scholarly journals Physical Therapy for Benign Positional Vertigo of Posterior Canal: The Role of Alternated Epley and Semont Maneuvers

2021 ◽  
pp. 014556132098018
Author(s):  
Andrea Lovato ◽  
Gino Marioni ◽  
Daniele Monzani ◽  
Giacomo Rossettini ◽  
Elisabetta Genovese ◽  
...  
Keyword(s):  
Physical Therapy ◽  
Benign Paroxysmal Positional Vertigo ◽  
Positional Nystagmus ◽  
Dizziness Handicap Inventory ◽  
Posterior Semicircular Canal ◽  
Positional Vertigo ◽  
Significant Difference ◽  
Paroxysmal Positional Vertigo

Objective: To investigate if alternated Epley (EP) and Semont (ST) maneuvers could be more effective than repetition of the same in benign paroxysmal positional vertigo of posterior semicircular canal (pBPPV). Design: We retrospectively reviewed the outcome of pBPPV patients treated with a second maneuver for the persistence of positional nystagmus. Study Sample: Forty-seven patients underwent 2 STs, 64 with 2 EPs, and 71 EPs followed by ST. Videonystagmography and Dizziness Handicap Inventory (DHI) questionnaire were performed. Results: Absence of positional nystagmus was achieved after 2 maneuvers in 136 patients with pBPPV: 65.9% in the ST group, 70.3% in the EP group, and 84.5% in the EP-ST group. Alternated EP and ST were significantly more effective than repeated ST ( P = .03), while we found no significant difference when compared with repeated EP ( P = .07). At 1-month follow-up, 12 patients showed persistent positional nystagmus without difference between groups. After 1 month, the 46 patients with negative outcome had significantly higher DHI values ( P = .01) than other 136 patients with pBPPV. Conclusions: Alternated EP and ST seemed more effective than repeating the same maneuver in treating pBPPV, and this should be confirmed in prospective clinical studies. Resolution of nystagmus after maneuvers was fundamental to reduce handicap deriving from dizziness as reported in DHI.

scholarly journals The efficacy of Epley and Semont maneuvers in posterior semicircular canal benign paroxysmal positional vertigo treatment: A short-term comparative study

2021 ◽  
Vol 9 (3) ◽  
pp. 75-80
Author(s):  
Mustafa Caner Kesimli
Keyword(s):  
Comparative Study ◽  
Semicircular Canal ◽  
Benign Paroxysmal Positional Vertigo ◽  
Posterior Semicircular Canal ◽  
Short Term ◽  
Positional Vertigo ◽  
Epley Maneuver ◽  
The One ◽  
Paroxysmal Positional Vertigo

OBJECTIVE: This study aimed to compare the effectiveness of the Epley maneuver with the Semont maneuver in the treatment of posterior semicircular canal benign paroxysmal positional vertigo and observe differences in the resolution time of symptoms in the short-term follow-up. METHODS: Sixty patients with posterior semicircular canal benign paroxysmal positional vertigo (23 males, 37 females; median age: 44.9 years; range, 14 to 80 years) were included in the prospective randomized comparative study conducted in our clinic between April 2019 and October 2019. Diagnosis and treatment maneuvers were performed under videonystagmography examination. Participants were randomly selected after the diagnostic tests for the Epley maneuver and the Semont maneuver treatment groups. RESULTS: In the evaluation of vertigo with videonystagmography, 25 (83.3%) patients in the Epley maneuver group and 20 (66.6%) patients in the Semont maneuver group recovered in the one-week follow-up, and 28 (93.3%) patients in the Epley maneuver group and 24 (80%) patients in the Semont maneuver group recovered in the two-week follow-up. All patients in the Epley maneuver group recovered at the end of one month; four patients in the Semont maneuver group still had vertiginous symptoms (100% vs. 86.6%, p=0.04). There was a statistically significant difference between the Epley and Semont groups regarding visual analog scores at the one-week, two-week, and one-month follow-ups (p=0.002, p<0.001, p=0.001, respectively). CONCLUSION: The Epley maneuver was significantly more effective than the Semont maneuver in resolving vertigo in the short-term treatment of posterior semicircular canal benign paroxysmal positional vertigo.

