Recovery of Regular Daily Physical Activities Prevents Residual Dizziness after Canalith Repositioning Procedures

Objective: Residual dizziness is a disorder of unknown pathophysiology, which may occur after repositioning procedures for benign paroxysmal positional vertigo. This study evaluates the relationship between regular daily physical activity and the development of residual dizziness after treatment for benign paroxysmal positional vertigo. Study Design: Prospective observational cohort study. Setting: Academic university hospital. Methods: Seventy-one patients admitted with benign paroxysmal positional vertigo involving the posterior semicircular canal were managed with Epley’s procedure. Three days after successful treatment, the patients underwent a telephone interview to investigate vertigo relapse. If the patients no longer complained of vertigo, they were asked about symptoms consistent with residual dizziness. Subsequently, they were asked about the recovery of physical activities they regularly performed prior to the onset of vertigo. Results: Sixty-nine patients (age: 57.79 ± 15.05) were enrolled: five (7.24%) reported vertigo relapse whereas twenty-one of sixty-four non-relapsed patients (32.81%) reported residual dizziness. A significant difference in the incidence of residual dizziness was observed considering the patients’ age (p = 0.0003). Of the non-relapsed patients, 46 (71.88%) recovered their regular dynamic daily activities after treatment and 9 (19.57%) reported residual dizziness, while 12 of the 18 patients (66.67%) who did not resume daily activity reported residual symptoms (p = 0.0003). A logistic regression analysis showed a significant association between daily activity resumption and lack of residual dizziness (OR: 14.01, 95% CI limits 3.14–62.47; p = 0.001). Conclusions: Regardless of age, the resumption of regular daily physical activities is associated with a lack of residual dizziness.

COMPARISON OF EFFICACY OF EPLEY MANOEUVRE AND VESTIBULAR SEDDATIVE IN POSITIONAL VERTIGO

Objective: To carry out the comparison of the effectiveness of Epleys manoeuvre and Vestibular Sedative in the management of benign paroxysmal positional vertigo. Study Design: Quasi experimental study. Place and Duration of Study: Department of ENT, Combined Military Hospital Peshawar, from Jul 2019 to Dec 2020. Methodology: The study was conducted on 60 patients who were diagnosed Benign Paroxysmal Positional Vertigo by Dix Hallpike test. The patients were divided into 2 groups of 30 each. Group A was treated with vestibular sedative and group B was treated with Epleys manoeuvre. The examination of all patients was done on day 3, day 7 and day 14 and the results were documented. Results: The study revealed that the 30 cases which were managed by Epleys manoeuvre, 27 cases were completely symptom free after 14 days. Meanwhile from the 30 patients who were treated by oral vestibular sedation, only 5 patients had total recovery on 14th day. Chi square test was used to compare the results. The results showed that Epleys manoeuvre has greater efficacy in the treatment of Epleys man oeuvre than vestibular sedative. Conclusion: Epleys manoeuvre is more effective for the management of benign paroxysmal positional vertigo than vestibular sedative.

COMPARISON OF EFFICACY OF SEMONTS MANOEUVRE VERSUS VESTIBULAR SEDDATIVE IN POSITIONAL VERTIGO

Objective: To carry out the comparison of the effectiveness of Semont manoeuvre and Vestibular Sedative in the management of benign paroxysmal positional vertigo (BPPV). Study Design: Quasi experimental study. Place and Duration of Study: Department of ENT, Combined Military Hospital Peshawar Pakistan, from Jan to Jul 2020. Methodology: The study was conducted on 60 patients who were diagnosed Benign Paroxysmal Positional Vertigo by Dix Hallpike test. The patients were divided into 2 groups of 30 each. Group A was treated with vestibular sedative and group B was treated with Semont manoeuvre. The examination of all patients was done on day 3, day 7 and day 14 and the results were documented. Results: The study was conducted on 60 patients who were diagnosed benign paroxysmal positional vertigo by Dix Hallpike test the study revealed that the 30 cases which were treated by Semont manoeuvre, 25 cases were completely symptom free after 14 days. Meanwhile out of 30 cases which were managed by oral vestibular sedative, only 4 cases showed complete recovery after 14 days. Chi square test was used to compare the results. The results revealed that Semont manoeuvre is more effective in the treatment of benign paroxysmal positional vertigo than vestibular sedative. Conclusion: Semont manoeuvre is more effective in the management of benign paroxysmal positional vertigo than vestibular sedative.

Objective findings in patients with multi-canal benign 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.

Case Report: Bow Hunter Syndrome—One Reason to Add Non-gravity Dependent Positional Nystagmus Testing to Your Clinical Neuro-Otologic Exam

This case study describes transient downbeat nystagmus with vertigo due to a bilateral Bow Hunters Syndrome that was initially treated for 7 months as a peripheral benign paroxysmal positional vertigo. Normal static angiography and imaging studies (magnetic resonance, computed tomography) contributed to the mis-diagnosis. However, not until positional testing with the patient in upright (non-gravity dependent) was a transient downbeat nystagmus revealed with vertigo. The patient was referred for neurosurgical consult. Unfortunately, surgery was delayed due to suicidal ideation and hospitalization. Eventually, vertigo symptoms resolved following a C4-5 anterior cervical dissection and fusion. This case highlights the critical inclusion of non-gravity dependent position testing as an augment to the positional testing component of the clinical examination as well as the extreme duress that prolonged positional vertigo can cause.