Benign Paroxysmal Positional Vertigo Treated with Maneuvers to Change Head Position.

Background: Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo in adults and is a result of otolithic particles or debris that become free floating within a semicircular canal or adhere to the cupula. Characteristics of BPPV include brief episodes of latent onset vertigo that occur with changes in head position, transient rotary nystagmus beating toward the dependent ear, and reversed nystagmus upon sitting up. Both the vertigo and nystagmus fatigue quickly while maintaining the same head position. The BPPV may be classified as objective or subjective. Objective BPPV presents all the aforementioned symptoms whereas subjective BPPV presents all the symptoms without nystagmus. The accepted method of treatment for objective BPPV is canalith repositioning maneuvers (CRM); however, CRM are not traditionally used as the method of treatment for cases of subjective BPPV. Purpose: The purpose of the study was to determine if the subjective report of dizziness using the Dizziness Handicap Inventory (DHI) was different in patients with objective and subjective BPPV and to determine if the two groups showed similar improvements in perceived dizziness handicap following CRM treatment. Research Design: The present study utilized a retrospective, repeated measures design. Study Sample: Sixty-three adults with BPPV that were given the DHI both before and after CRM treatment. Data Collection and Analysis: Pre and post DHI results were analyzed for participants with objective versus subjective BPPV. A five-question DHI subscale was also analyzed between the groups. Results: A significant difference was noted between initial and posttreatment DHI scores for patients in both the subjective and objective groups when using the full-scale and subscale DHI. No significant difference was noted between groups for their initial or posttreatment DHI scores. The two groups also did not differ significantly in their initial or posttreatment DHI subscale scores. Conclusions: The results of the study indicated that individuals with both objective and subjective BPPV demonstrated significant improvement in DHI scores following CRM treatment. Additionally, there was no difference in DHI improvement for the subjective versus objective group suggesting CRM are effective for both subjective BPPV and objective BPPV. This improvement in DHI scores was also noted in the five-question DHI subscale with no significant difference noted between groups. These findings combined with previous studies suggest the presence or absence of nystagmus during Dix-Hallpike maneuvers is not related to the effectiveness of treatment using CRM.

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The Dix-Hallpike and Modified Epley Manoeuvres in the diagnosis and management of Benign Paroxysmal Positional Vertigo (BPPV)

Acute Medicine Journal ◽

10.52964/amja.0063 ◽

2004 ◽

Vol 3 (1) ◽

pp. 36-37

Author(s):

Matthew Clarke ◽

◽

Liz Stallworthy ◽

J Dulay ◽

◽

...

Keyword(s):

Benign Paroxysmal Positional Vertigo ◽

Head Position ◽

Balance Disorders ◽

Diagnosis And Management ◽

Positional Vertigo ◽

Rapid Changes ◽

Common Balance ◽

Paroxysmal Positional Vertigo

Benign Paroxysmal Positional Vertigo (BPPV) is one of the most common balance disorders and one of the easiest to diagnose and treat. It is characterised by short lived episodes of vertigo and geotropic rotatory nystagmus, which occur a few seconds after rapid changes in head position. The vertigo usually lasts no more than a minute and the symptoms reduce in severity with repetitions of the evoking movement.

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Relationship between the affected ear in benign paroxysmal positional vertigo and habitual head-lying side during bedrest

The Journal of Laryngology & Otology ◽

10.1017/s002221510600082x ◽

2006 ◽

Vol 120 (7) ◽

pp. 534-536 ◽

Cited By ~ 15

Author(s):

B Ö Çakir ◽

İ Ercan ◽

Z A Çakir ◽

Ş Civelek ◽

S Turgut

Keyword(s):

Benign Paroxysmal Positional Vertigo ◽

Prospective Trial ◽

Head Position ◽

Posterior Semicircular Canal ◽

Positional Vertigo ◽

Head Positioning ◽

Falling Asleep ◽

The Right ◽

Lateral Head ◽

Paroxysmal Positional Vertigo

Objective: To assess the association between the habitual head position during bedrest and the affected ear in benign paroxysmal positional vertigo (BPPV).Study design: Prospective trial of patients with active BPPV of the posterior semicircular canal, confirmed on physical examination.Methods: Seventy-five patients were asked to explain the head position and lying side they were accustomed to before falling asleep in bed.Results: Fifty patients (67 per cent) habitually adopted a lateral head position during bedrest. The ear affected by BPPV was found to be consistent with the head-lying side during bedrest in 43 cases (86 per cent) (29 cases for the right ear and 14 cases for the left ear).Conclusion: Habitual lateral head-positioning during bedrest can be a major factor leading to the development of BPPV in the ipsilateral ear.

