The Risk of Benign Paroxysmal Positional Vertigo After Head Trauma (original) (raw)
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Symptom Resolution Rates of Posttraumatic versus Nontraumatic Benign Paroxysmal Positional Vertigo
Otolaryngology–Head and Neck Surgery, 2015
Objective To determine the rate of symptom resolution in patients with posttraumatic benign paroxysmal positional vertigo (BPPV) and to determine if it differs from resolution rates in patients with BPPV and without a history of head trauma. Data Sources Systematic review of the literature was performed using Medline, EMBASE, and Cochrane databases. English and French articles meeting inclusion criteria and published between 1946 and October 2014 were included. Review Methods Data were independently extracted from the articles by 2 reviewers using data collection forms developed a priori. Inclusion and exclusion criteria were decided a priori. Studies were included if they reported on at least 1 case of posttraumatic BPPV (t-BPPV), reported on outcomes of all patients with t-BPPV, had a clearly defined inception point, and provided a clear diagnosis of BPPV (defined a priori by reviewers). Results A total of 3017 titles, 362 abstracts, and 67 articles were reviewed, from which 16 ar...
Management of posttraumatic vertigo
Otolaryngology - Head and Neck Surgery, 2005
OBJECTIVE: To evaluate patients after blunt trauma of the head, neck, and craniocervical junction (without fractures) with vertigo and to report the results of treatment after extensive diagnostics. STUDY DESIGN: Prospective study of consecutive new cases with vertigo after trauma at different periods of onset. During 2000-2002, 63 patients were examined and treated. SETTING: Regional trauma medical center for the greater Berlin Area, tertiary referral unit. RESULTS: The primary disorders included labyrinthine concussion (18), rupture of the round window membrane (6), and cervicogenic vertigo (12). The secondary disorders included otolith disorders (5), delayed endolymphatic hydrops (12), and canalolithiasis (9). The patients were free of vertigo symptoms (except cervicogenic and otolith disorder) after treatment, which consisted of habituation training, medical and surgical therapy options. The follow-up was 1 year. CONCLUSION: Posttraumatic vertigo can be treated with a high success rate once the underlying disorder has been identified. The extent of the neurotological test battery determines the precision and quality of diagnostics. Surgical measures should be an integral part of treatment modalities if conservative treatment is not effective. SIGNIFICANCE: Minor trauma of the head, neck, and craniocervical junction can have major impact on the vestibular system at different sites. Patients need to be carefully diagnosed, even if the onset of vertigo occurs a few weeks or months after the initial trauma. (Otolaryngol Head Neck Surg 2005;132:554-558.)
Risk Factors for Recurrence of Benign Paroxysmal Positional Vertigo. A Clinical Review
Journal of Clinical Medicine
Benign paroxysmal positional vertigo (BPPV) is one of the most common peripheral vestibular dysfunctions encountered in clinical practice. Although the treatment of BPPV is relatively successful, many patients develop recurrence after treatment. Our purpose is to evaluate the mean recurrence rate and risk factors of BPPV after treatment. A review of the literature on the risk factors of BPPV recurrence was performed. A thorough search was conducted using electronic databases, namely Pubmed, CINAHL, Academic Search Complete and Scopus for studies published from 2000 to 2020. Thirty studies were included in this review with 13,358 participants. The recurrence rate of BPPV ranged from 13.7% to 48% for studies with follow-up <1 year, and from 13.3% to 65% for studies with follow-up ≥2 years. Pathophysiologic mechanisms and implication of each of the following risk factors in the recurrence of BPPV were described: advanced age, female gender, Meniere’s disease, trauma, osteopenia or o...
Cranio-Cervical Traumatology and Vertigo
BULLETIN OF THE TRANSILVANIA UNIVERSITY OF BRASOV SERIES VI - MEDICAL SCIENCES
The traumatic pathology of the head and neck is often associated with peripheral or central vertiginous manifestations. These are due either to direct or indirect traumatic damage of the temporal bonesthe labyrinth's place-(involving direct damage to the middle or inner ear, or by affecting the cervical vascularization or the osteo-muscular skeleton of the cervical area. The secondary psychopathological reactions associated with this type of traumatology may also be the secondary source of vertigo. This article reviews the clinical forms of vertigo that may occur as an immediate or delayed consequence of cervical and cranial traumatic pathology, with their particular diagnostic and modalities of therapy.
