A multicenter observational study on the role of comorbidities in the recurrent episodes of benign paroxysmal positional vertigo (original) (raw)
Related papers
Why do Treatment Failure and Recurrences of Benign Paroxysmal Positional Vertigo Occur?
Otology & Neurotology, 2014
Objective: To investigate the potential risk factors associated to the treatment failure and recurrence of benign paroxysmal positional vertigo (BPPV). Study Design: Prospective cohort study. Setting: Tertiary referral center. Patients: Four hundred patients with benign paroxysmal positional vertigo, 119 men and 281 women, aged 27 to 88 years. Intervention: Patients were treated once a week, with only one, appropriate, depending on the affected canal, repositioning maneuver (modified Epley, Semont, barbecue/inverted Gufoni, Kim). The control Dix-Hallpike test and the roll test were performed on 7 days. Main Outcome Measures: The treatment outcome and recurrence were evaluated with regard to sex, age, duration of symptoms, etiologic factors, migraines, osteoporosis, vascular risk factors, endocrine diseases, localization of otoconia, and simultaneous involvement of multiple canals. Results: The results indicate that treatment was negatively affected by patients' age, osteoporosis, and head trauma, without them causing recurrent symptoms. The highest number of uncured patients was observed in the 73-to 88-year-old age group (14.8%). The application of more than one maneuver was necessary in 27.5% of cases with primary BPPV and 88.9% with secondary BPPV. The highest treatment success was achieved in the group with BPPV of the posterior semicircular canal (F = 3.668, p = 0.026). The recurrence rate was 15.5%. Conclusion: Potential risk factors associated to the treatment failure were as follows: the age older than 50, secondary BPPV, head trauma, the occurrence of osteoporosis, and localization of otoconia in the anterior semicircular canal. The analyzed factors did not have impact on the recurrence.
Recurrence in Benign Paroxysmal Positional Vertigo: A Large, Single-Institution Study
Objective: To report rates of recurrence in benign paroxys-mal positional vertigo (BPPV) and associated patient and disease factors. Study Design: Retrospective chart review. Setting: Single high-volume otology practice. Patients: Patients diagnosed with BPPV from 2007 to 2016 with documented resolution of symptoms. Intervention: Diagnostic and particle repositioning maneuvers for BPPV. Main Outcome Measures: BPPV recurrence, time to recurrence , and ear(s) affected at recurrence. Results: A total of 1,105 patients meeting criteria were identified. Of this population, 37% had recurrence of BPPV in either ear or both ears. Overall same-ear recurrence rate was 28%; 76% of recurrences involved the same ear(s) as initial presentation. Recurrences that occurred after longer disease-free intervals were more likely to involve the opposite ear than early recurrences (p ¼ 0.02). Female sex (40.4% versus 32.7%, p ¼ 0.01) and history of previous BPPV (57.5% versus 32.4%, p < 0.0005) were associated with increased risk of recurrence, while history of Menière's disease, diabetes mellitus, and traumatic etiology were not. Approximately, half (56%) of recurrences occurred within 1 year of resolution. Conclusions: A large single-institution study of recurrence in BPPV is presented along with Kaplan-Meier disease-free survival curves. Female sex and history of previous BPPV were associated with increased recurrence, while previously suspected risk factors for recurrence including history of Menière's disease, diabetes, and trauma were not. Remote recurrence is more likely to involve the contralateral ear than early recurrence. These data solidify the expected course of treated BPPV allowing for improved clinical care and patient counseling.
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...
