scholarly journals Repositioning maneuvers in benign paroxysmal positional vertigo: how do we improve outcomes?

2021 ◽  
Vol 9 (12) ◽  
pp. 3764
Author(s):  
Tapas Kumar Banerjee
Keyword(s):  
Hair Cells ◽  
Benign Paroxysmal Positional Vertigo ◽  
Recovery Of Function ◽  
Pharmacological Intervention ◽  
Vestibular Disorder ◽  
Positional Vertigo ◽  
Betahistine Dihydrochloride ◽  
Peripheral Vestibular Disorder ◽  
Patients Experience ◽  
Paroxysmal Positional Vertigo

Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular disorder. A series of meetings with clinicians treating BPPV were conducted to seek their views on improving outcomes in patients with BPPV. BPPV is primarily treated by Otolith repositioning maneuvers (ORM) to help to move the otoconia out of the canal and lead it back to the vestibule. Although repositioning maneuvers are effective in BPPV management, some patients experience residual dizziness, postural instability, recurrences, and psycho-emotional consequences after about 1 month after repositioning. An important and useful non-pharmacological intervention for patients with balance disturbances is Vestibular rehabilitation (VR), which includes vestibular adaptation, habituation and substitution, and patient education. Repositioning devices and mastoid vibration could help a subgroup of patients with BPPV who do not respond to conventional management. Betahistine dihydrochloride accelerates the recovery of function of vestibular system by improving blood flow in the inner ear, and normalization of the function of motion sensitive hair cells is faster. Betahistine-treated patients may have faster recovery, lesser recurrence, and longer relief of symptoms. The use of betahistine in combination with maneuvers can help prevent the development of residual dizziness.

scholarly journals Diagnosis of Single- or Multiple-Canal Benign Paroxysmal Positional Vertigo according to the Type of Nystagmus

2011 ◽  
Vol 2011 ◽  
pp. 1-13 ◽  
Author(s):  
Dimitris G. Balatsouras ◽  
George Koukoutsis ◽  
Panayotis Ganelis ◽  
George S. Korres ◽  
Antonis Kaberos
Keyword(s):  
Primary Care ◽  
Benign Paroxysmal Positional Vertigo ◽  
Accurate Diagnosis ◽  
Positional Nystagmus ◽  
Vestibular Disorder ◽  
Pathogenetic Mechanism ◽  
Positional Vertigo ◽  
Peripheral Vestibular Disorder ◽  
Test Current ◽  
Paroxysmal Positional Vertigo

Benign paroxysmal positional vertigo (BPPV) is a common peripheral vestibular disorder encountered in primary care and specialist otolaryngology and neurology clinics. It is associated with a characteristic paroxysmal positional nystagmus, which can be elicited with specific diagnostic positional maneuvers, such as the Dix-Hallpike test and the supine roll test. Current clinical research focused on diagnosing and treating various types of BPPV, according to the semicircular canal involved and according to the implicated pathogenetic mechanism. Cases of multiple-canal BPPV have been specifically investigated because until recently these were resistant to treatment with standard canalith repositioning procedures. Probably, the most significant factor in diagnosis of the type of BPPV is observation of the provoked nystagmus, during the diagnostic positional maneuvers. We describe in detail the various types of nystagmus, according to the canals involved, which are the keypoint to accurate diagnosis.

scholarly journals Objective findings in patients with multi-canal benign paroxysmal positional vertigo

2021 ◽  
pp. 014556132110666
Author(s):  
Yanhan Zhu ◽  
Xiaoming He ◽  
Mei Hu ◽  
Chun Mao ◽  
Zheng Liu ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Benign Paroxysmal Positional Vertigo ◽  
Disease Onset ◽  
Vestibular Disorder ◽  
Female Ratio ◽  
Positional Vertigo ◽  
Significant Difference ◽  
Peripheral Vestibular Disorder ◽  
Male To Female ◽  
Paroxysmal Positional Vertigo

