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Alashram AR. Gufoni maneuver for treatment of horizontal canal benign paroxysmal positional vertigo: a systematic review of randomized controlled trials. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08712-y. [PMID: 38705895 DOI: 10.1007/s00405-024-08712-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 04/29/2024] [Indexed: 05/07/2024]
Abstract
PURPOSE This review aims to investigate the effects of the Gufoni maneuver on horizontal semicircular canal benign paroxysmal positional vertigo (HC-BPPV). METHODS A comprehensive search, including PubMed, PEDro, REHABDATA, SCOPUS, EMBASE, and Web of Science, was conducted to determine randomized clinical trials (RCTs) studying the effects of the Gufoni maneuver for HC-BPPV from inception to March 1, 2024. The quality of the included studies was estimated using the Physiotherapy Evidence Database (PEDro) scale. RESULTS Ten randomized controlled trials (RCTs) were included in this review with a total of 1025 HC-BPPV patients (mean age = 58.58 years; 63% female; 55% right-side HC-HBPPV; 49% geotropic HC-BPPV). The included RCTs ranged from 4 to 9 out of 10 (median = 6.5) on the PEDro scale. The included studies showed that the Gufoni maneuver revealed efficacy when compared to the sham maneuver but not when compared to other maneuvers such as the Barbecue roll maneuver, the Appiani maneuver, the Mastoid oscillation, the head shaking, and the modified Gufoni maneuver. CONCLUSIONS The Gufoni maneuver is considered an option for treating patients with geotropic or apogeotropic HC-BPPV. Precise diagnosis of the BPPV, the subtype of HC-BPPV, symptom duration, history of previous BPPV attacks, the applied methods of maneuver and the proficiency of the clinician performing the maneuver, proper diagnosis, presence of any underlying health conditions are critical for successful treatment. Further studies are strongly warranted.
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Affiliation(s)
- Anas R Alashram
- Department of Physiotherapy, Middle East University, Airport Road 1666, Amman, Jordan.
- Applied Science Research Center, Applied Science Private University, Amman, Jordan.
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy.
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Vats AK, Vats S, Kothari S, Khamesra R. Direct Resolution of Horizontal Semicircular Cupulolithiasis by Zuma Plus Maneuver Vis-à-Vis Transformation to Canalolithiasis by Zuma Maneuver. Ann Indian Acad Neurol 2024; 27:203-205. [PMID: 38751927 PMCID: PMC11093160 DOI: 10.4103/aian.aian_767_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/19/2023] [Accepted: 11/29/2023] [Indexed: 05/18/2024] Open
Affiliation(s)
- Ajay Kumar Vats
- Chaudhary Hospital and Medical Research Centre Private Limited, Hiran Magri, Udaipur, Rajasthan, India
| | - Shreya Vats
- Clinical Vestibulology Observer, Otoneurology Centre, Shikarbadi, Udaipur, Rajasthan, India
| | - Sudhir Kothari
- Professor, Department of Neurology, Poona Hospital and Research Centre, Pune, Maharashtra, India
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Kinne BL, Breuer RE, Fitkin OM, Kelly RL. Interventions for apogeotropic horizontal canal benign paroxysmal positional vertigo: a systematic review. Physical Therapy Reviews 2023. [DOI: 10.1080/10833196.2022.2163082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Bonni Lynn Kinne
- Department of Physical Therapy & Athletic Training, Grand Valley State University, Grand Rapids, Michigan, USA
| | - Rachel Elizabeth Breuer
- Department of Physical Therapy & Athletic Training, Grand Valley State University, Grand Rapids, Michigan, USA
| | - Olivia Margeurite Fitkin
- Department of Physical Therapy & Athletic Training, Grand Valley State University, Grand Rapids, Michigan, USA
| | - Rebecca Lynn Kelly
- Department of Physical Therapy & Athletic Training, Grand Valley State University, Grand Rapids, Michigan, USA
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De Hertogh W, Castien R, Jacxsens L, De Pauw J, Vereeck L. Outcome for dizzy patients in a physiotherapy practice: an observational study. Ann Med 2022; 54:1787-1796. [PMID: 35786105 PMCID: PMC9258437 DOI: 10.1080/07853890.2022.2091790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Dizziness is a common reason for referral to physiotherapy. Additional information on clinical characteristics, treatment effect and prognostic indicators in physiotherapy practice are needed. METHODS A retrospective observational study. Based on a standardised clinical evaluation patients were labelled as having Benign Paroxysmal Positioning Vertigo (BPPV) or not (no-BPPV). BPPV was treated with repositioning manoeuvres and exercises. In no-BPPV, treatment was based on additional clinical tests. Treatment was provided once per week and considered successful when the patient was free of symptoms confirmed by negative positional tests. RESULTS From 148 referred patients, 88 were labelled as having BPPV, 60 as no-BPPV. The symptom of a short-lasting spinning sensation provoked by head movements was highly suggestive of BPPV. On average, in BPPV treatment was completed after 2.27 ± 1.68 treatments, in no-BPPV this was after 4.91 ± 3.46 treatments. The delayed outcome was related to higher 'age' and 'concomitant neck pain' in BPPV and with higher 'age' only in no-BPPV. Favourable outcome was related to the feature 'dizziness provoked by movements in the horizontal plane' in BPPV. CONCLUSIONS Clinical evaluation and treatment in physiotherapy practice can be an effective and safe option for patients with dizziness. Several clinical variables with prognostic values were identified.Key messagesClinical evaluation and treatment in physiotherapy practice can be part of low threshold care for dizzy patients.Despite prior medical screening, one-third of patients without signs of BPPV were sent back for further evaluation, illustrating the need for interdisciplinary collaboration.Based on the description of the dizziness symptom (vertigo rather than light-headedness), provocation of the dizziness by movements, and a short duration of the dizziness attack, and positive clinical vestibular tests, BPPV treatment could be initiated.