Diagnosis and Management of Post-Traumatic Vertigo
The Laryngoscope, 2004
Patients with posttraumatic vertigo can be difficult to treat secondary to the chronicity of their symptoms. Patients can have peripheral, central, and combined vestibular deficits. Furthermore, no comprehensive guidelines exist for returning these patients to work. The objectives of the study were to discuss diagnosis, management techniques, and guidelines for returning these patients to work. Study Design: Retrospective analysis of a tertiary referral neurotology and balance clinic. Methods: Between July 1997 and July 2003, 2390 patients with chief complaints of vertigo and/or dizziness were analyzed. Of these, 16 patients met the requirements for inclusion in the study, including head trauma and/or concussion and residual vertigo. Their inpatient and outpatient charts, imaging studies, audiograms, vestibular tests, and physical therapy evaluations were reviewed. All patients had at least 6 months of follow-up. Results: There were 5 women and 11 men, with an average age of 42 years. Five patients had symptoms consistent with traumatic perilymphatic fistulas, and two patients had symptoms consistent with post-traumatic Meniere's syndrome. Surgical therapy was not beneficial in relieving dysequilibrium. Balance testing results did not predict return-to-work status. Eleven patients were not allowed to return to work in any capacity, two patients were allowed to return to work with limited duties, and three patients were allowed to return to work with no restrictions. Conclusion: Post-traumatic vertigo can result in chronic symptoms. Balance testing did not predict the ability of patients to return to work. Surgical intervention might not control patient symptoms. Many patients were unable to return to work.
International Journal of Otolaryngology, 2011
BPPV is the most common cause of vertigo. It most often occurs spontaneously in the 50 to 70 year age group. In younger individuals it is the commonest cause of vertigo following head injury. There is a wide spectrum of severity from inconsistent positional vertigo to continuous vertigo provoked by any head movement. It is likely to be a cause of falls and other morbidity in the elderly. Misdiagnosis can result in unnecessary tests. The cardinal features and a diagnostic test were clarified in 1952 by Dix and Hallpike. Subsequently, it has been established that the symptoms are attributable to detached otoconia in any of the semicircular canals. BPPV symptoms can resolve spontaneously but can last for days, weeks, months, and years. Unusual patterns of nystagmus and nonrepsonse to treatment may suggest central pathology. Diagnostic strategies and the simplest "office" treatment techniques are described. Future directions for research are discussed.
European Archives of Oto-Rhino-Laryngology
Benign paroxysmal positional vertigo (BPPV) is the most common type of vertigo, caused by otoconia falling from the utricle into a semicircular canal (SCC). After successful repositioning maneuvers residual dizziness (RD) has been described and several reasons are used to explain RD. It can last for only a few days or weeks, but also much longer. We present a patient with a severe traumatic loss of otoconia from both maculae utriculi and a persistent imbalance more than 9 years. We think that the loss of otoconia from the utricular and probably also saccular macula induced a sudden reduction of her ability to sense gravity thus logically explaining her symptoms. We show the vestibular test results also supporting our hypothesis and we extrapolate this support to other forms of so far unexplained dizziness especially increasing imbalance with aging. We also discuss the normal c-and oVEMP indicating intact haircell function and supporting our hypothesis of isolated otoconial loss as the major cause for imbalance.
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.
Otoneurological Evaluation and Rehabilitative Considerations after Head Trauma
IntechOpen eBooks, 2023
Head injuries due to traffic accidents, falls, gunshots and blows in sports fights, among others, with or without a skull or petrosal fractures, can lead to a Traumatic Labyrinth Concussion (TLC), defined as a disorder of the peripheral vestibular system comprising vestibular, auditory and neurovegetative signs and symptoms, which can persist for weeks or months after a traumatic injury. It is often accompanied by central nervous system (CNS) concussion, manifested by objective symptoms such as tachycardia, headache, thermoregulatory instability and mydriasis; and subjective complaints such as emotional disorders, memory loss, visual disorders, insomnia, hyperemotivity and behaviour disorders. Otoneurologic examination is relevant in the identification and topographic diagnosis of vestibular disorders This chapter will verse on symptoms, audiometric and vestibular findings in TLC, as well as rehabilitation perspectives.
Revisiting pathophysiology of benign paroxysmal positional vertigo: a review
Benign paroxysmal positional vertigo (BPPV) is the most common cause of peripheral vertigo. There are several possible underlying causes of BPPV, although the idiopathic form is the most common. BPPV is characterized by brief recurrent episodes of vertigo that are triggered by changes in head position. Although BPPV is a benign vestibular disorder, it can be a severe and disabling problem for some of patients. The pathophysiology of BPPV is still unclear. The pathophysiology for BPPV is complex and the underlying mechanism is related to free-floating debris/otoliths in the semicircular canal (canalolithiasis) or debris/otoliths attached to the cupula (cupulolithiasis). These otolith/debris are originally accumulated after detachment from the neuroepithelium of the utricular macula secondary to degeneration. BPPV can occur following other vestibular disorders. In the majority of cases, the triggering factors are unknown. Some patients of BPPV have a history of previous inner ear diseases such as Meniere's disease or acute unilateral peripheral vestibulopathy. This clinical entity is well-defined in medical literature and usually effectively treated by certain physical maneuvers. However, the pathophysiology is still obscure and is being critically discussed in this article, which reviews the details pathological mechanism for BPPV. This review article will discuss that aging, trauma, migraine, Meniere's disease, vestibular neuronitis, and vitamin-D deficiency are the most commonly investigated etiopathological factors resulting in BPPV.