scholarly journals Benign Paroxysmal Positional Vertigo and Positional Vertigo Variants

2012 ◽  
Vol 4 (1) ◽  
pp. 25-40 ◽  
Author(s):  
Giacinto Asprella Libonati
Keyword(s):  
Differential Diagnosis ◽  
Semicircular Canal ◽  
Benign Paroxysmal Positional Vertigo ◽  
Positional Nystagmus ◽  
Posterior Semicircular Canal ◽  
Diagnosis And Therapy ◽  
Positional Vertigo ◽  
Peripheral Origin ◽  
Paroxysmal Positional Vertigo

ABSTRACT This article reviews the causes of positional vertigo and positional nystagmus of peripheral origin. Benign paroxysmal positional vertigo is described in all its variants, its diagnosis and therapy are highlighted. In addition, nonparoxysmal positional vertigo and nystagmus due to light/heavy cupula of lateral and posterior semicircular canal is focused on. The differential diagnosis between positional vertigo due to otolithic and nonotolithic causes is discussed. How to cite this article Asprella Libonati G. Benign Paroxysmal Positional Vertigo and Positional Vertigo Variants. Int J Otorhinolaryngol Clin 2012;4(1):25-40.

Particle Repositioning Maneuver for Benign Paroxysmal Positional Vertigo

1993 ◽  
Vol 102 (5) ◽  
pp. 325-331 ◽  
Author(s):  
Lorne S. Parnes ◽  
R. Greg Price-Jones
Keyword(s):  
Semicircular Canal ◽  
Benign Paroxysmal Positional Vertigo ◽  
Poor Response ◽  
Posterior Semicircular Canal ◽  
Positional Vertigo ◽  
Lost To Follow Up ◽  
Repositioning Maneuver ◽  
Simple Bedside ◽  
Paroxysmal Positional Vertigo

Benign paroxysmal positional vertigo is a common, most often self-limited, vestibular end organ disorder that in some cases may be quite disabling. Recent evidence suggests that some, if not most, cases result from free-floating posterior semicircular canal endolymph particles. We postulate that the particle repositioning maneuver displaces these particles from the posterior canal through the common crus into the utricle, where they no longer induce pathologic responses. Our report focuses on 38 consecutive patients treated with this simple bedside technique during a 10-month period. On follow-up, 26 patients (68.4%) were free of disease, 4 (10.5%) were significantly improved, 4 (10.5%) remained unchanged, and 4 (10.5%) were lost to follow-up. Of the 4 patients who remained unchanged, 2 underwent successful posterior semicircular canal occlusions. The direction of the nystagmus during the second stage of the maneuver appears important in predicting the efficacy, with reversal of nystagmus denoting a poor response. These findings provide additional insight into the pathophysiology of this disorder.

The role of the vestibular assessment

2009 ◽  
Vol 123 (11) ◽  
pp. 1212-1215 ◽  
Author(s):  
J S Phillips ◽  
J E FitzGerald ◽  
A P Bath
Keyword(s):  
Benign Paroxysmal Positional Vertigo ◽  
Vestibular Rehabilitation ◽  
Careful Consideration ◽  
Test Results ◽  
Positional Vertigo ◽  
Vestibular Assessment ◽  
Dizzy Patient ◽  
Paroxysmal Positional Vertigo

AbstractObjective:To evaluate the role of vestibular assessment in the management of the dizzy patient.Materials and methods:A retrospective review of case notes and vestibular assessment reports of 100 consecutive patients referred for vestibular assessment.Results:Sixty of the 100 patients had an abnormal vestibular assessment. Eleven patients had benign paroxysmal positional vertigo as the sole diagnosis, of whom nine had not had a Dix–Hallpike manoeuvre performed before referral. Of patients referred for vestibular rehabilitation, 76 per cent had an abnormal electrophysiological assessment. After vestibular assessment, 35 patients were discharged with no further follow-up appointments in the ENT department.Conclusions:All patients should have a Dix–Hallpike manoeuvre performed prior to referral for vestibular assessment. The majority of our patients undergoing vestibular rehabilitation had abnormal test results, although a significant number did not. Prior to referral, it is worth considering the implication of a ‘normal’ and ‘abnormal’ result for the management of the patient. Careful consideration should be given to the development of dedicated dizziness clinics run by practitioners with a specialist interest in balance disorders, in order to ensure appropriate requests for vestibular assessment.

