Treatment of Benign Paroxysmal Positional Vertigo: Necessity of Postmaneuver Patient Restrictions

Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo, resulting from migration of otoconia into the semicircular canals. Several treatment methods involving positioning maneuvers that return the otoconia to the utricle have been described. Following treatment, most patients are provided with a variety of activity restrictions. Previous studies suggest that, overall, BPPV treatment may be successful without these restrictions. The purpose of this study was to determine the necessity of postmaneuver restrictions using an experimental and control group with participants matched for age, gender, involved ear, and symptoms. A canalith repositioning maneuver was used to treat the BPPV. During postmaneuver instruction, the 21 participants assigned to the restricted group were provided with typical activity restrictions. Twenty-one participants assigned to the nonrestricted group were given no postmaneuver restrictions. Only one participant in the restricted group and two participants in the nonrestricted group were not clear at the one-week follow-up appointment. Results indicated that postmaneuver restrictions do not improve treatment efficacy.

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

Otolaryngology ◽

10.1016/j.otohns.2009.04.006 ◽

2009 ◽

Vol 141 (2) ◽

pp. 232-236 ◽

Cited By ~ 14

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.

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Argon laser irradiation of the semicircular canal in two patients with benign paroxysmal positional vertigo

The Journal of Laryngology & Otology ◽

10.1258/002221502760238046 ◽

2002 ◽

Vol 116 (9) ◽

pp. 723-725 ◽

Cited By ~ 10

Author(s):

Yasuya Nomura

Keyword(s):

Laser Irradiation ◽

Benign Paroxysmal Positional Vertigo ◽

Semicircular Canals ◽

Argon Laser ◽

Laser Device ◽

Positional Vertigo ◽

Long Term Follow Up ◽

Paroxysmal Positional Vertigo

The results of long-term follow-up after surgical treatment of two patients with intractable benign paroxysmal positional vertigo are reported. Argon laser irradiation of the blue-lined posterior and lateral semicircular canals in one patient, and of only the posterior canal in the other was performed seven and six years ago, respectively. Argon laser irradiation was carried out 10 times in succession three mm along the canal to occlude it. The power applied each time was 1.5.W on the dial of the laser device for 0.5.sec. Relief of vertigo was noted on the second post-irradiation day. There has been no recurrence of vertigo in these patients.

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

Praxis of Otorhinolaryngology ◽

10.5606/kbbu.2021.73645 ◽

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.

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Residual Dizziness in Elderly Patients after Benign Paroxysmal Positional Vertigo

ORL ◽

10.1159/000516961 ◽

2021 ◽

pp. 1-8

Author(s):

Yaser Said Çetin ◽

Aydın Çağaç ◽

Ufuk Düzenli ◽

Nazım Bozan ◽

Sadi Elasan

Keyword(s):

Benign Paroxysmal Positional Vertigo ◽

Negative Impact ◽

Control Group ◽

Control Groups ◽

Positional Vertigo ◽

Obesity And Diabetes ◽

Epley Maneuver ◽

And Control ◽

Mean Time ◽

Paroxysmal Positional Vertigo

Introduction: The aim of this study was to compare the effects of Brandt-Daroff (BD) exercise and shopping exercise (SE) on the resolution of residual dizziness (RD) in patients with benign paroxysmal positional vertigo (BPPV) following a successful modified Epley canalith repositioning maneuver (CRP). Methods: This single-blind, randomized clinical trial included patients with posterior semicircular canal type of BPPV. Following the modified Epley maneuver, patients that experienced RD were randomly assigned to 3 groups: (i) BD, (ii) SE, and (iii) control groups. Primary outcomes were quantified using the Dizziness Handicap Inventory (DHI). Results: Following CRP, 240 (63%) participants experienced RD. All these patients were followed up weekly for RD. After the resolution of RD, patients were followed up monthly for recurrence. Mean time to recovery was 16.4 ± 10 (range, 5–49) days in the BD group, 11.5 ± 4.6 (range, 6–32) days in the SE group, and 23.4 ± 16.8 (range, 6–89) days in the control group. The SE group recovered significantly faster than the BD and control groups (p < 0.001). Baseline emotional DHI (E-DHI) scores were significantly correlated with the duration of pre-CRP symptoms (p < 0.001). Correlation analysis indicated that patients with obesity and diabetes mellitus (DM) recovered later than patients without these comorbidities. Conclusion: We found that RD improved significantly in the SE group compared to the BD and control groups. Additionally, a significant relationship was established between RD and high anxiety levels and DM, and obesity had a negative impact on the resolution of RD.