Objective The study aimed to investigate the clinical characteristics of patients with multi-canal benign paroxysmal positional vertigo (MC-BPPV). Methods We performed a retrospective analysis of 927 patients with BPPV who were admitted to our hospital between January 1, 2016 and December 31, 2019. The clinical data of all patients were collected. The Dix-Hallpike, straight head-hanging, and supine Roll tests were performed in all patients. The nystagmus was recorded using videonystagmography. The clinical characteristics of patients with MC-BPPV and single canal BPPV (SC-BPPV) was analyzed and compared. Results Among 927 patients included, 49 (5.29%) patients had MC-BPPV, 878 (94.71%) patients had SC-BPPV. There were significant differences in the male to female ratio (1:3.90 vs 1:1.81, P < .05), mean age (62.47±12.51 vs 59.04±13.72, P < .05), as well as the ratio of cupulolithiasis to canalithiasis (1:1.45 vs 1:4.78, P < .01) between patients with MC-BPPV and SC-BPPV. The frequency of involvement of PC, HC, and AC were involved for 66 (67.35%), 23 (23.47%), and 9 (9.18%) times, respectively, in patients with MC-BPPV, which were involved in 581 (66.17%), 281 (32.0%), and 16 (1.82%) patients, respectively, in patients with SC-BPPV. No significant difference was found in the frequency of involvement of PC and HC between patients with MC-BPPV and SC-BPPV, while there was significant difference in the frequency of AC involvement between 2 groups ( P < .01). Ipsilateral PC-HC-BPPV (n = 18) and bilateral PC-BPPV (n=19) were the most common among patients with MC-BPPV. Twenty-six (53.06%) patients had ipsilateral MC-BPPV, 23 (46.94%) had bilateral MC-BPPV. Of the 26 patients with ipsilateral MC-BPPV, 7 patients combined with unilateral peripheral vestibular disorder. Conclusion Patients with MC-BPPV had a significantly older mean age at disease onset and a higher proportion of females compared with patients with SC-BPPV. Cupulolithiasis was more common in MC-BPPV. AC involvement was also much more common in MC-BPPV than in SC-BPPV.

scholarly journals Teleconsultation and Teletreatment Protocol to Diagnose and Manage Patients with Benign Paroxysmal Positional Vertigo (BPPV) during the COVID-19 Pandemic

2021 ◽  
Vol 25 (01) ◽  
pp. e141-e149
Author(s):  
Renato Gonzaga Barreto ◽  
Darío Andrés Yacovino ◽  
Lázaro Juliano Teixeira ◽  
Mayanna Machado Freitas
Keyword(s):  
Disease Transmission ◽  
Benign Paroxysmal Positional Vertigo ◽  
Good Clinical Practice ◽  
Relevant Information ◽  
Remote Access ◽  
Vestibular Disorder ◽  
Face To Face ◽  
Positional Vertigo ◽  
Video And Audio ◽  
Paroxysmal Positional Vertigo

Abstract Introduction Telehealth consists in the application of technology to provide remote health service. This resource is considered safe and effective and has attracted an exponential interest in the context of the COVID pandemic. Expanded to dizzy patients, it would be able to provide diagnosis and treatment, minimizing the risk of disease transmission. Benign paroxysmal positional vertigo (BPPV) is the most common vestibular disorder. The diagnosis typically rests on the description of the symptoms along with the nystagmus observed at a well-established positional testing. Objectives The aim of the present study was to propose a teleconsultation and teletreatment protocol to manage patients with BPPV during the COVID-19 pandemic. Methods Specialists in the vestibular field met through remote access technologies to discuss the best strategy to manage BPPV patients by teleconsultation and teletreatment system. Additionally, several scientific sources were consulted. Technical issues, patient safety, and clinical assessment were independently analyzed. All relevant information was considered in order to design a clinical protocol to manage BPPV patients in the pandemic context. Results Teleconsultation for BPPV patients requires a double way (video and audio) digital system. An adapted informed consent to follow good clinical practice statements must be considered. The time, trigger and target eye bedside examination (TiTRaTe) protocol has proven to be a valuable first approach. The bow and lean test is the most rational screening maneuver for patients with suspected positional vertigo, followed by most specific maneuvers to diagnostic the sub-variants of BPPV. Conclusion Although with limited evidence, teleconsultation and teletreatment are both reasonable and feasible strategies for the management of patients with BPPV in adverse situations for face-to-face consultation.

scholarly journals Benign Paroxysmal Positional Vertigo in Children and Adolescents With Concussion

