Recurrent paroxysmal positional vertigo related to oral contraceptive treatment

Variants of posterior semicircular canal involvement in benign paroxysmal positional vertigo

Benign paroxysmal positional vertigo is the most common cause of peripheral vertigo. It is characterized by short and recurrent episodes of vertigo, trigged by specific head movements that displace otoconia within the semicircular canals. The movement of dislodge otoconia from the utricle cause abnormal positional endolymphatic currents. Primary treatment involves reposition maneuvers aimed at moving the displaced otoconia out the affected canal, therefore correct identification of the affected canal is essential for the diagnosis. The posterior semicircular canal (PSC) is the most frequently affected due to its spatial orientation and the force of gravity. Recent technological advances have allowed for better assessment of positional nystagmus during diagnostic and therapeutic maneuvers, revealing various possible scenarios of PSC involvement. Regarding the PSC, otoconia may be found in different parts of the canal, and not just in the expected location, floating in the long arm of the canal. The understanding of these variants is crucial, as the prognosis and the disease progression differ in such cases. This review aims to describe the six possible variants of PSC involvement described so far.

Correlation of idiopathic benign paroxysmal positional vertigo with cerebral small vessel disease

BACKGROUND

Benign paroxysmal positional vertigo (BPPV) is the most prevalent form of peripheral vertigo, with vascular lesions being one of its suspected causes. The older adults are particularly vulnerable to BPPV. Cerebral small vessel disease (CSVD), on the other hand, is a clinical condition that results from damage of cerebral small vessels. Vascular involvement resulting from age-related risk factors and proinflammatory state may act as the underlying factor linking both BPPV and CSVD.

AIM

The objective of this study is to explore the potential correlation between BPPV and CSVD by examining whether individuals aged 50 and older with BPPV exhibit a greater burden of CSVD.

MATERIALS AND METHODS

This retrospective study included patients aged 50 years and older who had been diagnosed with BPPV. A control group consisting of patients diagnosed with idiopathic facial neuritis (IFN) during the same time period was also included. The burden of cerebral white matter hyperintensities (WMHs) was evaluated using the Fazekas scale. An ordinal regression analysis was conducted to investigate the potential correlation between BPPV and WMHs.

RESULTS

The study included a total of 101 patients diagnosed with BPPV and 116 patients with IFN. Patients with BPPV were found to be significantly more likely (OR = 2.37, 95% CI 1.40-4.03, p = 0.001) to have a higher Fazekas score compared to the control group. Brain infarctions, hypertension, and age were all identified as significant predictors of white matter hyperplasia on MRI, with OR of 9.9 (95% CI 4.21-24.84, P<0.001), 2.86 (95% CI 1.67-5.0, P<0.001), and 1.18 (95% CI 1.13-1.22, P<0.001) respectively.

CONCLUSION

Our findings suggest that vascular impairment caused by age-related risk factors and proinflammatory status may be contributing factors to the development of BPPV in individuals aged 50 and above, as we observed a correlation between the suffering of BPPV and the severity of WMHs.

A Systematic Review of Vertigo: Negligence in Pregnancy

From conception to childbirth, there are many physical, hormonal, and psychological changes that a woman undergoes during pregnancy. During this time, balance is also affected, resulting in symptoms like vertigo and unsteadiness. These symptoms can lead to physical impairment and disability and can develop at any time. Vertigo in pregnancy has not been extensively written about. The subject of a narrative review is vertigo in pregnant patients. In pregnant women, hormonal alterations in the peripheral tissues and inner ear organs may contribute to vertigo. Meniere's disease, mild convulsive positional dizziness, and oculomotor migraines are all commonly exacerbated by pregnancy. Between the second and third trimesters of pregnancy, specific modifications to proprioception and hearing are also detected during physical examination. Patients who are pregnant typically experience these symptoms throughout this time. Some vertigo conditions can worsen during pregnancy, while others can appear at any time. Understanding audio-vestibular symptoms' pathological and clinical relationship during pregnancy requires more study.