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Affiliation(s)
- Willem De Hertogh
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Primary Care Rehabilitation Practice Kineglazenleeuw, Beveren, Belgium
| | - René Castien
- Department of General Practice and Elderly Care Medicine, EMGO + Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.,Healthcare Center Haarlemmermeer, Hoofddorp, The Netherlands
| | - Laura Jacxsens
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Joke De Pauw
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Luc Vereeck
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Vadlamani S, Dorasala S, Dutt SN. Diagnostic Positional Tests and Therapeutic Maneuvers in the Management of Benign Paroxysmal Positional Vertigo. Indian J Otolaryngol Head Neck Surg 2022; 74:475-487. [PMID: 36032928 PMCID: PMC9411440 DOI: 10.1007/s12070-020-02292-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 11/24/2020] [Indexed: 11/24/2022] Open
Abstract
Benign Paroxysmal Positional Vertigo (BPPV), the most common vestibular disorder characterized by recurrent, brief episodes of vertigo, is attributed to the presence of otoconia in the semicircular canals. Two mechanisms contribute to its cause-canalolithiasis (otoconia freely mobile in the semicircular canal) and cupulolithiasis (otoconia adherent to the cupula). Posterior semicircular canal is the most common canal involved. Although the occurrence of BPPV in lateral and superior semicircular canal is rare, with the advancement in diagnostic techniques, their incidence is being reported in the past few years. Various diagnostic tests and therapeutic maneuvers have been described in the management of BPPV. The present report is a comprehensive review of the tests and maneuvers for BPPV written as a guide intended to help the clinicians in the accurate diagnosis and application of a canal-specific treatment maneuver for BPPV. A simplified algorithmic approach ("The Bangalore BPPV Algorithm") for the management of BPPV is described.
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Dong J, Li L, He S, Liu H, Dai F. Case Report: New Application of a Gufoni Maneuver Variation for Apogeotropic Lateral Semicircular Canal Benign Paroxysmal Positional Vertigo. Front Neurol 2022; 13:902758. [PMID: 35756915 PMCID: PMC9226421 DOI: 10.3389/fneur.2022.902758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background Several canalith repositioning procedures (CRPs) such as Gufoni maneuver have been proposed to treat the apogeotropic lateral semicircular canal variant of BPPV (LC-BPPV). The reported success rate varied widely in different studies. Research showed that there was a risk of treatment failure due to insufficient repositioning of the debris. So far, there is insufficient evidence to recommend a preferable CRP for apogeotropic LC-BPPV. Case description A 49-year-old woman and a 48-year-old man diagnosed with apogeotropic LC-BPPV relapse were treated with original Gufoni maneuver for apogeotropic variant but no satisfactory result was obtained. A variation of Gufoni maneuver originally proposed for the geotropic variant was applied to detach otoconia toward the utricle or the non-ampullary arm. Apogeotropic nystagmus was successfully transformed into the geotropic variant. The subsequent Gufoni maneuver was successful. On a 64-year-old male with untreated apogeotropic LC-BPPV, we performed the Gufoni maneuver variation and observed a change in nystagmus direction. In all the three cases, no relapse of vertigo was reported after 1 month. Conclusion The new application of Gufoni maneuver variation may improve the treatment of apogeotropic LC-BPPV. Treatment efficacy and patient-specific optimization such as head rotation angle deserve a large-scale validation and further investigation.
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Affiliation(s)
- Jiaoxuan Dong
- Department of Neurology, Zhoushan Hospital, Wenzhou Medical University, Zhoushan, China
| | - Ling Li
- Department of Neurology, Zhoushan Hospital, Wenzhou Medical University, Zhoushan, China
| | - Songbin He
- Department of Neurology, Zhoushan Hospital, Wenzhou Medical University, Zhoushan, China
| | - Haipeng Liu
- Research Centre for Intelligent Healthcare, Coventry University, Coventry, United Kingdom
| | - Fangyu Dai
- Department of Neurology, Zhoushan Hospital, Wenzhou Medical University, Zhoushan, China
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Ramos BF, Cal R, Mangabeira Albernaz PL, Zuma e Maia F. Practical approach for lateral canal benign paroxysmal positional vertigo. J Neurol Sci 2022; 434:120180. [DOI: 10.1016/j.jns.2022.120180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 01/25/2022] [Accepted: 01/30/2022] [Indexed: 11/29/2022]
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Ramos BF, Cal R, Albernaz PLM, Zuma e Maia F. The role of the reversed nystagmus during Zuma maneuver in patients treated for geotropic lateral canal benign paroxysmal positional vertigo. J Neurol Sci 2022; 434:120160. [DOI: 10.1016/j.jns.2022.120160] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/23/2021] [Accepted: 01/13/2022] [Indexed: 11/28/2022]
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Elmoursy MM, Abbas AS. The role of low levels of vitamin D as a co-factor in the relapse of benign paroxysmal positional vertigo (BPPV). Am J Otolaryngol 2021; 42:103134. [PMID: 34166965 DOI: 10.1016/j.amjoto.2021.103134] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 06/12/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Benign paroxysmal positional vertigo is characterized as brief episodes of vertigo that are exacerbated by the unexpected act of moving to a current provoking location. It is thought to be an otoconia-related balance disorder. Our objectives were to assess the serum concentrations of vitamin D and calcium (total and ionized) in cases with BPPV, determine if low vitamin D levels were regarded as a cause for BPPV relapse, and determine whether vitamin D supplementation would minimize the risk of BPPV relapse. RESULTS Sixty cases with BPPV were included in the study; 53 cases had posterior canal BPPV, while seven had lateral canal BPPV. Canalithiasis was the most common type of BPPV pathology. Forty cases had abnormally low levels of vitamin D. There was a statistically significant positive correlation between the mean vitamin D assay for all cases with BPPV and serum calcium. There was statistically significant difference in comparing the relapse of BPPV for group that receive vitamin D after one year follow up. CONCLUSION Abnormal vitamin D levels were linked with the incident and relapse of BPPV. Correction of low vitamin D levels was linked with the reduction of the relapse of BPPV.