2021 ◽  
pp. 194173812097051
Author(s):  
Alicia Wang ◽  
Guangwei Zhou ◽  
Kosuke Kawai ◽  
Michael O’Brien ◽  
A. Eliot Shearer ◽  
...  
Keyword(s):  
Benign Paroxysmal Positional Vertigo ◽  
Pediatric Patients ◽  
Head Injuries ◽  
Vestibular Disorder ◽  
Symptom Scale ◽  
Level Of Evidence ◽  
Pediatric Concussion ◽  
Positional Vertigo ◽  
Level 3 ◽  
Paroxysmal Positional Vertigo

Background: Dizziness after concussion is primarily attributed to effects on the brain, but traumatic inner ear disorders can also contribute. Benign paroxysmal positional vertigo (BPPV) is a common vestibular disorder that can result from minor head trauma and can be easily diagnosed and rapidly treated in an office setting. The role of BPPV in pediatric postconcussive dizziness has not been well-studied. Purpose: To evaluate the prevalence and clinical features of BPPV in a group of pediatric patients with concussion and prolonged dizziness after concussion. Study Design: Case-control study. Level of Evidence: Level 3. Methods: Retrospective review of 102 patients seen within the past 3 years in a pediatric multidisciplinary concussion clinic for evaluation of postconcussive dizziness. Results: BPPV was diagnosed in 29.4% (30/102) of patients with postconcussion syndrome and dizziness. All patients with BPPV were treated with repositioning maneuvers, except for 5 patients who had spontaneous resolution of symptoms. Patients were evaluated at an average of 18.8 weeks (SD, 16.4 weeks) after the injury. BPPV was diagnosed at similar rates regardless of gender or age group (children vs adolescents). The mean Post-Concussion Symptom Scale (PCSS) score did not differ significantly between patients with (58.3 [SD, 22.5]) or without BPPV (55.8 [SD, 29.4]; P = 0.39). The PCSS “balance problems or dizziness” subscore also did not differ between patients with (3.3 [SD, 1.7]) or without BPPV (2.8 [SD, 1.6]; P = 0.13). Conclusion: BPPV is fairly common in pediatric concussion, occurring in one-third of the patients studied. BPPV is often not diagnosed and treated until many weeks after the injury. Increased awareness of the evaluation and management of BPPV among pediatric concussion providers may help expedite resolution of dizziness and hasten overall recovery in affected patients. Clinical Relevance: BPPV is a treatable cause of dizziness caused by minor head injuries and is more common than previously reported in pediatric patients with concussion. Improved awareness of BPPV by concussion providers may expedite recovery.

scholarly journals Residual dizziness after successful repositioning maneuver for idiopathic benign paroxysmal positional vertigo: a review

2017 ◽  
Vol 7 (1) ◽  
Author(s):  
Giorgia Giommetti ◽  
Ruggero Lapenna ◽  
Roberto Panichi ◽  
Puya Dehgani Mobaraki ◽  
Fabrizio Longari ◽  
...  
Keyword(s):  
English Language ◽  
Benign Paroxysmal Positional Vertigo ◽  
Early Recognition ◽  
The Elderly ◽  
Vestibular Disorder ◽  
Risk Of Falling ◽  
Search Terms ◽  
Positional Vertigo ◽  
Repositioning Maneuver ◽  
Paroxysmal Positional Vertigo

The benign paroxysmal positional vertigo (BPPV) is a vestibular disorder cause of vertigo. The BPPV may be corrected mechanically by repositioning maneuvers but even after successful maneuvers, some patients report residual dizziness for a certain period afterward. Early recognition and treatment might decrease the incidence of residual dizziness in patients with BPPV, especially in those patients with psychiatric comorbidities and in the elderly, lowering the risk of falling. Many pathogenetic hypotheses for residual dizziness are under debate. The purpose of this review was to identify, evaluate and review recent researches about possible causal factors involved in residual dizziness and the implications on clinical practice. A literature search was performed using different databases such as Pubmed and Scopus. The following search terms were used: <em>residual dizziness, otolithic membrane and BPPV</em>. The search found a total of 1192 titles, which were reduced to 963 after a procedure of de-duplication of the found titles. The research was then restricted to an interval of time comprised between 2000 and 2016 for a total of 800 titles. Among these titles, only those including the terms <em>benign paroxysmal positional vertigo</em> were considered eligible for this review. Only publications in English language were taken into consideration and we excluded those with not available abstract. Finally, 90 abstracts were obtained and critically evaluated by two different Authors, and additional studies were identified by hand searching from the references of artiche of interest. Only 53 were included in this work.