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RELATIONSHIP BETWEEN MIGRAINE AND THE OCCURANCE OF BENIGN PAROXYSMAL POSITIONAL VERTIGO (BPPV)

International journal of Research science and Management - September-2020 ◽

10.29121/ijrsm.v7.i8.2020.10 ◽

2020 ◽

Vol 7 (8) ◽

pp. 70-74

Keyword(s):

Benign Paroxysmal Positional Vertigo ◽

Control Group ◽

Case Group ◽

Vestibular Disorder ◽

Inconsistent Result ◽

Positional Vertigo ◽

History Of ◽

And Control ◽

The Relationship ◽

Paroxysmal Positional Vertigo

Introduction: Benign Paroxysmal Positional Vertigo (BPPV) is the most common vestibular disorder. Migren also common in general population. Several studies have shown inconsistent result for the relationship between migraine and BPPV.This study aims to determine relationship between migraine and the occurance of BPPV Methode: This case control study selected subjects with consecutive sampling techniques. Sampling was conducted at H. Adam Malik General Hospital Medan and network hospital. Thirty two patients with BPPV were selected as case group and matched with thirty two patients without BPPV as control group. Migraine history was taken in medical record. This study began in March until June 2020. Result: The majority of case and control group were female with eighteen subjects (56.2%) and median age about 60.5 (27-78) years old. We found eight patients (25.0%) with history of migraine in case group and in control group four patients (12,5%) with history of migraine. There is no significance relationship in migraine and the occurance of BPPV with p= 0.33 and OR=2.33 (95% CI = 0.62-8.71) Conclusion: There is no relationship between migraine and the occurance of BPPV.

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Study on Platelet Indices in Benign Paroxysmal Positional Vertigo

Research in Vestibular Science ◽

10.21790/rvs.2021.20.4.141 ◽

2021 ◽

Vol 20 (4) ◽

pp. 141-146

Author(s):

Byeong Min Lee ◽

Chae Dong Yim ◽

Dong Gu Hur ◽

Seong-Ki Ahn

Keyword(s):

Benign Paroxysmal Positional Vertigo ◽

Control Group ◽

Platelet Distribution Width ◽

Platelet Volume ◽

Distribution Width ◽

Platelet Indices ◽

Positional Vertigo ◽

Common Causes ◽

And Control ◽

Paroxysmal Positional Vertigo

Objectives: Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of dizziness. Even though the etiology of BPPV has been widely studied, the exact mechanism remains still unclear. One of the possible factors explaining the pathophysiology of BPPV is ischemia of vestibule. In the present study, we have focused on the platelet indices including mean platelet volume (MPV), platelet distribution width (PDW), and platelet crit (PCT) to assess a risk of vestibule ischemia causing BPPV.Methods: From January 2021 to March 2021, a retrospective review was performed on 39 patients diagnosed with BPPV through vestibular nystagmography. For each platelet indices, a comparative analysis was conducted between the patient group and control group.Results: There were no significant differences when the platelet, MPV, PDW, and PCT values were compared between the study and control group. Rather, the control group showed higher PDW value than the study group.Conclusions: Ischemia of vestibule is one of the well-known causes of BPPV, but the current study showed that BPPV cannot be explained by the vestibule ischemia itself. Further studies are needed to identify the potential of ischemia regarding BPPV by approaching with other methods with a large study group.

