included 112 patients (28 horizontal canal BPPV and 94 PC BPPV cases). Among the 122 BPPV cases, only 14 (14.9%) were analyzed, due to their occurrence during EM. Down-beating nystagmus appeared at 3.6 seconds on average after returning to the sitting position, and the patients fell onto or off the examination table at 4.4 seconds on average after the onset of the nystagmus. The average duration of the down-beating nystagmus was 20.3 seconds. In all 14 cases, no nystagmus was induced by the Dix-Hallpike test performed again after EM, confirming that the treatment was successful. During the EM, down-beating nystagmus and falling onto or off the examination table occurred in approximately 15% of cases. As the risk of falls increases, the patient should be secured immediately after EM. Moreover, it can be inferred that the findings occur when otoconia in the PC enter the utricle, suggesting a successful treatment.

Perioperative vestibular assessment and testing

Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of vertigo, and the posterior canal is the most frequently involved structure because of its anatomical position. In the majority of posterior canal BPPV cases, a particle-repositioning maneuver, such as the Epley maneuver, is effective, since the otoconia is thought to be located in the long arm of the posterior canal. However, Oas et al. has proposed a subtype of posterior canal BPPV, known as short-arm type BPPV, in which the otoconia is assumed to be located not in the long arm of the posterior canal, but in the short arm (between the utricle and the cupula). Here, we present four cases of BPPV that presumably involve the short-arm type posterior canal. The duration of nystagmus was extended in all four cases when the head was moved as in the Dix Halllpike test. Furthermore, when the head was moved back to a sitting position, the reversal of nystagmus was not or very faintly observed. As a treatment, the Epley maneuver was initially attempted, but this treatment was not effective. However, vibration methods (involving the application of vibration to the mastoid process of the affected ear with the intact ear positioned downwards) were effective in all four cases.

Benign Paroxysmal Positional Vertigo: 16‐Year Experience

Clinical Features of Recurrent or Persistent Benign Paroxysmal Positional Vertigo

Background: Canalith repositioning procedure (CRP) has increasingly been utilized for the last 15 years for the treatment of benign paroxysmal positional vertigo (BPPV). We assess the short- and long-term efficacy of CRP on the treatment of patients with BPPV. Methods: Nine hundred sixty-five patients (481 men and 484 women, from 18 to 87 years of age) were enrolled in this prospective study during 1995–2010. Inclusion criteria were a patient history compatible with BPPV and a positive provocative maneuver (either Dix-Hallpike or Roll test). Reported duration of symptoms at the time of their first examination varied from 1 day to 18 months. Variants of the Epley and Barbeque maneuver were used for posterior and anterior canal involvement, and horizontal canal involvement, respectively. Short-term follow-up was obtained 48 h and 7 days after initial treatment, whereas long-term follow-up was obtained at repeated 6-month intervals. Results: Symptoms subsided immediately in 819 patients (85%) by the first CRP. Only 19 patients (2%) required CRP more than 3 times. Patients’ mean follow-up was 74 months; symptom recurrence was noted in 139 patients. A statistically significantly higher recurrence rate was noted in elderly people or those with head trauma or a history of vestibular neuropathy (p < 0.001). Conclusions: This study provides class IV evidence that CRP remains an efficient and long-lasting noninvasive treatment for BPPV, especially for younger patients without a history of head trauma or vestibular neuropathy. Elderly people have a significantly higher recurrence rate requiring additional education to minimize potential morbidity of their falls.

Objective: We compared the efficacy of Semont's maneuver with Epley's maneuver in the management of benign paroxysmal positional vertigo (BPPV).We conducted a randomized and prospective double-blind study. Materials and Methods: We included 60 diagnosed cases of BPPV. These patients were categorized into Group 1 and Group 2. Epley's maneuver was performed in 30 patients of Group 1. Semont's maneuver was performed in the rest of the 30 patients of Group 2. We included diagnosed patients of BPPV above 20 years of age of both genders. Patients having peripheral and central causes of vertigo and cervical spondylosis were excluded from the study. Results: The mean age in Group 1 and Group 2 were 50.07 and 44.87 years, respectively. Sixty five percent of the patients were females and 35% of the patients were males. A total of 26 out of 30 Group 1 (87%) patients and 17 out of 30 Group 2 (57%) patients showed improvement. Comparing the two groups on the basis of improvement after maneuver showed that Group 1had greater improvement (54%) compared to Group 2 (46%). Statistical tests such as Chi-square test and t-test were applied. Conclusions: Epley's maneuver is more effective in the treatment of BPPV than Semont's maneuver.