scholarly journals Teaching Patient-Centered Counseling Skills for Assessment, Diagnosis, and Management of Benign Paroxysmal Positional Vertigo

2018 ◽  
Vol 39 (01) ◽  
pp. 052-066 ◽  
Author(s):  
Richard Roberts ◽  
Carole Johnson ◽  
Anna Jilla
Keyword(s):  
Experiential Learning ◽  
Clinical Education ◽  
Benign Paroxysmal Positional Vertigo ◽  
Learning Opportunities ◽  
Primary Concern ◽  
Vestibular Disorder ◽  
Patient Centered ◽  
Diagnosis And Management ◽  
Positional Vertigo ◽  
Paroxysmal Positional Vertigo

AbstractAudiologists are an integral part of the management of those with dizziness and vestibular disorders. However, little research has been performed on counseling approaches for patients who present with dizziness as a primary concern. Accordingly, it is important that audiology students are provided with didactic and experiential learning opportunities for the assessment, diagnosis, and management of this population. Benign paroxysmal positional vertigo is the most common vestibular disorder among adults. Doctor of Audiology students, at a minimum, should be provided with learning opportunities for counseling patients with this particular disorder. Implementation of patient-centered counseling is applied across various parts of the patient encounter from initial intake to treatment and patient education. The purpose of this article is to present the available evidence and to apply widely accepted theories and techniques to counseling those with benign paroxysmal positional vertigo. Didactic resources and experiential learning activities are provided for use in coursework or as a supplement to clinical education.

Effectiveness of the Parnes particle repositioning manoeuvre for posterior canal benign paroxysmal positional vertigo

2015 ◽  
Vol 129 (12) ◽  
pp. 1188-1193 ◽  
Author(s):  
B L Kinne ◽  
J S Leafman
Keyword(s):  
Benign Paroxysmal Positional Vertigo ◽  
Descriptive Statistics ◽  
Vestibular Disorder ◽  
Posterior Canal ◽  
Positional Vertigo ◽  
Related Quality ◽  
Health Related ◽  
The Mean ◽  
Paroxysmal Positional Vertigo

AbstractBackground:Benign paroxysmal positional vertigo is a common vestibular disorder that negatively affects an individual's health-related quality of life. This study aimed to examine the effectiveness of the Parnes particle repositioning manoeuvre as an intervention for individuals with posterior canal benign paroxysmal positional vertigo.Methods:The de-identified records of 155 individuals treated with the Parnes manoeuvre were examined. Descriptive statistics were calculated, including the frequency and valid per cent of participants whose nystagmus was resolved with the Parnes manoeuvre.Results:In all, nystagmus was resolved with the Parnes manoeuvre in 145 participants (93.5 per cent). The mean number of manoeuvres needed to resolve the nystagmus was 1.3.Conclusion:The Parnes manoeuvre proved to be as effective as the Epley canalith repositioning manoeuvre, currently the most common intervention, in treating individuals with posterior canal benign paroxysmal positional vertigo.

scholarly journals Benign Paroxysmal Positional Vertigo (BPPV) in Adult Patients between 15-40 years of age: A study on Treatment Outcome in Teaching Hospitals

2021 ◽  
Vol 15 (6) ◽  
pp. 2115-2118
Author(s):  
Zafar Iqbal ◽  
Rehan Saleem ◽  
Muhammad Tayyab Rasheed ◽  
Mohammed Habib ◽  
Naseem ul Haq ◽  
...  
Keyword(s):  
Treatment Outcome ◽  
Medical Treatment ◽  
Benign Paroxysmal Positional Vertigo ◽  
Combined Treatment ◽  
Clinical History ◽  
Adult Patients ◽  
Teaching Hospitals ◽  
Vestibular Disorder ◽  
Positional Vertigo ◽  
Paroxysmal Positional Vertigo

