BENIGN PAROXYSMAL POSITIONAL VERTIGO: OUR EXPERIENCE AT A TERTIARY CARE CENTRE OF CENTRAL INDIA

Tertiary Care ◽

Care Centre ◽

Tertiary Care Centre ◽

Duration Of Symptoms ◽

Common Cause ◽

Patient Profile ◽

Positional Vertigo ◽

Age Range ◽

Background: - Benign paroxysmal positional vertigo (BPPV) is a common cause of vertigo. The diagnosis is often delayed and patients are unnecessarily investigated and treated with drugs. Aim: To analyze the patient profile, duration of symptoms, etiology, associated co-morbidities, type of canal involvement and response to CRP in cases of BPPV. Material & Methods: The present prospective study was conducted at a tertiary care centre from January 2015 to December 2016 in 90 patients with a clinical diagnosis of BPPV. Patient particular and disease specific data were recorded in preset profoma and analyzed. All these patients were treated by different CRP specific for the canal involved. All cases were reassessed for post procedural response. Results: Total 90 patients were included in the study with age range of 20 to 76 year. Mean age was 46.74. Maximum patients (26.67%) were in the age range of 41-50 year with male: female was 1:1.43. The duration of symptoms was in from 2 days to more than 3 years. Most common morbidity was diabetes and most common cause was Idiopathic (82.22%). Most of these patients presented with positional vertigo (94.44%). Right posterior canal was involved in 52 cases (57.78%) and left in 30 (33.33%) cases. Conclusion: BPPV is a common cause of vertigo. More awareness needed about its symptoms, early application of Dix-Hallpike test and Epley’s procedure to reduce the suffering of patients and to reduce unnecessary diagnostic tests and costs.

Clinico-Aetiological Profile of Patients with Vertigo: A Cross-sectional Observational Study

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2020/45457.14003 ◽

2020 ◽

Author(s):

Shiraz Syed ◽

Himanshu Kumar Mittal ◽

Sampan Singh Bist ◽

Lovneesh Kumar ◽

Vinish Kumar Agarwal

Keyword(s):

Observational Study ◽

Orthostatic Hypotension ◽

Tertiary Care ◽

Aetiological Factor ◽

Cross Sectional ◽

Duration Of Symptoms ◽

Female Ratio ◽

Positional Vertigo ◽

Introduction: Nearly 5-10 percent of patients seen in general OPD, and between 10-20 percent of patients seen by ENT specialists and neurologists are those with complaints pertaining to vertigo and dis-equilibrium. The standard definition of vertigo states it to be an illusion of motion particularly rotatory sensation. Overlapping symptoms and terms such as dizziness, light headedness, giddiness and pre-syncope make it challenging to achieve a proper diagnosis. Aim: To study the clinical profile and revisit the various aetiological factors for vertigo in patients with actual sensation of rotatory motion seen in contemporary Otolaryngology practice. Materials and Methods: The present study was a cross-sectional observational study carried out over a period of 12 months in the Department of Otorhinolaryngology at a tertiary care centre. One-hundred and ten cases complaining of the sense of rotation of either head or their surroundings with at least a single episode in preceding one month were included. Comprehensive otological and vestibular evaluation was done. Each patient was subjected to thorough clinical vestibular and laboratory tests. Subjects with known cervical spine disease, neurological disorders and cardiac ailments were excluded. Statistical analysis was done and Chi-square test was applied. Results: The mean age of patients in the study was 49.75 years with a male to female ratio of 1:1. Majority of the patients (90%) presented with acute onset of vertigo. The total duration of symptoms most commonly observed ranged between one week to one month. Nearly, all patients had intermittent character of vertigo. The duration of each episode in most of the patients ranged between 1 minute to 10 minutes. Maximum patients (90.9%) were observed with intensity of vertigo as mild and moderate type (Level II and III SVVSLCRE). Positional variation was observed in 64.5% of the patients. The most common aetiological diagnosis deduced from the study was benign paroxysmal positional vertigo (30.4%) followed by orthostatic hypotension (17.9%) and Meniere’s disease (13.4%). Conclusion: The most common aetiological factor of vertigo was found to be benign paroxysmal positional vertigo, which can be effectively treated by performing Epley’s maneuver. Orthostatic hypotension has been observed as an important cause liable to be missed by otologists. The management of vertigo must be directed by a meticulous work up of aetiologies and should not be treated under a blanket regimen.