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Effect of Sitting Position vs. Supine Position With the Head Turned to the Affected Side on Benign Paroxysmal Positional Vertigo Fatigue

Frontiers in Neurology ◽

10.3389/fneur.2021.705034 ◽

2021 ◽

Vol 12 ◽

Author(s):

Takao Imai ◽

Suetaka Nishiike ◽

Tomoko Okumura ◽

Noriaki Takeda ◽

Takashi Sato ◽

...

Keyword(s):

Supine Position ◽

Benign Paroxysmal Positional Vertigo ◽

Head Position ◽

Sitting Position ◽

Positional Nystagmus ◽

Positional Vertigo ◽

Affected Side ◽

Group A ◽

Group B ◽

Paroxysmal Positional Vertigo

Objective: In benign paroxysmal positional vertigo (BPPV), positional nystagmus becomes generally weaker when the Dix–Hallpike test is repeated. This phenomenon is termed BPPV fatigue. We previously reported that the effect of BPPV fatigue deteriorates over time (i.e., the positional nystagmus is observed again after maintaining a sitting head position). The aim of this study was to investigate whether the effect of BPPV fatigue attenuates after maintaining a supine position with the head turned to the affected side.Methods: Twenty patients with posterior-canal-type BPPV were assigned to two groups. Group A received Dix–Hallpike test, were returned to the sitting position (reverse Dix–Hallpike test) with a sitting head position for 10 min, and then received a second Dix–Hallpike test. Group B received Dix–Hallpike test, were kept in the supine position with the head turned to the affected side for 10 min, and then received reverse Dix–Hallpike test followed by the second Dix–Hallpike test. The maximum slow phase eye velocity (MSPEV) of positional nystagmus induced by the first, reverse, and second Dix–Hallpike test were analyzed.Results: The ratio of MSPEV of the positional nystagmus induced by the second Dix–Hallpike test relative to the first Dix–Hallpike test was significantly smaller in group B than that in group A. There was no difference in the MSPEV of the positional nystagmus induced by the reverse Dix–Hallpike test between group A and B.Conclusions: The effect of BPPV fatigue is continued by maintaining a supine position with the head turned to the affected side, while the effect is weakened by maintaining a sitting head position. On the basis of the most widely accepted theory of the pathophysiology of BPPV fatigue, in which the particles become dispersed along the canal during head movement in the Dix–Hallpike test, we found an inconsistency whereby the dispersed otoconial debris return to a mass during the sitting position but do not return to a mass in the supine position with the head turned to the affected side. Future studies are required to determine the exact pathophysiology of BPPV fatigue.Classification of Evidence: 2b.

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Benign paroxysmal positional vertigo

Journal of Neurosciences in Rural Practice ◽

10.4103/0976-3147.80091 ◽

2011 ◽

Vol 02 (01) ◽

pp. 109-110 ◽

Cited By ~ 2

Author(s):

Xiang-Dong Guo

Keyword(s):

Recurrence Rate ◽

Successful Treatment ◽

Benign Paroxysmal Positional Vertigo ◽

Head Position ◽

Clinical Disorder ◽

Positional Vertigo ◽

Multiple Recurrences ◽

Unnecessary Testing ◽

Paroxysmal Positional Vertigo

ABSTRACTBenign paroxysmal positional vertigo (BPPV) is a common clinical disorder characterized by brief recurrent spells of vertigo often brought about by certain head position changes as may occur with looking up, turning over in bed, or straightening up after bending over. It is important to understand BPPV not only because it may avert expensive and often unnecessary testing, but also because treatment is rapid, easy, and eff ective in >90% of cases. The diagnosis of BPPV can be made based on the history and examination. Patients usually report episodes of spinning evoked by certain movements, such as lying back or getting out of bed, turning in bed, looking up, or straightening after bending over. At present, the generally accepted recurrence rate of BPPV after successful treatment is 40%–50% at 5 years of average follow-up. There does appear to be a subset of individuals prone to multiple recurrences..

