Balance in posterior and horizontal canal type benign paroxysmal positional vertigo before and after canalith repositioning maneuvers (original) (raw)

Effectiveness of the canalith repositioning procedure in idiopathic and posttraumatic benign paroxysmal positional vertigo

Family Medicine & Primary Care Review, 2016

Background. Vertigo as a symptom accompanies many pathological processes leading to damage of the vestibular system at a peripheral or central level. it is a manifestation of systemic diseases. Vertigo is one of the most common causes of presentation of the patient to a general practitioner. one of the most common causes of sudden vertigo is benign paroxysmal positional vertigo (BPPV). Objectives. assessment of the effectiveness of the canalith repositioning procedure in idiopathic and posttraumatic BPPV. Material and methods. 50 people with BPPV aged 22-78 (mean 53 ± 13), divided into 2 groups of 25 subjects each, suffering from posttraumatic (group a, aged 53 ± 15) and idiopathic (group B, aged 53 ± 11) vertigo. The treatment was conducted using the epley manoeuver, controlling its effectiveness by means of the Dix-hallpike manoeuvre. Results. all the treated patients benefited from the therapy. the percentage of patients cured after the first two medical manoeuvres was 52% (13) and 92% (23) in groups a and B, respectively, which is a statistically significant difference (p = 0.0016). Patients in group B had an 18 times higher chance of regression of symptoms as early as after the first medical manoeuvre. The number of performed manoeuvres which guaranteed full effectiveness was on average 1.16 per patient with only one semicircular canal affected, and 3.5 when semicircular canals on both sides were affected. Conclusions. 1. the application of motor rehabilitation in the course of BPPV is a non-invasive method for treating vertigo with high effectiveness. 2. trauma in medical history prolongs the treatment of BPPV using manoeuvre. 3. if BPPV affects both sides, the manoeuvre should be repeated more times. 4. the characteristic medical history and risk factors (trauma) facilitate forming a suspicion of the diagnosis with a high probability as early as in the office of a general practitioner.

Features of Residual Dizziness after Canalith Repositioning Procedures for Benign Paroxysmal Positional Vertigo

Objectives. To assess factors related to residual dizziness (RD) in patients who underwent successful canalith reposi-tioning procedures (CRPs) for benign paroxysmal positional vertigo (BPPV). Subjects and Methods. Ninety-seven consecutive patients with BPPV of the posterior semicircular canal were initially enrolled. Diagnosis was assessed according to clinical history and bedside evaluation. All patients were treated with CRPs until nystagmus disappeared. Three days after the successful treatment, presence of RD was investigated. If RD was present, patients were monitored every 3 days until the symptoms disappeared. Subjects who required 4 CRPs or who failed to meet the follow-up visit were excluded. The Dizziness Handicap Inventory (DHI) was obtained from patients at the time of diagnosis and at every subsequent visit. Results. At the end of selection, 86 patients were included; 33 (38.36%) reported RD after successful treatment. A significant difference in the incidence of RD was observed in consideration of the age of the subjects (P = .0003) and the DHI score at the time of diagnosis (P \ .001). A logistic regression analysis showed that the probability of RD occurrence increased with the increase of the emotional subdo-main score of the DHI questionnaire. Conclusion. RD is a common self-limited disorder, more frequent in the elderly, which may occur after the physical treatment for BPPV. The DHI score at the time of BPPV diagnosis represents a useful tool to quantify the impact of this vestibular disorder on the quality of life and to estimate the risk of RD after CRPs. B enign paroxysmal positional vertigo (BPPV) is a common disorder of the inner ear characterized by repeated episodes of vertigo that are triggered by changes in head position. 1,2 BPPV is the most prevalent peripheral vestibular impairment during the life span, which accounts for approximately 17% of complaints of vertigo. 1-4 The suggested pathophysiology is a displacement of otoconial matter from the utricle to the semicircular canals. The movement of the otoconial matter due to gravity causes the flow of endolymph, which consequently causes vertigo and nystagmus. BPPV is usually idiopathic but can occur after head trauma or secondary to various disorders that damage the inner ear and detach the otolith from the utricular macule. The posterior semicircular canal is affected in most cases. 1-5 BPPV is effectively managed via different repositioning maneuvers, which are noninvasive procedures meant to