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Affiliation(s)
| | - Awad Saad Abbas
- Rheumatology and Rehabilitation Department, Al-Azhar University, Assiut, Egypt
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Kinne BL, Harless MG, Lauzon KA, Wamhoff JR. Roll maneuvers versus side-lying maneuvers for geotropic horizontal canal BPPV: a systematic review. Physical Therapy Reviews 2021. [DOI: 10.1080/10833196.2021.1978778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Bonni Lynn Kinne
- Department of Physical Therapy, Grand Valley State University, Grand Rapids, MI, USA
| | - Mikaela Grace Harless
- Department of Physical Therapy, Grand Valley State University, Grand Rapids, MI, USA
| | - Kyra Ann Lauzon
- Department of Physical Therapy, Grand Valley State University, Grand Rapids, MI, USA
| | - Jill Renee Wamhoff
- Department of Physical Therapy, Grand Valley State University, Grand Rapids, MI, USA
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Vats AK. Lying-Down Nystagmus (LDN) - When a Lateralizing Sign of Secondary Importance Attains Ascendancy in the Diagnosis of Horizontal Semicircular Canal Benign Paroxysmal Positional Vertigo (HSC-BPPV). Ann Indian Acad Neurol 2021; 24:401-404. [PMID: 34447005 PMCID: PMC8370150 DOI: 10.4103/aian.aian_322_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 05/03/2020] [Accepted: 05/22/2020] [Indexed: 11/04/2022] Open
Abstract
Background The diagnosis of horizontal semicircular canal benign paroxysmal positional vertigo (HSC-BPPV) mainly depends on the elicitation of asymmetric horizontal positional nystagmus on rolling head to either side, during the diagnostic supine roll test (SRT). The asymmetry in the strength of the elicited horizontal positional nystagmus during SRT is explained by the Ewald's second law and is crucial for lateralizing the affected ear. Rarely the elicited horizontal positional nystagmus on the head roll to either side during the SRT is of symmetric strength. In such situations, the signs with secondary lateralizing value are useful in management by the repositioning maneuvers that require the affected side to be precisely known. Aim The submitted article is a case report. Results and Discussion A 38-year-old male with two days history of vertigo on rolling to either of the lateral recumbent position was seen in the second week of March 2019. His SRT elicited a lying-down nystagmus (LDN) to the right, while the head roll to either side elicited a geotropic horizontal positional nystagmus of symmetric strength. The symmetrical strength of elicited positional nystagmus on SRT to either side led to ascendance of LDN from a lateralizing sign of secondary importance to one that reliably lateralized the involved horizontal semicircular canal. At two short term follow-ups at 1 hour and 24 hours after the therapeutic Gufoni maneuver, patient neither had vertigo nor any nystagmus elicited on the verifying supine roll test. Conclusion In rare instances, LDN, which is a lateralizing sign of secondary importance becomes pivotal in the management of HSC-BPPV especially when the affected side needs to be precisely determined for the execution of the therapeutic repositioning maneuver.
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Affiliation(s)
- Ajay K Vats
- Department of Medicine and Neurology, Chaudhary Hospital and Medical Research Centre Private Limited, Udaipur, Rajasthan, India
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Zuma e Maia F, Ramos BF, Cal R, Brock CM, Mangabeira Albernaz PL, Strupp M. Management of Lateral Semicircular Canal Benign Paroxysmal Positional Vertigo. Front Neurol 2020; 11:1040. [PMID: 33041982 PMCID: PMC7522363 DOI: 10.3389/fneur.2020.01040] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 08/10/2020] [Indexed: 11/23/2022] Open
Abstract
Benign paroxysmal positional vertigo (BPPV) is the most common cause of peripheral vestibular vertigo. It is caused by free-floating otoconia moving freely in one of the semicircular canals (canalolithiasis) or by otoliths adhered to the cupula (cupulolithiasis). The posterior canal is the most common canal affected, followed by the lateral canal. Diagnosis of the side affected is critical for successful treatment; therefore, suppressing visual fixation is essential to examination of these patients' eye movement. On the basis of our experience, we have adopted the Zuma maneuver and the modified Zuma maneuver for both apogeotropic and geotropic variants of lateral canal BPPV. Knowledge of the anatomy and pathophysiologic mechanisms of the semicircular canals is essential for correct management of these patients. Hence, using a single maneuver and its modification may facilitate daily neurotological practice.