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Serum otolin-1 as a biomarker for benign paroxysmal positional vertigo: a case-control study

The Journal of Laryngology & Otology ◽

10.1017/s0022215121001274 ◽

2021 ◽

pp. 1-4

Author(s):

D V K Irugu ◽

A Singh ◽

H Yadav ◽

H Verma ◽

R Kumar ◽

...

Keyword(s):

Serum Level ◽

Benign Paroxysmal Positional Vertigo ◽

Case Control Study ◽

Serum Levels ◽

Case Control ◽

Control Group ◽

Positional Vertigo ◽

The Difference ◽

Control Study ◽

Paroxysmal Positional Vertigo

Abstract Objectives This study aimed to evaluate serum otolin-1 levels in patients with benign paroxysmal positional vertigo and to compare these levels with healthy individuals. Method This was a case-control study. After obtaining institutional ethical committee clearance, the serum level of otolin-1 was calculated in adult individuals (18–75 years old) who were divided into group 1 (patients presenting with benign paroxysmal positional vertigo) and group 2 (healthy patients without benign paroxysmal positional vertigo as the control group). Data analysis was carried out to compare the serum levels in the cases and controls. A p-value less than 0.05 was considered significant. Results A total of 70 age-matched individuals (cases, n = 40; controls, n = 30) were included in the study. The mean serum level of otolin-1 was 636.8 pg/ml (range, 259–981 pg/ml) in the group of patients with benign paroxysmal positional vertigo and 236.2 pg/ml (range, 189–370 pg/ml) in the control group. The difference was statistically significant (p = 0.0000). Conclusion The serum levels of otolin-1 in patients with benign paroxysmal positional vertigo are significantly higher compared with individuals without benign paroxysmal positional vertigo.

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Persistent Upbeat Positional Nystagmus in a Patient with Bilateral Posterior Canal Benign Paroxysmal Positional Vertigo

Case Reports in Otolaryngology ◽

10.1155/2019/4281641 ◽

2019 ◽

Vol 2019 ◽

pp. 1-3

Author(s):

Akihide Ichimura ◽

Shigeto Itani

Keyword(s):

Supine Position ◽

Benign Paroxysmal Positional Vertigo ◽

Semicircular Canals ◽

Downbeat Nystagmus ◽

Positional Vertigo ◽

Head Roll ◽

The Right ◽

Upbeat Nystagmus ◽

Torsional Nystagmus ◽

Paroxysmal Positional Vertigo

Here, we report a patient with persistent positional upbeat nystagmus in a straight supine position with no evident abnormal central nervous system findings. A 43-year-old woman with rotatory positional vertigo and nausea visited our clinic 7 days after the onset. Initially, we observed persistent upbeat nystagmus in straight supine position with a latency of 2 s during the supine head roll test. However, an upbeat nystagmus disappeared on turning from straight to the left ear-down supine position, and while turning from the left to right ear-down position, an induced slight torsional nystagmus towards the right for >22 s was observed. In the Dix–Hallpike test, the left head-hanging position provoked torsional nystagmus towards the right for 50 s. In prone seated position, downbeat nystagmus with torsional component towards the left was observed for 45 s. Neurological examination and brain computed tomography revealed no abnormal findings. We speculated that persistent positional upbeat nystagmus in this patient was the result of canalolithiasis of benign paroxysmal positional vertigo of bilateral posterior semicircular canals.

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Serum levels of superoxide dismutases in patients with benign paroxysmal positional vertigo

Bioscience Reports ◽

10.1042/bsr20193917 ◽

2020 ◽

Vol 40 (5) ◽

Author(s):

Jing Li ◽

Rui Wu ◽

Bin Xia ◽

Xinhua Wang ◽

Mengzhou Xue

Keyword(s):