Prognosis of patients with benign paroxysmal positional vertigo treated with repositioning manoeuvres

The Journal of Laryngology & Otology ◽

10.1017/s0022215106000958 ◽

2006 ◽

Vol 120 (7) ◽

pp. 528-533 ◽

Cited By ~ 25

Author(s):

S Korres ◽

D G Balatsouras ◽

E Ferekidis

Keyword(s):

Treatment Outcome ◽

Prognostic Factors ◽

Retrospective Study ◽

Duration Of Symptoms ◽

Repeat Treatment ◽

Positional Vertigo ◽

Small Subgroup ◽

Duration Of Disease ◽

Objective: To evaluate the prognostic factors in benign paroxysmal positional vertigo (BPPV) treated with canalith repositioning procedures (CRPs).Material and methods: Retrospective study of consecutive BPPV cases diagnosed over three years. All patients underwent a complete otolaryngologic, audiologic and neurotologic evaluation. The appropriate CRP was performed, depending on the type of BPPV. Prognostic factors studied included age, sex, aetiology, duration of disease, abnormal electronystagmographic findings, canal involvement, improper performance of manoeuvres, response on first or repeat treatment, and presence of recurrences.Results: One hundred and fifty-five patients were studied, 66 men and 89 women, with mean ages of 58.7 and 60.4 years, respectively. Age and the involvement of two canals or bilateral disease had an effect on initial treatment outcome and were correlated to increased recurrences but not to repeat treatment outcome. Secondary BPPV, abnormal electronystagmographic findings and improper performance of manoeuvres had a significant effect both on initial and repeat treatment, but not on recurrences. Sex and duration of symptoms had no effect.Conclusion: Canalith repositioning procedures provide fast and long-lasting treatment of BPPV in most patients. However, in a small subgroup of patients, failures may be noticed that may be attributed to various prognostic factors.

Benign paroxysmal positional vertigo may be the most common cause of dizziness in emergency department

Journal of the Neurological Sciences ◽

10.1016/j.jns.2015.08.625 ◽

2015 ◽

Vol 357 ◽

pp. e181

Author(s):

W.Y. Qiao ◽

J.G. Liu ◽

H. Zeng ◽

W.H. Jia ◽

B. Liu ◽

...

Keyword(s):

Emergency Department ◽

Common Cause ◽

Positional Vertigo ◽

Incidence of Benign Paroxysmal Positional Vertigo in Head Injury Patients

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i48a33237 ◽

2021 ◽

pp. 188-194

Author(s):

Celastina Synthia ◽

. Rameshwar

Keyword(s):

Head Injury ◽

Traffic Accidents ◽

Road Traffic ◽

Tertiary Care ◽

Care Hospital ◽

Female Ratio ◽

Posterior Canal ◽

Positional Vertigo ◽

Background: Traumatic brain injury is a common secondary cause of Benign Paroxysmal Positional Vertigo(BPPV). Objective: To determine the incidence and clinical profile of patients with BPPV in mild and moderate head injury. Materials and Methods: A prospective observational study done in patients admitted with mild and moderate head injury who developed BPPV from January 2020 to March 2020 in a tertiary care hospital of South India. Demographic and clinical parameters were noted and were treated with canalith repositioning procedures. Results: Among 42 patients admitted with mild and moderate head injury, 9(21.4%) were diagnosed with BPPV in the follow up. The male female ratio was 2.5:1. The mean age was 44 ±21.4years.Two wheeler accidents contributed to nearly half of (55.6%) traumatic BPPV. Posterior canal was commonly involved in 7(77.8%) followed by horizontal in 2 (22.2%).The type of head injury was mild in 7 (77.8%) and moderate in 2 (22.2%) in traumatic BPPV patients. 5 (55.6%) patients with BPPV had abnormal findings in neuroimaging. 4 (44.4%) patients developed recurrent BPPV in our cohort. Conclusion: The incidence of traumatic BPPV was 21.4% in our study. Road traffic accidents due to two wheeler accidents were the common mode of head trauma. Posterior canal was commonly involved in three fourth of cases. Recurrence of vertigo was documented in 4 (44.4%).