Background: Benign paroxysmal positional vertigo (BPPV) is a condition with sudden onset which causes short episodes of severe vertigo on altering the position of the head. Superoxide dismutases (SODs) are antioxidant proteins that regulate oxidative stress response in the body. Through this study, we evaluate the role of SOD in causing BPPV and effect of a new alternating maneuver, head rotation maneuver, for the treatment of BPPV of the posterior canal in reducing oxidative stress levels. Methodology: For investigating the role of serum SOD in the occurrence of BPPV Posterior canal, 60 BPPV and 60 healthy controls will be recruited. Their serum samples will be collected and SOD levels will be evaluated through colorimetry. For evaluating the effectiveness of head rotation maneuver in reducing the oxidative stress, patients with posterior canal BPPV (PC-BPPV) will be enrolled and divided into two groups through random allocation. Both the groups will be treated with head rotation and Epley maneuvers, respectively, by two separate therapists. Post-therapy SOD level will also be assessed. Results: Two-way repeated measures analysis of variance will be used to compare the groups’ improvement; treatment measures will be referred to as intergroup variables. Binary logistic regression analysis will be used to determine how SOD levels affect BPPV and recurrent BPPV. Pre- and postmaneuver SOD level will also be compared. Conclusion: SOD can be established as a reliable and strong biomarker for the occurrence of BPPV. Moreover, head rotation maneuver which is easy to perform can be used for managing PC-BPPV if the results show promising outcomes.

Background and Objectives This study aimed to investigate whether benign paroxysmal positional vertigo (BPPV) accompanied by temporal bone fracture would be more resistant to canalith repositioning procedures (CRPs) than idiopathic BPPV.Subjects and Method Seventy-eight patients with BPPV were included in this study. Among them, 13 patients had temporal bone fractures and 65 had no temporal bone fractures. To identify the factors related to the number of CRPs performed until the remission of BPPV, sex, age, the presence of temporal bone fracture, hypertension, diabetes, dyslipidemia or osteopenia, BPPV affected side, and the type of affected semicircular canal were analyzed using the univariable regression analysis. Thereafter, the multivariable regression analysis was performed using only the variables that had a &lt;i&gt;p&lt;/i&gt;-value of 0.2 or less in the univariable analysis.Results In the univariable analysis, temporal bone fracture, diabetes mellitus, and BPPV side showed relatively significant association with the number of CRPs (&lt;i&gt;p&lt;/i&gt;&lt;0.2). In the multivariable analysis, only temporal bone fracture showed a significant association with the number of CRPs (&lt;i&gt;p&lt;/i&gt;=0.043, β=0.532, 95% CI: 0.017-1.046).Conclusion The major finding of this study is that BPPV, accompanied by temporal bone fracture, precipitated more resistance to CRPs than idiopathic BPPV did. Thus, patients with temporal bone fracture might need more intensive examination and treatment for BPPV than those without temporal bone fracture.