Strategies to Prevent Recurrence of Benign Paroxysmal Positional Vertigo
Archives of Otolaryngology-head & Neck Surgery, 2005
To determine if a daily routine of Brandt-Daroff exercises increases the time to recurrence and reduces the rate of recurrence of benign paroxysmal positional vertigo (BPPV). Design: Random sample of convenience and retrospective case review. Setting: Tertiary referral center and outpatient clinic. Patients: One hundred sixteen patients diagnosed with BPPV involving the posterior semicircular canal (BPPV-PC) who were successfully treated with the canalith repositioning procedure. Interventions: Patients in the treatment group (n=43) performed daily Brandt-Daroff exercises, while patients in the no-treatment group (n = 73) performed no exercises. Main Outcome Measures: Follow-up was as long as 2 years. Every 2 months patients were mailed a questionnaire. If BPPV had recurred, patients contacted the principal investigator within 24 hours. Within 1 to 2 weeks, patients were evaluated in the clinic with the Dix-Hallpike maneuver or, if unable to travel to the clinic, interviewed by telephone. Results: Symptoms recurred in 50 (43%) of the 116 subjects, 34 (47%) of 73 in the no-treatment group and 16 (37%) of 43 in the treatment group. There was no significant difference in the frequency of recurrence (Pearson 2 , P=.33) or time to recurrence (survival analysis, log-rank test, P=.92). A history of recurrent BPPV-PC did not affect frequency of recurrence (Pearson 2 , P=.33) or time to recurrence (survival analysis, log-rank test, P=.72). Conclusion: Our results suggest that a daily routine of Brandt-Daroff exercises does not significantly affect the time to recurrence or the rate of recurrence of BPPV-PC.
International Journal of Otolaryngology, 2012
Background. Canalith repositioning techniques are adequately established in the literature, as the treatment of choice for benign paroxysmal positional vertigo. However, the role of the posttreatment instructions is still not clearly defined. Patients and Methods. A retrospective chart review of 82 patients was conducted in order to determine the efficacy of postural restrictions, when combined with the classic canalith repositioning techniques, in terms of successful treatment and recurrence rates. Follow-up period reached at least 12 months after the initial treatment. Results. In this study, postural restrictions did not appear to significantly affect the outcomes of repositioning maneuvers, as well as the recurrence rate. Conclusions. Although this study, as well as most recent control studies, states that there is no significant effect of postmaneuver postural restrictions on both treatment and recurrence rates, larger multicentric research projects, adopting improved methodology, are still necessary in order to determine the contribution of such restrictions to both the therapeutic results and the prevention of recurrence. Adequate followup, focusing on the first six months after the initially successful repositioning maneuver, is also of paramount importance.
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.
Journal of geriatric physical therapy (2001)
The model provided by the World Health Organization's International Classification of Functioning, Disability, and Health (ICF) was created to describe, classify, and measure function in both health care practice and research. This model has not been applied to management of many physical therapy cases, limiting its implementation conceptually into practice as a whole. The purpose of this case report is to illustrate the use of the ICF model in the evidence-based management of posterior canal benign paroxysmal positional vertigo. One patient with acute posterior canal canalithiasis benign paroxysmal positional vertigo was treated using the evidence-based clinical practice guideline for the diagnosis as well as the ICF framework. Repositioning maneuvers and education were provided to ameliorate the relevant body structure and function impairments, activity limitations, and contextual factors related to the patient's overall functioning and disability. The patient demonstrated...
Acta Otorrinolaringologica (English Edition), 2008
Introduction: Benign paroxysmal positional vertigo (BPPV) is the most common cause of vestibular vertigo, but it is not well known in routine clinical practice. Objective: To determine the awareness of BPPV outside the ENT clinic. Patients and method: Retrospective study of 69 patients treated for BPPV between June 2005 and December 2006 at the specialist clinic. We analyzed the routes and details for their referral and the time elapsed since the start of the symptoms. Results: 42 patients (61%) were referred through the conventional route (primary healthcare or non-hospital ENT); 17 patients (25%) came from the emergency room (one third of them were admitted); the remainder were patients hospitalized for some other problem (5%) or informal consultations (9%). Only 1 patient had been referred with a specific diagnosis of BPPV. The onset of vertigo symptoms before treatment was, on average, 20 weeks (SD, 32 weeks) and was significantly longer among patients coming from primary care (28 weeks) as compared with the other groups (P<.01, Kruskall-Wallis test). The mean time to referral was shorter among patients with idiopathic BPPV or with BPPV secondary to recurrent vestibulopathy whereas it was more prolonged among patients with a concomitant pathology capable of justifying the presence of positional symptoms, such as vestibular neuritis or posttraumatic BPPV (P<.01, Kruskall-Wallis test). The medical cost of treating BPPV prior to referral has been calculated at €364 per individual (mostly for non-specific medical treatments) instead of the €136 needed for effective positional treatment. Conclusions: BPPV continues to be a poorly understood pathology outside specialist neuro-otology clinics, leading to delays in diagnosis and treatment, as well as the unnecessary consumption of resources.