Effects of cranial osteopathic techniques in the symptoms of benign positional paroxistic vertical

Manual Therapy Posturology & Rehabilitation Journal ◽

10.17784/mtprehabjournal.2020.18.788 ◽

2020 ◽

Vol 18 ◽

pp. 1-5

Author(s):

Otávio Augusto do Nascimento Oliveira ◽

Laiana Sepúlveda de Andrade Mesquita ◽

Maurício Rocha Mendes ◽

Lílian Maria Magalhães Costa de Oliveira ◽

Laís Cristina Almeida

Keyword(s):

Statistical Analysis ◽

Intervention Group ◽

Control Group ◽

Common Cause ◽

A Value ◽

Positional Vertigo ◽

Before And After ◽

Temporal Bones ◽

Background: The benign paroxysmal positional vertigo (BPPV) is the most common cause of dizziness among the population. The osteopathy is a practice of manual therapy which is guided by a holistic perspective of human being, the cranial osteopathy affirms that the respective bones of the cranium represent mobility. Objective: To investigate the effect of the cranial osteopathy techniques on the benign paroxysmal positional vertigo. Methods: The current study included 20 female subjects, each one of them with benign paroxysmal positional vertigo, distributed in two groups, an intervention group and a control group (placebo); in order to detect the BPPV, was applied the Dix-Hallpike test before and after the interventions. Three techniques of cranial osteopathy were used on the structures related to vestibule and to the temporal bones: mobilization of temporal bones, tensioning of cerebellar tentorium and mobilization of eyeball. All statistical analyzes were performed using the GraphPad Prism 6.0 software (GraphPad Software, CA).Results: Among the intervention group, 7 of 10 individuals were negative to the Dix-Hallpike test, whilst individuals of the control group remained positive to the test. In the statistical analysis verified that the intervention with osteopathic techniques had a significant effect in compared to the control group, with a value p=0.0261. Conclusion: The cranial osteopathy appears to be able of produce effects on the vestibular activity, whereas were able to reduce, in a significant means, the symptoms concerning to BPPV.

Effect of vitamin D levels in benign paroxysmal positional vertigo

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20212355 ◽

2021 ◽

Author(s):

Shweta Sawant ◽

Taranath Nandini ◽

Rajashree Partabad

Keyword(s):

Vitamin D ◽

Semicircular Canals ◽

Vitamin D Supplementation ◽

High Rate ◽

Common Cause ◽

Rehabilitation Therapy ◽

Positional Vertigo ◽

Vitamin D Levels ◽

Background: Benign paroxysmal positional vertigo (BPPV) is a common cause of disabling vertigo with a high rate of recurrence. BPPV is the most common cause of neurotological disorder. It is caused by dislodged otoconia which fall from the utricular macula and float into the semicircular canals there by making them sensitive to gravity. It has been shown that elderly people may suffer from unrecognized, chronic BPPV. Patients with unrecognized BPPV were more likely to have reduced activity of daily living scores, to have sustained a fall in the previous 3 months and to have depression.Methods: A prospective study of 100 patients with clinical diagnosis of BPPV visiting Navodaya medical college and hospital between June 2019 to May 2020 were included in the study.Results: Patients taking both vitamin D supplementation and rehabilitation therapy improved better than patients taking rehabilitation therapy alone.Conclusions: Both rehabilitation therapy and supplementation of vitamin D is helpful in patients with vitamin D deficient BPPV patients.

Efficacy of Epley maneuver in treatment of benign paroxysmal positional vertigo of the posterior semicircular canal

Vojnosanitetski pregled ◽

10.2298/vsp1208669b ◽

2012 ◽

Vol 69 (8) ◽

pp. 669-674 ◽

Cited By ~ 3

Author(s):

Snezana Babac ◽

Nenad Arsovic

Keyword(s):