Vertigo in Pregnancy: A Narrative Review

During pregnancy, physical, hormonal, and psychological changes may occur from conception to labor. Balance is also impacted throughout this time, leading to symptoms such as vertigo and unsteadiness. These symptoms may appear at any time and can cause disability and physical impairment. Little has been published about vertigo in pregnancy. We performed a narrative review of vertigo in pregnant patients. Vertigo in pregnant females may be associated with hormonal changes in peripheral structures and inner ear organs. Meniere’s disease, vestibular migraine, and benign paroxysmal positional vertigo are usually exacerbated during pregnancy. Specific changes to hearing and proprioception in the physical examination are also noted between the second and third trimester of pregnancy. These symptoms are usually seen in pregnant patients throughout this time. Some types of vertigo may be exacerbated and others may present at any time of pregnancy. Further research is needed to understand the clinical and pathological association of audiovestibular symptoms during pregnancy.

Can Type of Dizziness Influence the Vestibular Caloric Test Result?

Background:

The broad range of vestibular tests used to diagnose labyrinth diseases allows for a functional assessment of the vestibular system. Among the many tests performed, the caloric test is considered the gold standard by providing an objective measurement of the vestibular function for each labyrinth.

Objective:

to correlate the different types of dizziness with the caloric test result.

Methods:

a descriptive study was performed based on the previous records of vestibular tests performed on patients with body balance disorders evaluated at Audiology Service between 2000 and 2020. The variables evaluated were sex, age, hearing loss, tinnitus, and caloric test result.

Results:

the sample was composed of 892 patients, 654 (73.4%) women, and 238 (26.6%) men. Normal results were obtained for 57.4% (N = 514) of the individuals, while peripheral disease 40.1% (N = 357), and central disease 2.5% (N = 21) accounted for the remaining. Complaint of vertigo was not common in central disorders (P = .02; OR = 0.17) and instability was associated with bilateral vestibular weakness (P = 0.02; OR = 5.92). Vertigo associated with tinnitus and/or hearing loss was more frequent in the caloric test with peripheral abnormality (P = 0.008).

Conclusion:

complaints of vertigo associated with tinnitus and/or hearing loss must be directed for clinical observation of unilateral peripheral lesion and instability to central disease or bilateral peripheral lesion.

Benign Paroxysmal Positional Vertigo Risk Factors Unique to Perimenopausal Women

Many investigations have found common occurrences of benign paroxysmal positional vertigo (BPPV) in women, and clinical experience has shown that BPPV can develop due to increased hormonal fluctuations, especially during menopause. Therefore, knowledge about neurochemicals and their involvement with BPPV is imperative for the management of neurological issues in women. This review will discuss appropriate gender-based considerations of BPPV based on experimental and clinical evidence. The studies describe 2 lines of evidence regarding the association of perimenopause in women and the development of BPPV: (1) experimental evidence: the existence of estrogen receptors in the inner ear, otoconial malformations in osteopenic/osteoporotic rats, changes in otoconin 90 caused by hormone replacement therapy, and impaired calcium absorption following estrogen deprivation corrected by estrogen replacement therapy and (2) clinical evidence: epidemiological aspects, osteoporosis and estrogen deficiency. Future studies are necessary to validate the effects of hormonal replacement therapy and phytoestrogen in women with recurrent BPPV.

Causes and treatment of idiopathic benign paroxysmal positional vertigo based on endocrinological and other metabolic factors

The genesis of the Benign Paroxysmal Positional Vertigo (BPPV) seems to be related to some metabolic factors. These factors, such as vitamin D, glucocorticoids, and even thyroid and growth hormones, can affect bone metabolism and the mineralization of otoconia. It also seems to link to factors related to aging or nutritional habits. Besides, since the incidence of BPPV is quantitatively higher in women than in men, female sex steroids could be associated with this process. It could be useful to understand how these factors act in otoconial mineralization if we want to develop treatments aimed at preventing or delaying BPPV recurrences. In this review, we will analyze the role of these metabolic and hormonal factors in otoconial mineralization and in the treatment of BPPV.

Benign Paroxysmal Positional Vertigo in Pregnancy

Benign paroxysmal positional vertigo (BPPV) is a clinical entity characterized by acute, brief paroxysmal attacks of rotational vertigo induced by head position changes. It is the most common peripheral vestibular pathology and is seen more frequently in women. However, to our knowledge, there is very limited data on the association between BPPV and pregnancy in both English and Turkish literature. We present four pregnant women diagnosed with BPPV for the first time during gestation and revise the etiological factors of BPPV and the role of pregnancy-related changes in BPPV.