scholarly journals A Case of Right Apogeotropic Posterior Semicircular Canal BPPV that Initially Emulated as Left Anterior Semicircular Canal BPPV

2020 ◽  
Author(s):  
Ajay Kumar Vats ◽  
Sudhir Kothari ◽  
Anirban Biswas
Keyword(s):  
Semicircular Canal ◽  
Benign Paroxysmal Positional Vertigo ◽  
Posterior Semicircular Canal ◽  
Positional Vertigo ◽  
Epley Maneuver ◽  
History Of ◽  
Anterior Semicircular Canal ◽  
The Right ◽  
Paroxysmal Positional Vertigo

AbstractIn any patient with a history of rotational vertigo triggered by changes in the position of head relative to the gravity, whose oculomotor patterns elicit a positional downbeating nystagmus (p-DBN), the localization could be either central in the brainstem, midline cerebellum, or at the craniocerebral junction; or else peripheral due to one of the rare variants of benign paroxysmal positional vertigo of vertical semicircular canals. Most serious causes of central vertigo in patients with p-DBN can be diagnosed by magnetic resonance imaging of the posterior fossa and craniovertebral junction. However, the peripheral p-DBN could be either due to anterior semicircular canal benign paroxysmal positional vertigo (ASC-BPPV) or a recently described apogeotropic variant of posterior semicircular canal BPPV (apo-PSC-BPPV) and the two are almost impossible to differentiate initially. The usual clinical scenario in apo-PSC-BPPV is diagnosing it initially as ASC-BPPV. However, following diagnostic or therapeutic positioning maneuvers for the purported ASC-BPPV, the positional oculomotor pattern changes to an upbeating nystagmus with the reversal in the direction of the torsion as well, localizing it to the contralateral PSC with respect to the ASC initially diagnosed. The initial oculomotor pattern observed on the right Dix–Hallpike test in this patient, of a short latency downbeating left torsional (from the patient’s perspective) positional nystagmus suggested a diagnosis of left ASC-BPPV, which was accordingly treated with multiple sessions of reverse Epley maneuvers daily for a week. At the end of the week, a verifying right Dix–Hallpike test elicited an upbeating right torsional (from the patient’s perspective) positional nystagmus. It is extremely unlikely that this patient had resolution of her initial left ASC-BPPV with the daily sessions of reverse Epley maneuvers carried over a week and immediately suffered from commoner geotropic variant of the right PSC-BPPV (geo-PSC-BPPV). It is plausible to interpret that this patient suffered from the right apo-PSC-BPPV from the very outset, and the reverse Epley maneuver performed for the ostensive left ASC-BPPV led to an intracanal shift of otoconial debris from its nonampullary to the ampullary arm resulting in right geo-PSC-BPPV. The reasons why situations like this outwit the clinician resulting in inaccurate localization as well as lateralization is discussed. The patient was successfully treated with right Epley maneuver after transformation to geo-PSC-BPPV and was asymptomatic at follow-up for 4 weeks. A peripheral p-DBN with torsional component in any patient with a history of positionally triggered vertigo can be either ASC-BPPV or apo-PSC-BPPV. A very close follow-up at a short interval of time with meticulously executed positional tests is the only definitive way to differentiate the two conditions.

Analysis of Residual Symptoms after Treatment in Benign Paroxysmal Positional Vertigo Using Questionnaire

2009 ◽  
Vol 141 (2) ◽  
pp. 232-236 ◽  
Author(s):  
No Hee Lee ◽  
Hee Jun Kwon ◽  
Jae Ho Ban
Keyword(s):  
Benign Paroxysmal Positional Vertigo ◽  
Control Group ◽  
Dizziness Handicap Inventory ◽  
Residual Symptoms ◽  
Positional Vertigo ◽  
Canalith Repositioning Procedure ◽  
And Control ◽  
Subsequent Comparison ◽  
Paroxysmal Positional Vertigo