Clinical practice guideline: Benign paroxysmal positional vertigo
2008
This guideline provides evidence-based recommendations on managing benign paroxysmal positional vertigo (BPPV), which is the most common vestibular disorder in adults, with a lifetime prevalence of 2.4 percent. The guideline targets patients aged 18 years or older with a potential diagnosis of BPPV, evaluated in any setting in which an adult with BPPV would be identified, monitored, or managed. This guideline is intended for all clinicians who are likely to diagnose and manage adults with BPPV. PURPOSE: The primary purposes of this guideline are to improve quality of care and outcomes for BPPV by improving the accurate and efficient diagnosis of BPPV, reducing the inappropriate use of vestibular suppressant medications, decreasing the inappropriate use of ancillary tests such as radiographic imaging and vestibular testing, and to promote the use of effective repositioning maneuvers for treatment. In creating this guideline, the American Academy of Otolaryngology-Head and Neck Surgery Foundation selected a panel representing the fields of audiology, chiropractic medicine, emergency medicine, family medicine, geriatric medicine, internal medicine, neurology, nursing, otolaryngology-head and neck surgery, physical therapy, and physical medicine and rehabilitation. RESULTS: The panel made strong recommendations that 1) clinicians should diagnose posterior semicircular canal BPPV when vertigo associated with nystagmus is provoked by the Dix-Hallpike maneuver. The panel made recommendations against 1) radiographic imaging, vestibular testing, or both in patients diagnosed with BPPV, unless the diagnosis is uncertain or there are additional symptoms or signs unrelated to BPPV that warrant testing; and 2) routinely treating BPPV with vestibular suppressant medications such as antihistamines or benzodiazepines.
Daily Exercise Does Not Prevent Recurrence of Benign Paroxysmal Positional Vertigo
Otology & Neurotology, 2008
The purpose of this study was to analyze if a daily routine of self-canalith repositioning procedure (CRP) will increase the time to recurrence and reduce the rate of recurrence of benign paroxysmal positional vertigo (BPPV). Study Design: Prospective study, nonrandomized control group. Setting: Outpatient clinic. Patients: Thirty-nine patients diagnosed with posterior canal BPPV successfully treated with the CRP. Based on a convenience sample, 17 (44%) patients were assigned to the treatment group, whereas 22 (56%) were assigned to the no-treatment group. The number of subjects lost at the time of follow-up were 5 (29.4%) of the treatment group and 2 (9%) of the notreatment group. Interventions: Patients assigned to the treatment group performed the self-CRP daily, whereas those assigned to the no-treatment group performed no exercises. Patients were followed for up to 2 years. Main Outcome Measures: The main outcome measures were the rate of recurrence of BPPV and the time for BPPV to recur. Results: Of the 39 subjects, symptoms recurred in 16 (41%) of the total population, 6 (35%) of 17 of the treatment group, and 10 (46%) of 22 of the no-treatment group. There was no difference in the frequency of recurrence (Pearson W 2 ; p = 0.522) or the time to recurrence (survival analysis; log-rank test; p = 0.242). Conclusion: Our results suggest that a daily routine of the self-CRP does not affect the time to recurrence and the rate of recurrence of posterior canalYBPPV.