Effectiveness of the Parnes particle repositioning manoeuvre for posterior canal benign paroxysmal positional vertigo

BACKGROUND

Benign paroxysmal positional vertigo is a common vestibular disorder that negatively affects an individual's health-related quality of life. This study aimed to examine the effectiveness of the Parnes particle repositioning manoeuvre as an intervention for individuals with posterior canal benign paroxysmal positional vertigo.

METHODS

The de-identified records of 155 individuals treated with the Parnes manoeuvre were examined. Descriptive statistics were calculated, including the frequency and valid per cent of participants whose nystagmus was resolved with the Parnes manoeuvre.

RESULTS

In all, nystagmus was resolved with the Parnes manoeuvre in 145 participants (93.5 per cent). The mean number of manoeuvres needed to resolve the nystagmus was 1.3.

CONCLUSION

The Parnes manoeuvre proved to be as effective as the Epley canalith repositioning manoeuvre, currently the most common intervention, in treating individuals with posterior canal benign paroxysmal positional vertigo.

Effects of oral contraceptives on selected parameters of the homeostatic control system in young women having a sudden disorder of the auditory and/or balance system

The purpose of the paper was to assess the effects of oral contraceptives on selected parameters of the homeostatic control system in women having a sudden disorder of the auditory and/or balance system. The study included 105 young women divided into two groups: Group I—52 women with the disorder of the auditory and/or balance system using hormonal contraceptives for at least 2 months, aged 20–49; and Group II—53 women without any disorder of the auditory and/or balance system using hormonal contraceptives for at least 2 months, aged 18–40. The patients included in the study underwent a full otoneurological evaluation, detailed laryngological diagnostics and an evaluation of selected parameters of the homeostatic control system—fibrinogen level, D-dimer level, evaluation of APTT and PT indicator, plasma estradiol and progesterone with the Roche Cobas analyser by means of chemiluminescence. The vertigo occurring in the study group was most often central (59.6 % of cases), mixed with compensation in 36.6 % of cases, and peripheral only in 3.8 % of cases, indicating labyrinth damage in 40.4 % of cases. An analysis of the progesterone level, considering the menstrual cycle phase in the group, showed that its value was abnormal in 51.0 % of women in the study group and 47.1 % in the control group. In their own studies, the authors observed that the estradiol level in the plasma, considering the menstrual cycle phase in the study group, was abnormal in 41.2 % of women and that the differences in its concentration were statistically significant in the study and control groups (p = 0.005), which may have a negative impact on the possibility of a thromboembolic episode.

Association between type 1 diabetes mellitus and deposits in the semicircular canals

OBJECTIVE

To compare the prevalence of cupular and free-floating deposits in the semicircular canals between temporal bones of type 1 diabetes mellitus patients and normal controls.

STUDY DESIGN

Case-control histopathologic human temporal bone study.

SETTING

Otopathology laboratory in a tertiary academic medical center.

SUBJECTS AND METHODS

Twenty-eight temporal bones from 14 patients with type 1 diabetes mellitus and 56 normal temporal bones from 28 age-matched individuals were histopathologically examined. The cupula and lumina of the semicircular canals were examined for evidence of deposits.

RESULTS

The prevalence of cupular and free-floating deposits in the lateral and posterior semicircular canals was significantly higher in type 1 diabetes mellitus patients compared with normal temporal bones (lateral, cupular deposits, odds ratio [OR], 5.47; 95% confidence interval [CI], 1.43 to 21.02; free-floating deposits, OR, 8.25; 95% CI, 2.42 to 27.85; posterior, cupular deposits, OR, 41.73; 95% CI, 5.96 to 275.50; free-floating deposits, OR, 7.44; 95% CI, 1.91 to 28.53). The prevalence of these deposits was associated with the duration of disease rather than with aging.

CONCLUSION

The findings suggest that type 1 diabetes mellitus is associated with cupular and free-floating deposits in the semicircular canals. The patients with type 1 diabetes mellitus with a longer duration of disease have an increased probability of suffering from benign paroxysmal positional vertigo.