Lateral Canal Paroxysmal Positional Vertigo Revisited

Annals of the New York Academy of Sciences, 2009

The first reports of an involvement of the lateral canal (LC) in paroxysmal positional vertigo (PPV), were published in 1985, by Luciano Cipparrone et al., from Italy and Joseph McClure from Canada. The increasing interest of otolaryngologists and neurologists has led to a progressive advance in the knowledge of this labyrinthine disorder regarding its epidemiological, physiopathological, clinical, and therapeutic aspects. According to the most recent data, LC-benign PPV accounts for 17% of all PPV patients, regardless of gender and between the two labyrinths. The LC-PPV syndrome is characterized by intense positional vertigo and direction-changing geotropic horizontal nystagmus, both caused by rotation of the head in the supine position. Less frequently, it presents with apogeotropic nystagmus. In some patients nystagmus is also detectable in the sitting position, mimicking a spontaneous nystagmus. In most cases nystagmus is caused by displaced otoconia floating in the semicircular canal. The pathological side, which must be identified for successful treatment, is usually indicated by nystagmus intensity: the more intense positional nystagmus beats toward the affected ear. In a few cases, where there is no difference in nystgmus intensity, other indicators are necessary to determine the pathological side. Vestibular neuritis and posterior fossa lesions should be considered in the differential diagnosis. Treatment of LC-PPV relies on some physical maneuvers, the objective of which is to allow the otoconial debris to exit from the LC by centrifugal inertia and/or by gravitation.

Horizontal canal benign paroxysmal positional vertigo: diagnosis and treatment of 37 patients

Arquivos De Neuro-psiquiatria, 2015

Benign paroxysmal positional vertigo (BPPV) is the most frequent type of vertigo 1,2,3 with prevalence between 10.7 and 64.0 per 100,000 population, and lifetime prevalence estimated of 3.2% in females, 1.6% in males, and 2.4% overall 1. BPPV generally has the highest age distribution in the sixth decade of life 3,4 , with a prevalence approaching 9% among the elderly population 5. It is characterized by brief, recurrent episodes of vertigo triggered by changes in head position. Its pathophysiology, so called the "vestibular stones, " concept, is either due to abnormal stimulation of the dome caused by free-floating otoliths within semicircular canals (canalolithiasis), or otoliths clinging in the dome (cupulolithiasis) 4,6,7. The duration, frequency and intensity of symptoms, as well as the nystagmus phenotype, vary depending on the canal in question and the location of the debris within them. The idiopathic form is the most frequent and the average duration of episodic symptoms is about two weeks 8. The right ear is usually more involved 9. Eighty-six percent of affected individuals seek medical care but only 8% receive effective treatment 8. When considering the frequency of affected semicircular canals, certainly for anatomical / positional reasons, BPPV of the horizontal canal (HC-BPPV) is four times less frequent than the posterior canal (PC-BPPV) 6,10 , but this frequency is increasing and currently, depending on the study, the recognition of HC-BPPV ranges from 10% to 42.7% 11,12. Although the symptoms in HC-BPPV and PC-BPPV are similar, important

Model experiments of otoconia stability after canalith repositioning procedure of BPPV

Acta Oto-laryngologica, 2010

Conclusion: Postural restrictions are probably not necessary after the canalith repositioning procedure (CRP). Objectives: Epley reported the effect of CRP for benign paroxysmal positional vertigo (BPPV). After CRP, patients are often requested to restrict postural change. However, some studies suggested that CRP may work without postural restrictions. The present study aimed to determine the necessity of post-maneuver postural restriction using the frog labyrinth model. Methods: The otoconial mass from the sacculus was placed on the utricular macular otoconia, mimicking a condition after CRP. The stability of the otoconial mass was observed by tilting the preparation, immediately, 3 min, and 5 min after it was placed on the macular otoconia. The utricular macula was maintained in the vertical plane for 10 s, during which period the behavior of the otoconial mass was observed. In experiment 1 the utricular macula was intact, in experiment 2 otoconia were partially removed, and in experiment 3 they were totally removed from the macula. Results: In experiments 1 and 2, in all preparations the otoconial mass became stabilized after 3 min. Even in experiment 3, in most preparations the otoconial mass became stabilized after 5 min.