OBJECTIVES: Canalith repositioning procedure (CRP) provides rapid and long-lasting relief of symptoms in most patients with benign paroxysmal positional vertigo. However, some patients express nonspecific symptoms such as anxiety or discomfort after treatment, even after the disappearance of nystagmus and vertigo. The purpose of this study was to assess the residual symptoms after CRP in patients with benign paroxysmal positional vertigo using the Dizziness Handicap Inventory (DHI) in a questionnaire format. STUDY DESIGN AND SETTING: Controlled, prospective study. SUBJECTS AND METHODS: CRP was performed in 135 patients until nystagmus and vertigo disappeared. Patients were asked to complete the questionnaire before and 5 to 7 days after treatment. A control group of 135 normal volunteers was selected and cross-matched according to the age and sex of the patient group. The data were compared for the pre-CRP, post-CRP, and control groups. RESULTS: There was a significant improvement in the DHI scores when comparing the pre- and post-CRP groups ( P = 0.000), although six items showed incomplete improvement. Subsequent comparison of DHI scores between the control group and the post-CRP group still showed a difference in some items so that the improvement was incomplete. CONCLUSION: Even after successful CRPs, Dizziness Handicap Inventory scores indicated that residual subjective symptoms may remain. Thus, additional follow-up and management are important for these patients.

Utricular Macular Ablation for Benign Paroxysmal Positional Vertigo

1996 ◽  
Vol 75 (7) ◽  
pp. 416-421 ◽  
Author(s):  
Philip F. Anthony
Keyword(s):  
Semicircular Canal ◽  
Benign Paroxysmal Positional Vertigo ◽  
Outpatient Surgery ◽  
Argon Laser ◽  
Laser Technique ◽  
Dizziness Handicap Inventory ◽  
Posterior Semicircular Canal ◽  
Positional Vertigo ◽  
A New Technique ◽  
Paroxysmal Positional Vertigo

Seventeen percent of all vertiginous patients have benign paroxysmal positional vertigo. Treatment can include occlusion of the posterior semicircular canal for control of these positional vertigo symptoms. More recently, use of an argon laser technique to occlude the posterior membranous semicircular canal has been proposed. However, this laser technique was not tolerated by a diabetic patient.3 This report describes a new technique using the argon laser to ablate the utricular macula in the affected ear in patients with benign paroxysmal positional vertigo. This procedure is done as outpatient surgery under local anesthesia. The procedure successfully resolved benign paroxysmal positional vertigo in 14 patients. Symptoms in these patients improved from 20-100% (median 87%; mean 80%) as measured by the Dizziness Handicap Inventory.

Efficacy of laser occlusion of posterior semicircular canal for benign paroxysmal positional vertigo: case report

2009 ◽  
Vol 124 (5) ◽  
Author(s):  
S-Z Lin ◽  
J-P Fan ◽  
A-H Sun ◽  
J Guan ◽  
H-B Liu ◽  
...  
Keyword(s):  
Case Report ◽  
Semicircular Canal ◽  
World Literature ◽  
Benign Paroxysmal Positional Vertigo ◽  
Posterior Semicircular Canal ◽  
Positional Vertigo ◽  
Long Term Effect ◽  
Paroxysmal Positional Vertigo

AbstractObjective:To observe the long-term effect of laser occlusion of the posterior semicircular canal for benign paroxysmal positional vertigo.Method:Case report and review of the relevant world literature.Results:We treated a patient with refractory benign paroxysmal positional vertigo using laser occlusion of the posterior semicircular canal, and achieved satisfactory results. Three months after the operation, the patient was able to lead a normal life. There was no recurrence over five years of follow up.Conclusion:To our knowledge, this is the first report in the world literature of a patient with refractory benign paroxysmal positional vertigo being treated with laser occlusion of the posterior semicircular canal. This method had long-term effectiveness, and may be one of the most effective methods of treating patients with refractory benign paroxysmal positional vertigo.

scholarly journals The Clinical Spectrum of Patients of Horizontal Semicircular Canal Benign Paroxysmal Positional Vertigo Attending an Otoneurology Center in South Rajasthan, India and Their Response to Appropriate Repositioning Maneuvers at a Short-Term Follow-Up

