The Epley maneuver for the treatment of benign paroxysmal positional vertigo

Assessment for benign paroxysmal positional vertigo in medical patients admitted with falls in a district general hospital

Having benign paroxysmal positional vertigo (BPPV) puts patients at a significantly higher risk of falling. It is poorly recognised and diagnosis is frequently delayed. BPPV has been studied in outpatient settings, but there have been no studies looking at the prevalence in patients admitted with falls. This study aims to establish how common BPPV is in these patients.For a 4-month period, patients admitted on an unselected medical take were screened for an admission precipitated by a fall. Patients who consented were assessed for BPPV using the Dix-Hallpike manoeuvre. Patients who tested positive were treated using the Epley manoeuvre. The assessments were carried out by specialist physiotherapists who were experienced at assessing and diagnosing patients with peripheral vestibular disorders. Out of the 111 patients initially identified, 37 (33%) were considered to be appropriate and consented to be part of the study. Of these, 20 patients (54%) had a positive Dix-Hallpike manoeuvre.Of the patients included in the study, over half tested positive for BPPV. This merits further study. Potentially, there is a proportion of patients admitted with falls who have an easily treatable contributing factor that is not being identified with standard practice.

Benign paroxysmal positional vertigo among elderly patients in primary health care

BACKGROUND

Dizziness influences well-being in old age, and benign paroxysmal positional vertigo (BPPV) is a common cause. The condition is diagnosed using the Hallpike maneuver and treated by the particle-repositioning maneuver or habituation exercises.

OBJECTIVE

To identify patients with BPPV among a variety of diagnoses represented by the ICD-10 diagnosis R42 in people 65 aged years and older who visited primary health care because of vertigo and dizziness.

METHODS

Searches were performed in the computerized medical records of 6 different health care centers over the period of 1 year for the ICD-10 diagnosis R42 and the age group 65 years and older. Letters were sent to the patients identified with an invitation for assessment and physical examination by a physiotherapist. Thirty-eight patients responded to the letter and were included in the study. All patients were assessed by physical examination including the Hallpike maneuver.

RESULTS

The study group included 13 men and 25 women, 65-94 (median 83) years of age. After physical examination, 15 patients were found to have BPPV (confidence interval 24-55%).

CONCLUSION

In this study, 2 of 5 of the patients with ICD-10 diagnosis R42 (dizziness and giddiness) had BPPV. BPPV is probably an underestimated cause of dizziness/vertigo among elderly patients in primary health care.

Modified particle repositioning procedure

OBJECTIVES

To evaluate the efficacy of modifications to traditional particle repositioning maneuvers in the treatment of benign paroxysmal positional vertigo.

STUDY DESIGN

Prospective trial of 118 patients with cupolocanalithiasis of the posterior canal treated with three different canal-repositioning techniques.

METHODS

Results were compared with the maneuvers employed and the statistical importance of rotating patients by 360 degrees along their longitudinal axis and head shaking on reaching each single position were evaluated.

RESULTS

Treatment of patients with our maneuver, which, in comparison with traditional repositioning maneuvers, was modified by breaking the procedure up into seven positions and rotating patients by 360 degrees along their longitudinal axis, gives a higher, but not statistically significant, number of treatment successes (84.5%) than the traditional Parnes maneuver (60%) (P = .154); treatment of a third group of patients with our modified particle repositioning maneuver with the addition of head-shaking on reaching each single position gives a higher (95.6%), statistically significant number of treatment successes than traditional Parnes maneuver (P = .00011).

CONCLUSIONS

The success rates achieved from modified particle repositioning maneuvers are statistically significant. Onset or persistence of dizziness, which patients frequently complain of after liberatory maneuvers, affects only 5.6% of the patients treated. This low incidence is statistically correlated to head-shaking.