Success Rate ◽

Semicircular Canal ◽

Spontaneous Nystagmus ◽

Posterior Semicircular Canal ◽

Duration Of Symptoms ◽

Positional Vertigo ◽

Epley Maneuver ◽

Repositioning Maneuver ◽

Background/Aim. Benign paroxysmal positional vertigo is one of the most frequent peripheral vestibular system disorders. The aim of this study was to examine the efficacy of the Epley maneuver in treating benign paroxysmal positional vertigo of the posterior semicircular canal (p- BPPV) and to discover possible causes of failure. Methods. This prospective study included 75 patients. In all the cases medical history showed and the positioning Dix-Hallpike test confirmed the diagnosis of p-BPPV. We also performed clinical ENT examination, searching for spontaneous nystagmus, vestibulospinal tests, caloric test, and audiometry. All the patients were treated by the modified Epley canalith repositioning maneuver. The patients were followed up at the intervals of seven and, fourteen days, and one, tree, and six months and one year. The maneuver was repeated if vertigo and nystagmus on control positioning test persisted. The transition from positive into negative Dix Hallpike test after one or two Epley maneuver was considered as success in treatment. Results. After the initial Epley maneuver the recovery rate was 90.7%, and after the second 96%. In three (4%) patients with secondary p-BPPV, symptoms did not cease even after the second repositioning maneuver. The etiology of p-BPPV had a significant effect on the maneuver?s success rate (p < 0.01), whereas duration of symptoms, age and gender had no effect (p > 0.05). After a successful treatment 11 (14.66%) patients had recurrent attack of BPPV during the first year. Conclusion. The Epley maneuver is very successful repositioning procedure in treating p- BPPV. The patients with idiopathic form p-BPPV showed higher success rate with Epley maneuver than those with secondary p-BPPV.

Short- and Long-Term Outcomes of Canalith Repositioning for Benign Paroxysmal Positional Vertigo

Otolaryngology ◽

10.1016/s0194-5998(00)70190-2 ◽

2000 ◽

Vol 122 (5) ◽

pp. 647-653 ◽

Cited By ~ 102

Author(s):

Robert A. Nunez ◽

Stephen P. Cass ◽

Joseph M. Furman ◽

G. Richard Holt

Keyword(s):

Recurrence Rate ◽

Duration Of Symptoms ◽

Telephone Interviews ◽

Positional Vertigo ◽

Kaplan Meier ◽

Study Population ◽

Short And Long Term ◽

Canalith Repositioning Procedure ◽

This is a prospective, nonrandomized study of the canalith repositioning procedure (CRP) for treatment of benign paroxysmal positional vertigo (BPPV). CRP was used to treat 168 patients with BPPV. Patient data were gathered by yearly telephone interviews to determine whether symptoms of position-induced vertigo had returned. After 1 or 2 treatment sessions 91.3% of patients reported complete symptom resolution. Average follow-up for the study population after the initial treatment was 26 months. A recurrence rate of 26.8% was found among those patients who initially reported resolution of symptoms after CRP. Application of recurrence data to a Kaplan-Meier estimation suggests a 15% recurrence rate per year of BPPV, with a 50% recurrence rate of BPPV at 40 months after treatment. There was no significant association between cure or recurrence rate and sex, age, duration of symptoms, presumed cause, or treating physician.

Epley's Maneuver in Benign Paroxysmal Positional Vertigo: Series of Cases Reports

Arquivos Internacionais de Otorrinolaringologia ◽

10.1590/s1809-48722011000200005 ◽

2011 ◽

Vol 15 (02) ◽

pp. 151-155 ◽

Cited By ~ 1

Author(s):

Luciana Lozza de Moraes Marchiori ◽

Juliana Jandre Melo ◽

Caroline Ravaghani Romagnoli ◽

Thaís Butieri de Oliveira

Keyword(s):

Treatment Method ◽

Therapeutic Procedure ◽

Common Cause ◽

Positional Vertigo ◽

Repositioning Maneuver ◽

Summary Introduction: Benign paroxysmal positional vertigo (BPPV) is probably the most common cause of vertigo in women. Objective: To report the result of Epley's maneuver when treating BPPV patients. Method: Study of a series of 9-month-long cases of five female individuals aged between 46 and 64 with BPPV, who were submitted to Epley's maneuver at a scholar clinics, having the positive Dix-Hallpike maneuver at the first consultation as an inclusion criterion, and evaluations were repeated in a six and nine-month term. Results: Only one Epley's maneuver, as the only therapeutic procedure, was enough to eliminate nystagmus and positional vertigo in 4 patients, who did not show a positive Dix-Hallpike maneuver in the two reevaluations performed. Only one patient showed BPPV in the first reevaluation of the study term, and nystagmus reoccurred in the second evaluation only. Conclusion: Epley's repositioning maneuver proved to be a simple and effective BPPV treatment method for this study's patients at length.