2020 ◽  
Author(s):  
Ajay Kumar Vats
Keyword(s):  
Physical Therapy ◽  
Semicircular Canal ◽  
Benign Paroxysmal Positional Vertigo ◽  
Clinical Spectrum ◽  
Short Term ◽  
Horizontal Semicircular Canal ◽  
Positional Vertigo ◽  
The Times ◽  
Paroxysmal Positional Vertigo

Abstract Introduction This article aims to study the clinical spectrum of 20 consecutive patients diagnosed with horizontal semicircular canal benign paroxysmal positional vertigo (HSC-BPPV) attending an otoneurology center in Udaipur, Rajasthan, India, over a period of 11 months and their response to appropriate repositioning maneuvers evaluated at short-term follow-up of 1 hour and 24 hours. Study Design This is a nonrandomized prospective interventional study. Materials and Methods Twenty patients with unilateral HSC-BPPV were treated with a session of an appropriate repositioning maneuver (Gufoni maneuver or barbecue roll maneuver for the geotropic variant of HSC-BPPV [geo-HSC-BPPV]; Appiani maneuver or barbecue roll maneuver or head-shaking maneuver for the apogeotropic variant of the HSC-BPPV [apo-HSC-BPPV]). Patients were followed up twice (at 1 hour and 24 hours) and audited by a supine roll test with questioning for the absence or presence of concomitant vertigo. Results At the 1-hour follow-up, 78.57% (11/14) patients of geo-HSC-BPPV treated with Gufoni maneuver recovered, and 66.67% (4/6) patients of apo-HSC-BPPV treated with some form of physical therapy recovered. The recovery was maintained at 24 hours’ follow-up in both groups. Conclusion To the best of the author’s knowledge, no such study on patients of HSC-BPPV has been reported from India hitherto. Gufoni maneuver is an effective and safe treatment for the geo-HSC-BPPV with a recovery rate of 78.57% (11/14) at a short-term follow-up. The physical therapy for the apo-HSC-BPPV must be tailored according to the purported site of pathology which cannot be precisely predetermined most of the times.

scholarly journals Effect of the Epley Maneuver and Brandt-Daroff Exercise on Benign Paroxysmal Positional Vertigo Involving the Posterior Semicircular Canal Cupulolithiasis: A Randomized Clinical Trial

2020 ◽  
Vol 11 ◽  
Author(s):  
Seo-Young Choi ◽  
Jae Wook Cho ◽  
Jae-Hwan Choi ◽  
Eun Hye Oh ◽  
Kwang-Dong Choi
Keyword(s):  
Clinical Trial ◽  
Randomized Clinical Trial ◽  
Therapeutic Effect ◽  
Semicircular Canal ◽  
Benign Paroxysmal Positional Vertigo ◽  
Positional Nystagmus ◽  
Posterior Semicircular Canal ◽  
Positional Vertigo ◽  
Epley Maneuver ◽  
Paroxysmal Positional Vertigo

Objective: To investigate the therapeutic efficacies of the Epley maneuver and Brandt-Daroff (BD) exercise in patients with benign paroxysmal positional vertigo involving the posterior semicircular canal cupulolithiasis (PC-BPPV-cu).Methods: We conducted a randomized clinical trial to evaluate the therapeutic effect of the Epley maneuver and BD exercise in patients with PC-BPPV-cu. Patients were randomly assigned to undergo the Epley maneuver (n = 29) or BD exercise (n = 33). The primary outcome was an immediate resolution of positional nystagmus within 1 h after a single treatment of each maneuver on the visit day. Secondary outcomes included the resolution of positional nystagmus at 1 week, the change of maximal slow phase velocity (mSPV) of positional nystagmus, and dizziness handicap inventory (DHI) immediately and at 1 week.Results: Immediate resolution occurred in none of 29 patients in the Epley maneuver group and only 1 of 33 patients in the BD exercise group. The Epley maneuver and BD exercise had an equivalent effect at 1 week in treating PC-BPPV-cu in terms of resolving positional nystagmus (48 vs. 36%, p = 0.436) and the decrease of mSPV and DHI.Conclusion: Neither the Epley maneuver nor BD exercise has an immediate therapeutic effect in treating PC-BPPV-cu. Clear classification of PC-BPPV should be required at the time of different pathology and different treatment response.

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