To investigate the clinical characteristics of benign paroxysmal positional vertigo (BPPV) associated with idiopathic sudden sensorineural hearing loss (ISSHL) and to compare them with the characteristics of idiopathic BPPV (i-BPPV). Retrospective case series. We retrospectively analyzed 519 patients with ISSHL and 597 patients with i-BPPV. The ISSHL patients with recent vertigo history before or after admission were tested with video-nystagmography that included the caloric test. BPPV with same-side ISSHL was identified and categorized as secondary BPPV (s-BPPV) using the roll or Dix-Hallpike test. All members of the s-BPPV and i-BPPV groups underwent a daily canalith repositioning procedure (CRP) during the admission periods. We investigated the clinical characteristics, including the number of CRPs performed to achieve successful reposition, canal involvement type, and effect of canal paresis and made comparisons between the s-BPPV and i-BPPV groups. Of the 519 ISSHL patients, 63 (12.1%) were identified as having s-BPPV. Multicanal involvement was more frequent in s-BPPV than i-BPPV patients (P < .001). The mean number of CRPs needed to achieve successful reposition was 4.28 in s-BPPV and 1.34 in i-BPPV (P < .001). The presence of canal paresis was also associated with a greater number of CRPs required for s-BPPV (P < .02). In about 12% of ISSHL patients, s-BPPV was concurrent. More CRPs were required for successful repositioning in patients with s-BPPV than in patients with i-BPPV. Also, the presence of canal paresis in s-BPPV was associated with a greater number of required CRPs.

To review the clinical features of benign paroxysmal positional vertigo (BPPV) secondary to sudden sensorineural hearing loss (SNHL) and to analyze the correlation between canal paresis and the effectiveness of canalith repositioning procedures (CRPs) for the treatment. Study case series with chart review. Academic university hospital. We retrospectively reviewed 277 patients with BPPV. For sudden SNHL with a recent vertigo, patients underwent electronystagmography and bithermal caloric tests. We investigated the clinical characteristics including causes, type of involved semicircular canal, frequency of CRPs, treatment results, and canal paresis (CP). The diagnosis of BPPV accompanied by same-sided sudden SNHL was based on the results of head roll and Dix-Hallpike tests. Of 277 patients with BPPV, 24 (8.7%) had sudden SNHL. Multiple-canal involvement most commonly developed in post-sudden SNHL BPPV (p < 0.01). Patients with post-sudden SNHL BPPV received a greater number of CRPs (2.95) than those with idiopathic BPPV (1.58) (p = 0.043). In patients with post-sudden SNHL BPPV, the average number of CRPs was 3.31 in the presence of CP and 2.1 sessions in the absence of CP (p = 0.030); the CP value was correlated with the frequency of CRPs (p = 0.020). In post-sudden SNHL BPPV, the worse the canal paresis becomes, the greater the number of CRPs will be needed for treatment; the simultaneous involvement of the posterior semicircular canal and horizontal semicircular canal is most common.

What Is the True Incidence of Horizontal Semicircular Canal Benign Paroxysmal Positional Vertigo?

Objective: Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause for peripheral vestibular vertigo. However, some patients still complain Residual Dizziness (RD) even after a successful Canalith Repositioning Procedure (CRP). This study was to explore the features of RD and its association with social support. Subjects and Methods: Between January 2015 and January 2016, 258 patients with BPPV were prospectively recruited in this study. The presence of RD was investigated after a successful CRP. Social Support Rating Scale (SSRS) and Dizziness Handicap Inventory (DHI) were adopted to evaluate the status of social support and the self-perceived handicapping effects of RD respectively. Results: Of them, 105 patients complained of RD after successful CRP. Univariate analysis indicated that the age, female sex, the length from BPPV onset to CRP and DHI score and SSRS score were significantly different between patients with RD and those without. After adjusting the confounding factors, multivariate logistic regression analysis suggested that the SSRS total score (OR 0.923, 95% CI 0.889-0.958, P=0.000) and the 3 subdomains of SSRS (subject support (OR 0.912, 95% CI 0.869-0.956, P=0.000), objective support (OR 0.889, 95% CI 0.799-0.989, P=0.031), and degree of social utilization (OR 0.825, 95% CI 0.716-0.951, P=0.008) ) were independently associated with the presence of RD after CRP. In conclusion, Residual dizziness is a common condition in patients with BPPV after CRP. Conclusion: Our study indicates that social support could help in reducing the incidence of RD in patients with BPPV after successfully CRP and returning to daily life more rapidly and comfortably.

Experience With Epley's Manoeuvre and Vestibular Habituation Training in Benign Paroxysmal Positional Vertigo