Clinical evaluation of posterior canal benign paroxysmal positional vertigo

Nigerian Medical Journal, 2012

Background: Benign paroxysmal positional vertigo (BPPV) is a mechanical peripheral vestibular disorder which may involve any of the three semicircular canals but principally the posterior. In as much as the literature has described theories to explain the mechanism of BPPV and also contains scholarly works that elucidate BPPV; its management remains an enigma to most clinicians. To this end, this work was aimed at outlining an evidence-based best practice for most common form of BPPV. Materials and Methods: A systematic review of the literature was conducted between 1948 and June 2011 in PubMed, Embase, Ovid, and Cochrane database through the online Library of the University of Cape Town. Seventy-nine worthy articles that addressed the study were selected on consensus of the two authors. Conclusion: There is consensus for the use of canalith repositioning procedures as the best form of treatment for posterior canal canalolithiasis. However, successful treatment is dependent on accurate identification of the implicated canal and the form of lithiasis. Furthermore, clinicians should note that there is no place for pharmacological treatment of BPPV; unless it is to facilitate repositioning.

Comparison of repositioning maneuvers for benign paroxysmal positional vertigo of posterior semicircular canal: advantages of hybrid maneuver

American Journal of Otolaryngology, 2012

Objective: The prevalence of benign paroxysmal positional vertigo (BPPV) is becoming more frequent in elderly population. The presence of comorbid factors has to be considered before assessment as well as before commencing any repositioning treatment. Our aims were evaluation of the maneuvers efficacy and evaluation of the applicability of hybrid maneuver (HM) in patients with physical limitation. Study design and setting: This is a randomized study in 2 tertiary referral centers. Intervention: This is a therapeutic intervention. Patients: All consecutive patients with diagnosis of BPPV of posterior canal matching the inclusion criteria were enrolled. Patients underwent treatment soon after the initial diagnosis in all cases with a repositioning maneuver. The maneuver was casually selected among Semont, Epley, and hybrid. Patients were divided into 3 groups according to the maneuver adopted. Results: Eighty-eight patients with posterior canal BPPV were enrolled for treatment. Fisher exact test showed that no statistical differences exist between HM and other maneuvers in terms of efficacy. Latency of repositioning nystagmus appeared longer in HM in comparison with other maneuvers (P b .05). Efficacy of maneuvers used for BPPV decreases in case of cupulolithiasis (P b .0001). We found no relationship between age, sex, and length of disturbance on response to maneuvers. Conclusions: All maneuvers evaluated demonstrated similar efficacy. The HM, as our data showed, allows us to obtain a good percentage of success similar to most maneuvers used. It is also more comfortable for the patients with hip or neck functional limitation allowing an effective treatment of the posterior canal BPPV.

Treating benign paroxysmal positional vertigo of the lateral semicircular canal with a shortened forced position

Frontiers in Neurology, 2023

Benign paroxysmal positional vertigo (BPPV) is the peripheral vestibular disorder that is most frequently encountered in routine neuro-otological practice. Among the three semicircular canals, the lateral semicircular canal (LSC) is the second most frequently interested in the pathological process. In most cases, LSC BPPV is attributable to a canalithiasis or cupulolithiasis mechanism. The clinical picture of LSC BPPV is that of positional nystagmus and vertigo evoked by turning the head from the supine to the side lateral position. With such a movement, a horizontal positional (and often also paroxysmal) direction-changing nystagmus is generated. Depending on whether the pathogenetic mechanism is that of canalithiasis or cupulolithiasis and depending on where the dense particles are located, LSC BPPV direction-changing positional nystagmus is geotropic or apogeotropic on both lateral sides. Due to its mechanical nature, BPPV is e ectively treated by means of physical therapy. In the case of a LSC BPPV, one of the most e ective therapies is the forced prolonged position (FPP), in which the patient is invited to lie for h on the lateral side on which vertigo and nystagmus are less intense, to move the canaliths out from the canal (or to shift them inside of the canal from one tract to another) exploiting the force of gravity. Despite its e cacy, FPP is not always well tolerated by every patient, and it cannot be done during the diagnostic session because of its duration. The present study aimed to verify the e cacy of a di erent forced position, shortened forced position (SFP), with respect to the original FPP. SFP treatment would allow patients to more easily bear the forced position and physicians to control the outcome almost immediately, possibly enabling them to dismiss patients without vertigo. After h of lying on the side where vertigo and nystagmus are the less intense, out of (. %) patients treated with SFP were either healed or improved. Although the outcomes are not as satisfying as those of the original FPP, SFP should be considered as a therapeutic prospect, especially by those physicians who work in collaboration with emergency departments or otherwise encounter acute patients to cure them of vertigo as soon as possible.