Objectives: To study treatment outcome of positional vertigo in adult patients of 15-40 years of age. Place and duration of study: This study was conducted at ENT department of Chaudhary Muhammad Akram Teaching & Research Hospital, Lahore and Kuwait Teaching Hospital, Peshawar from June 2019 to June 2020. Material and Methods: 50 patients with diagnosis of benign positional vertigo were included in the study. Patients were treated and their outcomes were analyzed. Results: 50 patients of age between 15-40 years were included in the study. The analysis of treatment outcome showed that 35 patients (70%) showed maximum improvement in vertigo with medical treatment, 10 patients (20%) showed improvement in their symptoms with positional exercises and 5 patients (10%) showed improvement by combined treatment. Conclusion: Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular disorder and presents as brief, episodic, positional provoked vertigo. The diagnosis can be made through clinical history along with diagnostic maneuvers and it can have a considerable impact on the quality of life. The medical treatment with vestibular dilators and vestibular suppressant is best option, with particle repositioning maneuver (Epley maneuver) for resistant and recurrent patients. Key words: Vestibular exercises, Dizziness, Positional vertigo, Dis equilibrium

scholarly journals Diabetes and the Vestibular System

2019 ◽  
Vol 40 (04) ◽  
pp. 300-307 ◽  
Author(s):  
Erin G. Piker ◽  
Daniel J. Romero
Keyword(s):  
Diabetes Mellitus ◽  
Vestibular System ◽  
Benign Paroxysmal Positional Vertigo ◽  
Large Population ◽  
Population Based ◽  
Vestibular Disorder ◽  
Vestibular Loss ◽  
Positional Vertigo ◽  
Patients With Diabetes ◽  
Paroxysmal Positional Vertigo

AbstractFalls are among the most injurious, costly, and feared conditions affecting older adults. Patients with diabetes have a significantly greater risk for falling due to complications affecting the sensory systems required for balance: vision, proprioception, and vestibular. The effects of diabetes mellitus on the vestibular system are perhaps the least understood of these systems. The vestibular system is complex, includes multiple structures, and is difficult and expensive to thoroughly assess. There is pathophysiologic evidence suggesting a direct effect of diabetes mellitus complications on the vestibular system, but there is limited clinical evidence regarding which specific vestibular structures are most adversely affected. Nevertheless, large population-based studies show that patients with diabetes are more likely to have vestibular loss, have a high prevalence of a specific vestibular disorder called benign paroxysmal positional vertigo, and are at a greater risk for falling. Based on the available evidence, a balance screening and an evaluation of benign paroxysmal positional vertigo, a common but easy to treat pathology, in patients with diabetes is recommended as well as counseling on falls risk and home modifications.

scholarly journals COMPARISON OF RECURRENCY OF BENIGN PAROXYSMAL POSITIONAL VERTIGO WITH AND WITHOUT HYPERTENSION

2020 ◽  
Vol 7 (12) ◽  
pp. 36-39
Keyword(s):  
Analytical Study ◽  
Benign Paroxysmal Positional Vertigo ◽  
Sampling Technique ◽  
Vestibular Disorder ◽  
Research Subjects ◽  
Consecutive Sampling ◽  
Cohort Design ◽  
Positional Vertigo ◽  
Significant Difference ◽  
Paroxysmal Positional Vertigo

Background: Benign paroxysmal positional vertigo (BPPV) is the most common vestibular disorder. Several studies have shown that comorbid hypertension can affect the prognosis of BPPV. This study aims to assess the comparison of BPPV patient recurrences with and without hypertension. Method: This research is an analytical study with a cohort design. The research was conducted at the Neurology Polyclinic of RSUP Haji Adam Malik Medan for the period of October 1, 2019 to December 1, 2019. A total of 40 BPPV patients with and without hypertension were taken into the study sample, using consecutive sampling technique. For 7 days recurrence was recorded and on the 7th day, BPPV symptoms were reassessed with the Dix-Hallpike maneuver. Furthermore, statistical analysis was performed using the Mann Whitney U test and the Kruskall Wallis test. Result:Of the 40 research subjects, there were 29 more women (72.5%) and the highest age was in the range >40 - 60 years as many as 23 subjects (57.5%). There were 18 people (90.0%) BPPV patients with hypertension and as many as 4 people (20.0%) BPPV patients without hypertension experienced recurrences, where one recurrence was found in 13 people (65.0%) and more than one recurrence. times or vertigo was felt continuously found in 5 people (25.0%) BPPV patients with hypertension (p = 0.000). Conclusion: There is a significant difference in recurrence between BPPV patients with and without hypertension.

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