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Affiliation(s)
- Francisco Zuma e Maia
- Department of Otorhinolaryngology and INSCER, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Bernardo Faria Ramos
- Department of Otorhinolaryngology, Federal University of Espirito Santo, Vitoria, Brazil
| | - Renato Cal
- Department of Otorhinolaryngology, University Center of Para (CESUPA), Belem, Brazil
| | - Camila Martins Brock
- Department of Otorhinolaryngology, Pontifical Catholic University of Rio Grande do Sul (PUC-RS), Porto Alegre, Brazil
| | | | - Michael Strupp
- Ludwig Maximilians University, Munich, Germany
- Department of Neurology and German Center for Vertigo and Balance Munich, Munich, Germany
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Vats AK. A case of apogeotropic horizontal canal benign paroxysmal positional vertigo that transformed to the geotropic variant during treatment with Appiani maneuver, followed by successful treatment with Gufoni maneuver. Physiother Theory Pract 2020; 38:952-960. [PMID: 32783761 DOI: 10.1080/09593985.2020.1805831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Lesions at three possible sites can masquerade as apogeotropic horizontal semicircular canal benign paroxysmal positional vertigo (HSC-BPPV), namely: 1) short anterior (ampullary) arm canalolithiasis; and 2) culpulolithiasis, which may be either canal (Cup-C) or utricle-sided (Cup-U). There are no clinical methods or investigations to determine the exact pathological site when a patient with a history compatible with HSC-BPPV is found to have apogeotropic positional nystagmus on the supine roll test. Therefore, the treatment of apogeotropic variant of HSC-BPPV not only poses difficulties but the therapeutic options need to be tailored according to the ostensible localization of the pathology. If the apogeotropic HSC-BPPV is transformed into the geotropic variant, it becomes relatively easier to treat, as the treatment options for the latter are very well established. There are reports of cases of the apogeotropic variant of HSC-BPPV being transformed inadvertently during diagnostic positional tests as well as during therapeutic (intention-to-treat) positional maneuvers. I report here a case of an apogeotropic variant of right HSC-BPPV, that transformed into a geotropic variant during the therapeutic (intention-to-treat) Appiani maneuver, which was subsequently successfully treated with two sequences of Gufoni maneuver after transformation. The patient was followed up at one and 24 hours after the second sequence of Gufoni maneuver with a diagnostic supine roll test, which was negative. The case report is supported by seven videos of the diagnostic and therapeutic positional maneuvers revealing positional nystagmus, its appearance, change, and disappearance as clinical events unfolded during the examination and treatment.
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Affiliation(s)
- Ajay Kumar Vats
- Department of Medicine and Neurology, Chaudhary Hospital & Medical Research Centre Private Limited, Udaipur, India
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Abstract
QUESTION: Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause of dizziness presenting to specialist vestibular centres and accounts for approximately 20–30% of referrals to these clinics. In spite of the amount of clinical knowledge surrounding its diagnosis and management, the treatment of BPPV remains challenging for even the most experienced clinicians. This study outlines the incidence of BPPV in a specialised vestibular physiotherapy clinics and discusses the various nuances encountered during assessment and treatment of BPPV. DESIGN: Observational Study PARTICIPANTS: 314 patients with various forms of Benign Paroxysmal Positional Vertigo (BPPV) INTERVENTION: Canalith repositioning manoeuvres (CRP) for posterior canal (PC) or horizontal canal (HC) BPPV depending on the canal and variant of BPPV. OUTCOME MEASURES: Negative Dix-Hallpike (DHP) or Supine roll test (SRT) examination. RESULTS: In 91% of cases, PC BPPV was effectively treated in 2 manoeuvres or less. Similarly, 88% of HC BPPV presentations were effectively managed with 2 treatments. Bilateral PC, multiple canal or canal conversions required a greater number of treatments. There was no noticeable difference in treatment outcomes for patients who had nystagmus and symptoms during the Epley manoeuvre (EM) versus those who did not have nystagmus and symptoms throughout the EM. Nineteen percent of patients experienced post treatment down-beating nystagmus (DBN) and vertigo or “otolithic crisis” after the first or even the second consecutive EM. CONCLUSION: Based on the data collected, we make several clinical recommendations for assessment and treatment of BPPV. Firstly, repeated testing and treatment of BPPV within the same session is promoted as a safe and effective approach to the management of BPPV with a low risk of canal conversion. Secondly, vertigo and nystagmus throughout the EM is not indicative of treatment success. Thirdly, clinicians must remain vigilant and mindful of the possibility of post treatment otolithic crisis following the treatment of BPPV. This is to ensure patient safety and to prevent possible injurious falls. Our results challenge several clinical assumptions about the assessment and treatment of BPPV including the utility of certain markers of treatment success; hence influencing the current clinical guidelines and clinical practice and paving the way for future studies of the assessment and management of patients with BPPV.