Serum Level ◽

Semicircular Canal ◽

Benign Paroxysmal Positional Vertigo ◽

Serum Levels ◽

Superoxide Dismutases ◽

Binary Logistic Regression Analysis ◽

Horizontal Semicircular Canal ◽

Positional Vertigo ◽

Paroxysmal Positional Vertigo

Abstract Objective: To investigate the possible role of superoxide dismutases (SODs) in the development of benign paroxysmal positional vertigo (BPPV) and recurrence events in a 1-year follow-up study. Methods: This was a prospective one-center study. A total of 204 patients with BPPV and 120 age-and sex matched healthy subjects were included. The levels of SOD between patients and control cases were compared. The levels of SOD between posterior semicircular canal (PSC) and horizontal semicircular canal (HSC) were also compared. In the 1-year follow-up, recurrence events were confirmed. The influence of SOD levels on BPPV and recurrent BPPV were performed by binary logistic regression analysis. Results: The serum levels of SOD in patients with BPPV were lower than in those control cases (P<0.001). Levels of SOD did not differ in patients with PSC and HSC (P=0.42). As a categorical variable, for per interquartile range (IQR) increment of serum level of SOD, the unadjusted and adjusted risks of BPPV would be decreased by 72% (with the odds ratio [OR] of 0.28 [95% confidence interval (CI): 0.21–0.37], P<0.001) and 43% (0.57 [0.42–0.69], P<0.001), respectively. Recurrent attacks of BPPV were reported in 50 patients (24.5%). Patients with recurrent BPPV had lower levels of SOD than in patients without (P<0.001). For per IQR increment of serum level of SOD, the unadjusted and adjusted risks of BPPV would be decreased by 51% (with the OR of 0.49 [95% CI: 0.36–0.68], P<0.001) and 24% (0.76 [0.60–0.83], P<0.001), respectively. Conclusion: Reduced serum levels of SOD were associated with higher risk of BPPV and BPPV recurrence events.

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Risk of benign paroxysmal positional vertigo in patients with depressive disorders: a nationwide population-based cohort study

BMJ Open ◽

10.1136/bmjopen-2018-026936 ◽

2019 ◽

Vol 9 (3) ◽

pp. e026936

Author(s):

Chiao-Lin Hsu ◽

Shih-Jen Tsai ◽

Cheng-Che Shen ◽

Ti Lu ◽

Yao-Min Hung ◽

...

Keyword(s):

Cohort Study ◽

Lupus Erythematosus ◽

Depressive Disorders ◽

Benign Paroxysmal Positional Vertigo ◽

Observation Time ◽

Research Database ◽

Positional Vertigo ◽

Increased Risk ◽

Paroxysmal Positional Vertigo

ObjectiveThe association between depression and benign paroxysmal positional vertigo (BPPV) remains debated. This study aimed to investigate the risk of BPPV in patients with depressive disorders.DesignLongitudinal nationwide cohort study.SettingNational health insurance research database in Taiwan.ParticipantsWe enrolled 10 297 patients diagnosed with depressive disorders between 2000 and 2009 and compared them to 41 188 selected control patients who had never been diagnosed with depressive disorders (at a 1:4 ratio matched by age, sex and index date) in relation to the risk of developing BPPV.MethodsThe follow-up period was defined as the time from the initial diagnosis of depressive disorders to the date of BPPV, censoring or 31 December 2009. Cox proportional hazard regression analysis was used to investigate the risk of BPPV by sex, age and comorbidities, with HRs and 95% CIs.ResultsDuring the 9-year follow-up period, 44 (0.59 per 1000 person-years) patients with depressive disorders and 99 (0.33 per 1000 person-years) control patients were diagnosed with BPPV. The incidence rate ratio of BPPV among both cohorts calculating from events of BPPV per 1000 person-years of observation time was 1.79 (95% CI 1.23 to 2.58, p=0.002). Following adjustments for age, sex and comorbidities, patients with depressive disorders were 1.55 times more likely to develop BPPV (95% CI 1.08 to 2.23, p=0.019) as compared with control patients. In addition, hyperthyroidism (HR=3.75, 95% CI 1.67–8.42, p=0.001) and systemic lupus erythematosus (SLE) (HR=3.47, 95% CI 1.07 to 11.22, p=0.038) were potential risk factors for developing BPPV in patients with depressive disorders.ConclusionsPatients with depressive disorders may have an increased risk of developing BPPV, especially those who have hyperthyroidism and SLE.

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