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Variants of benign paroxysmal positional vertigo in relation to head position during sleep

Journal of Vestibular Research ◽

10.3233/ves-180616 ◽

2021 ◽

pp. 1-9

Author(s):

Kohichiro Shigeno ◽

Hideaki Ogita ◽

Kazuo Funabiki

Keyword(s):

Benign Paroxysmal Positional Vertigo ◽

Head Position ◽

Unknown Etiology ◽

Lateral Canal ◽

Positional Vertigo ◽

Light Cupula ◽

The Right ◽

Head Positions ◽

The Relationship ◽

Paroxysmal Positional Vertigo

BACKGROUND: Patients with posterior- and lateral-(canal)-benign paroxysmal positional vertigo (BPPV)-canalolithiasis sleep in the affected-ear-down head position. Posterior-BPPV-canalolithiasis typically affects the right than left ear; sleeping in the right-ear-down head position may be causal. OBJECTIVE: To investigate the relationship between habitual head position during sleep and the onset of BPPV variants. METHODS: Among 1,170 cases of BPPV variants with unknown etiology, the affected ears, habitual head positions during sleep based on interviews, and relationships among them were investigated. RESULTS: Posterior-BPPV-canalolithiasis and lateral-BPPV-canalolithiasis-geotropic affected the right ear significantly more often. Significantly more patients with posterior-BPPV-canalolithiasis and lateral-BPPV-canalolithiasis-apogeotropic habitually slept in the right-ear-down head position. Patients with posterior- and lateral-BPPV-canalolithiasis and light cupula were more likely to sleep habitually in the affected-ear-down position than in the healthy-ear-down head position; no relationship was observed in patients with posterior- and lateral-BPPV-cupulolithiasis. In patients with posterior-BPPV-canalolithiasis and lateral-BPPV-canalolithiasis-geotropic, the proportion of right-affected ears in those sleeping habitually in the right-ear-down head position was significantly greater than that for the left-affected ear. CONCLUSIONS: A habitual affected-ear-down head position during sleep may contribute to BPPV-canalolithiasis and light cupula onset, but not BPPV-cupulolithiasis onset. However, habitual sleeping in the right-ear-down head position cannot explain the predominance of right-affected ears.

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Reversible Canalith Jam of the Horizontal Semicircular Canal Mimicking Cupulolithiasis

Annals of Otology Rhinology & Laryngology ◽

10.1177/00034894211007245 ◽

2021 ◽

pp. 000348942110072

Author(s):

Olivia A. Kalmanson ◽

Davis M. Aasen ◽

Samuel P. Gubbels ◽

Carol A. Foster

Keyword(s):

Literature Review ◽

Semicircular Canal ◽

Benign Paroxysmal Positional Vertigo ◽

Head Position ◽

Positional Nystagmus ◽

Horizontal Semicircular Canal ◽

Horizontal Canal ◽

Positional Vertigo ◽

Horizontal Head ◽

Paroxysmal Positional Vertigo

Objective: To describe a case of benign paroxysmal positional vertigo (BPPV) resulting in reversible horizontal semicircular canalith jam successfully treated with horizontal canal occlusion. A brief literature review of similar cases was performed. Methods: Case report and literature review. Results: A 68-year-old female presented with apogeotropic positional nystagmus, attributed to reversible horizontal canalith jam mimicking cupulolithiasis that was refractory to tailored repositioning maneuvers across months. She was unable to work due to the severity of her symptoms. She underwent surgical occlusion of the affected canal with immediate resolution of her symptoms. A literature review revealed similar cases of canalith jam mimicking cupulolithiasis. Conclusions: Reversible canalith jam, in which particles moving with horizontal head position alternate between obstructing the semicircular canal and resting on the cupula, can mimic signs of cupulolithiasis. This variant of BPPV can be effectively managed with surgical canal occlusion should symptoms fail to resolve after tailored repositioning maneuvers.

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