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Affiliation(s)
- Laura Power
- Balance Disorders and Ataxia Service, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, Australia
- Dizzy Day Clinics, Burnley, VIC, Australia
| | | | - David J. Szmulewicz
- Balance Disorders and Ataxia Service, Royal Victorian Eye and Ear Hospital, East Melbourne, VIC, Australia
- Cerebellar Ataxia Clinic, Neuroscience Department, Alfred Health/Monash University, Melbourne, VIC, Australia
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Pal'chun VT, Guseva AL, Kryukov AI, Kunel'skaya NL. [Repositioning maneuver for self-performing by patients in cupulolithiasis of horizontal canal BPPV]. Vestn Otorinolaringol 2020; 85:6-12. [PMID: 33474909 DOI: 10.17116/otorino2020850616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE The aim of the study is to evaluate the efficiency of the new repositioning maneuver for patients with horizontal canal cupulolithiasis benign paroxysmal positional vertigo (BPPV) to perform independently at home between doctor's sessions. MATERIALS AND METHODS 28 patients with isolated horizontal canal cupulolithiasis BPPV were enrolled. In all of them treatment with Gufoni maneuver was not successful after first session. They were divided in M«-» group (17 patients), M«-» group (11 patients). M«-» group performed forced prolong prositionig on the side with less dizziness between sessions. M«-» group performed forced prolong prositionig on the side with less dizziness and 3-5 repetitions of new repositioning maneuver 2-3 times a day between sessions. Repositioning maneuver consists of head shaking, then moving to one side-lying position with maintaining it until dizziness stops and resuming the upright sitting position, then without a pause performing head shaking and moving to the other side-lying position with maintaining it until dizziness stops and resuming the upright sitting position. The patients visited doctor once a week. Before treatment and 1 week after treatment dizziness handicap inventory (DHI) was administrated. RESULTS After 2 and 3 weeks of treatment more patients in M«-» group than in M«-» group were cured (p<0.05). After 4 weeks of treatment the number of recovered patients did not significantly differ in both groups. After 1 week of treatment according to DHI scores in M«-» group there were less patients with mild dizziness and more patients with moderate dizziness than in M«-» group (p<0.05). CONCLUSION Recovery from horizontal canal cupulolithisis BPPV could be achieved at an early date with self-performing of new repositioning maneuver. Patient-perceived disability in persisting horizontal canal cupulolithiasis could be less if the new repositioning maneuver is performed.
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Affiliation(s)
- V T Pal'chun
- N.I. Pirogov Russian National Research Medical University of the Ministry of Health of Russia, Moscow, Russia
- Sverzhevsky Research Institute of Clinical Otorhinolaryngology, Moscow, Russia
| | - A L Guseva
- N.I. Pirogov Russian National Research Medical University of the Ministry of Health of Russia, Moscow, Russia
| | - A I Kryukov
- N.I. Pirogov Russian National Research Medical University of the Ministry of Health of Russia, Moscow, Russia
- Sverzhevsky Research Institute of Clinical Otorhinolaryngology, Moscow, Russia
| | - N L Kunel'skaya
- N.I. Pirogov Russian National Research Medical University of the Ministry of Health of Russia, Moscow, Russia
- Sverzhevsky Research Institute of Clinical Otorhinolaryngology, Moscow, Russia
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Hoppes CW, Klatt BN, Dunlap PM, Jacks B, Whitney SL. Management of Benign Paroxysmal Positional Vertigo in an Adult With Severe Osteogenesis Imperfecta. Laryngoscope 2019; 130:2241-2244. [PMID: 31800107 DOI: 10.1002/lary.28431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 10/29/2019] [Accepted: 11/06/2019] [Indexed: 11/10/2022]
Abstract
The purpose of this case report was to describe the evaluation and management of atypical benign paroxysmal positional vertigo (BPPV) in an adult with severe osteogenesis imperfecta. A 29-year-old male was referred to a physical therapist with extensive experience in vestibular rehabilitation who provided horizontal canal BPPV treatment with a canalith repositioning maneuver over two treatment sessions. The individual's symptoms had reduced by 65% and his nystagmus during the roll test was reduced. Extreme care is needed to safely reposition individuals living with severe osteogenesis imperfecta, but the repositioning can reduce symptoms and improve quality of life. Laryngoscope, 130:2241-2244, 2020.
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Affiliation(s)
- Carrie W Hoppes
- Army-Baylor University Doctoral Program in Physical Therapy, Fort Sam Houston, Texas
| | - Brooke N Klatt
- The Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Pamela M Dunlap
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Beth Jacks
- E Jacks Physical Therapy, Wexford, Pennsylvania, U.S.A
| | - Susan L Whitney
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania
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Lee G, Lee SG, Park HS, Kim BJ, Choi SJ, Choi JW. Clinical characteristics and associated factors of canal switch in benign paroxysmal positional vertigo. J Vestib Res 2019; 29:253-260. [DOI: 10.3233/ves-190667] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Geonho Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Chungnam National University, College of Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Seul-Gi Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Chungnam National University, College of Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Hee-Sung Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Chungnam National University, College of Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Bong Jik Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Chungnam National University, College of Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Seong-Jun Choi
- Department of Otolaryngology—Head and Neck Surgery, College of Medicine, Soonchunhyang University, Cheonan Hospital, Cheonan, Republic of Korea
| | - Jin Woong Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Chungnam National University, College of Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
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You P, Instrum R, Parnes L. Benign paroxysmal positional vertigo. Laryngoscope Investig Otolaryngol 2018; 4:116-123. [PMID: 30828628 PMCID: PMC6383320 DOI: 10.1002/lio2.230] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/11/2018] [Accepted: 10/24/2018] [Indexed: 11/11/2022] Open
Abstract
Objectives Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular end‐organ disease. This article aims to summarize research findings and key discoveries of BPPV. The pathophysiology, diagnosis, nonsurgical, and surgical management are discussed. Methods A comprehensive review of the literature regarding BPPV up through June 2018 was performed. Results BPPV is typified by sudden, brief episodes of vertigo precipitated by specific head movements. While often self‐limited, BPPV can have a considerable impact on quality of life. The diagnosis can be established with a Dix‐Hallpike maneuver for the posterior and anterior canals, or supine roll test for the horizontal canal, and typically does not require additional ancillary testing. Understanding the pathophysiology of both canalithiasis and cupulolithiasis has allowed for the development of various repositioning techniques. Of these, the particle repositioning maneuver is an effective way to treat posterior canal BPPV, the most common variant. Options for operative intervention are available for intractable cases or patients with severe and frequent recurrences. Conclusions A diagnosis of BPPV can be made through clinical history along with diagnostic maneuvers. BPPV is generally amenable to in‐office repositioning techniques. For a small subset of patients with intractable BPPV, canal occlusion can be considered. Level of Evidence N/A
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Affiliation(s)
- Peng You
- Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry Western University, London Health Sciences Centre London Ontario Canada
| | - Ryan Instrum
- Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry Western University, London Health Sciences Centre London Ontario Canada
| | - Lorne Parnes
- Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry Western University, London Health Sciences Centre London Ontario Canada
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Pérez-Vázquez P, Franco-Gutiérrez V, Soto-Varela A, Amor-Dorado JC, Martín-Sanz E, Oliva-Domínguez M, Lopez-Escamez JA. Practice Guidelines for the Diagnosis and Management of Benign Paroxysmal Positional Vertigo Otoneurology Committee of Spanish Otorhinolaryngology and Head and Neck Surgery Consensus Document. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.otoeng.2018.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Smith LJ. Benign Paroxysmal Positional Vertigo. Physician Assistant Clinics 2018. [DOI: 10.1016/j.cpha.2017.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Pérez-Vázquez P, Franco-Gutiérrez V, Soto-Varela A, Amor-Dorado JC, Martín-Sanz E, Oliva-Domínguez M, Lopez-Escamez JA. Practice Guidelines for the Diagnosis and Management of Benign Paroxysmal Positional Vertigo Otoneurology Committee of Spanish Otorhinolaryngology and Head and Neck Surgery Consensus Document. Acta Otorrinolaringol Esp (Engl Ed) 2018; 69:345-66. [PMID: 28826856 DOI: 10.1016/j.otorri.2017.05.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 05/04/2017] [Indexed: 11/21/2022]
Abstract
Benign Paroxysmal Positional Vertigo is the most frequent episodic vestibular disorder. The purpose of this guide, requested by the committee on otoneurology of the Spanish Society of Otolaryngology and Head and Neck Surgery, is to supply a consensus document providing practical guidance for the management of BPPV. It is based on the Barany Society criteria for the diagnosis of BPPV. This guideline provides recommendations on each variant of BPPV, with a description of the different diagnostic tests and the therapeutic manoeuvres. For this purpose, we have selected the tests and manoeuvres supported by evidence-based studies or extensive series. Finally, we have also included a chapter on differential diagnosis and a section relating to general aspects in the management of BPPV.
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Bhattacharyya N, Gubbels SP, Schwartz SR, Edlow JA, El-Kashlan H, Fife T, Holmberg JM, Mahoney K, Hollingsworth DB, Roberts R, Seidman MD, Steiner RWP, Do BT, Voelker CCJ, Waguespack RW, Corrigan MD. Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update). Otolaryngol Head Neck Surg 2017; 156:S1-S47. [DOI: 10.1177/0194599816689667] [Citation(s) in RCA: 363] [Impact Index Per Article: 51.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Objective This update of a 2008 guideline from the American Academy of Otolaryngology—Head and Neck Surgery Foundation provides evidence-based recommendations to benign paroxysmal positional vertigo (BPPV), defined as a disorder of the inner ear characterized by repeated episodes of positional vertigo. Changes from the prior guideline include a consumer advocate added to the update group; new evidence from 2 clinical practice guidelines, 20 systematic reviews, and 27 randomized controlled trials; enhanced emphasis on patient education and shared decision making; a new algorithm to clarify action statement relationships; and new and expanded recommendations for the diagnosis and management of BPPV. Purpose The primary purposes of this guideline are to improve the 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 testing such as radiographic imaging, and increasing the use of appropriate therapeutic repositioning maneuvers. The guideline is intended for all clinicians who are likely to diagnose and manage patients with BPPV, and it applies to any setting in which BPPV would be identified, monitored, or managed. The target patient for the guideline is aged ≥18 years with a suspected or potential diagnosis of BPPV. The primary outcome considered in this guideline is the resolution of the symptoms associated with BPPV. Secondary outcomes considered include an increased rate of accurate diagnoses of BPPV, a more efficient return to regular activities and work, decreased use of inappropriate medications and unnecessary diagnostic tests, reduction in recurrence of BPPV, and reduction in adverse events associated with undiagnosed or untreated BPPV. Other outcomes considered include minimizing costs in the diagnosis and treatment of BPPV, minimizing potentially unnecessary return physician visits, and maximizing the health-related quality of life of individuals afflicted with BPPV. Action Statements The update group made strong recommendations that clinicians should (1) diagnose posterior semicircular canal BPPV when vertigo associated with torsional, upbeating nystagmus is provoked by the Dix-Hallpike maneuver, performed by bringing the patient from an upright to supine position with the head turned 45° to one side and neck extended 20° with the affected ear down, and (2) treat, or refer to a clinician who can treat, patients with posterior canal BPPV with a canalith repositioning procedure. The update group made a strong recommendation against postprocedural postural restrictions after canalith repositioning procedure for posterior canal BPPV. The update group made recommendations that the clinician should (1) perform, or refer to a clinician who can perform, a supine roll test to assess for lateral semicircular canal BPPV if the patient has a history compatible with BPPV and the Dix-Hallpike test exhibits horizontal or no nystagmus; (2) differentiate, or refer to a clinician who can differentiate, BPPV from other causes of imbalance, dizziness, and vertigo; (3) assess patients with BPPV for factors that modify management, including impaired mobility or balance, central nervous system disorders, a lack of home support, and/or increased risk for falling; (4) reassess patients within 1 month after an initial period of observation or treatment to document resolution or persistence of symptoms; (5) evaluate, or refer to a clinician who can evaluate, patients with persistent symptoms for unresolved BPPV and/or underlying peripheral vestibular or central nervous system disorders; and (6) educate patients regarding the impact of BPPV on their safety, the potential for disease recurrence, and the importance of follow-up. The update group made recommendations against (1) radiographic imaging for a patient who meets diagnostic criteria for BPPV in the absence of additional signs and/or symptoms inconsistent with BPPV that warrant imaging, (2) vestibular testing for a patient who meets diagnostic criteria for BPPV in the absence of additional vestibular signs and/or symptoms inconsistent with BPPV that warrant testing, and (3) routinely treating BPPV with vestibular suppressant medications such as antihistamines and/or benzodiazepines. The guideline update group provided the options that clinicians may offer (1) observation with follow-up as initial management for patients with BPPV and (2) vestibular rehabilitation, either self-administered or with a clinician, in the treatment of BPPV.
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Affiliation(s)
- Neil Bhattacharyya
- Department of Otolaryngology, Harvard Medical School, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Samuel P. Gubbels
- Department of Otolaryngology, School of Medicine and Public Health, University of Colorado, Aurora, Colorado, USA
| | - Seth R. Schwartz
- Department of Otolaryngology, Virginia Mason Medical Center, Seattle, Washington, USA
| | - Jonathan A. Edlow
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Hussam El-Kashlan
- Department of Otolaryngology, University of Michigan, Ann Arbor, Michigan, USA
| | - Terry Fife
- Barrow Neurological Institute and College of Medicine, University of Arizona, Phoenix, Arizona, USA
| | | | | | | | - Richard Roberts
- Alabama Hearing and Balance Associates, Inc, Birmingham, Alabama, USA
| | - Michael D. Seidman
- Department of Otolaryngology–Head and Neck Surgery, College of Medicine, University of Central Florida, Orlando, Florida, USA
| | - Robert W. Prasaad Steiner
- Department of Health Management and Systems Science and Department of Family and Geriatric Medicine, School of Public Health and Information Science, University of Louisville, Louisville, Kentucky, USA
| | - Betty Tsai Do
- Department of Otorhinolaryngology, Health Sciences Center, University of Oklahoma, Oklahoma City, Oklahoma, USA
| | - Courtney C. J. Voelker
- Department of Otolaryngology–Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Richard W. Waguespack
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Maureen D. Corrigan
- American Academy of Otolaryngology–Head and Neck Surgery Foundation, Alexandria, Virginia, USA
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Ban JH, Kim MB, Hong SM. Immediate and Short-Term Therapeutic Results Between Direction-Changing Positional Nystagmus with Short- and Long-Duration Groups. Ear Hear 2016; 37:243-6. [PMID: 26469290 DOI: 10.1097/AUD.0000000000000232] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Clinicians sometimes treat patients with relatively long-duration geotropic direction-changing positional nystagmus (DCPN), without latency. Recently, the concept of a "light cupula" in the lateral canal that reveals persistent geotropic DCPN has been introduced. In the present study, we investigated the immediate and short-term therapeutic findings in long-duration DCPN. DESIGN The authors prospectively compared the therapeutic efficacy of a canalith-repositioning procedure (CRP) in short- and long-duration geotropic DCPN. RESULTS In patients with long-duration DCPN, the authors found no immediate therapeutic effect, and the number of patients showing short-term effects (on the next day) was very low compared with the comparable figure among those with short-duration DCPN. In addition, no cases exhibited canal conversion after the CRP. CONCLUSION Our results suggest that CRP is not useful in patients with long-duration geotropic DCPN, and the pathogenesis of long-duration geotropic DCPN may not originate from free-floating debris but from deflection of the cupula.
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Zuma e Maia F. New Treatment Strategy for Apogeotropic Horizontal Canal Benign Paroxysmal Positional Vertigo. Audiol Res 2016; 6:163. [PMID: 27942374 PMCID: PMC5134676 DOI: 10.4081/audiores.2016.163] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 09/29/2016] [Accepted: 09/29/2016] [Indexed: 11/22/2022] Open
Abstract
The apogeotropic variant of horizontal semicircular canal benign paroxysmal positional vertigo (HC-BPPV) is attributed to canalithiasis of the anterior arm or cupulolithiasis. Despite some therapeutic maneuvers, I propose a new treatment strategy for apogeotropic HC-BPPV that is designed to detach both the otoconial debris from the anterior arm of the semicircular canal and the debris that is attached to the utricular side of the cupula using inertia and gravity and based on simulations with a 3D biomechanical model.
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Abstract
Benign paroxysmal positional vertigo is the most common peripheral vestibular disorder. It can be defined as transient vertigo induced by a rapid head position change, associated with a characteristic paroxysmal positional nystagmus. Canalolithiasis of the posterior semicircular canal is considered the most convincing theory of its pathogenesis and the development of appropriate therapeutic maneuvers resulted in its effective treatment. However, involvement of the horizontal or the anterior canal has been found in a significant rate and the recognition and treatment of these variants completed the clinical picture of the disease. This paper describes the advances in understanding how this disease is generated and discusses the current therapeutic modalities.
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Affiliation(s)
- Stavros G Korres
- ENT Department, National University of Athens, Hippokration Hospital, Greece
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Abstract
OBJECTIVES To compare the diagnostic value of the head-bending test (HBT), lying-down positioning test (LDPT) and patient's report to identify the affected canal in video-nystagmographically (VNG) confirmed patients with lateral canal benign paroxysmal positional vertigo (LC-BPPV). STUDY DESIGN Case series with chart review. SETTING Head-bending, lying-down positioning and the head-roll maneuver (HRM) under VNG guidance. The data were collected in a referral community hospital. PATIENTS Seventy-eight patients (32 apogeotropic and 46 geotropic nystagmus) with LC-BPPV who had been recruited between 2009 and 2013 were enrolled in the study. MAIN OUTCOME MEASURES Patients were tested with the HRM and then were asked about subjectively worse side. Later, they were subjected to HBT when sitting and the LDPT. The results were compared and studied with the 1-way ANOVA and chi-square tests. Statistical significance was set at p < 0.05. RESULTS Affected side was identified by HRM in 75% of patients with apogeotropic nystagmus and 95.6% of patients with geotropic nystagmus. Approximately 65.6% of patients with apogeotropic and 52% of patients with geotropic nystagmus had nystagmus during LDPT. However, its comparability with HRM was low. However, treatment plan based on LDPT results alone provided relief of symptoms in additional 12.5% of patients with apogeotropic and in 2.2% of patients with geotropic nystagmus. Approximately 63% of patients with apogeotropic and 56% of patients with geotropic nystagmus were able to tell the worse side. Nystagmus comparable with HRM during HBT was low and not diagnostic. CONCLUSION HRM has the greatest diagnostic value of positioning tests in LC-BPPV in this study. LDPT provides some contribution in the diagnosis of LC-BPPV but much less than HRM. Patients' subjective feeling of vertigo was also a useful test. However, HBT was not as sensitive as other measures in uncertain cases.
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Silva C, Amorim AM, Paiva A. Benign paroxysmal positional vertigo--a review of 101 cases. Acta Otorrinolaringol Esp 2015; 66:205-9. [PMID: 25865125 DOI: 10.1016/j.otorri.2014.09.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 08/26/2014] [Accepted: 09/01/2014] [Indexed: 10/23/2022]
Abstract
INTRODUCTION AND OBJECTIVE Benign paroxysmal positional vertigo is one of the most common vestibular disorders, with a lifetime prevalence of 2.4%. This study aimed to assess age, gender, lesion type and site, association with other vestibular diseases, progression and recurrence in a Portuguese population. METHODS This was a retrospective observational study of 101 patients diagnosed with benign paroxysmal positional vertigo by the same senior doctor, in a tertiary academic hospital, between January 2009 and May 2011. RESULTS A total of 101 cases were pooled, with a mean age of 56.57±15.33 years (15-90 years). From these, 72.3% were women. The posterior canal was affected in 72.3%, the lateral in 24.7%, the anterior in 2% and multiple canals in 1%. Unilateral canal and left labyrinth involvement were more frequent. The therapeutic maneuver used most was Epley's. Recurrence was observed in 10.9% of the cases. It was idiopathic in 83.2% of cases. No association was found between the number of maneuvers necessary to treat benign paroxysmal positional vertigo and etiology. CONCLUSION Benign paroxysmal positional vertigo is more frequent in female subjects, in the 6th decade and involves preferably the posterior semicircular canal of the right labyrinth. In most cases it is idiopathic and treatment with repositioning maneuvers has a mean success of 90%. Our results were in accordance with the literature; nevertheless, in this study the left labyrinth was most affected and the follow-up period was variable.
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Affiliation(s)
- Clara Silva
- Otorhinolaryngology and Head and Neck Surgery Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
| | - Ana Margarida Amorim
- Otorhinolaryngology and Head and Neck Surgery Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - António Paiva
- Otorhinolaryngology and Head and Neck Surgery Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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Oron Y, Cohen-Atsmoni S, Len A, Roth Y. Treatment of horizontal canal BPPV: Pathophysiology, available maneuvers, and recommended treatment. Laryngoscope 2015; 125:1959-64. [DOI: 10.1002/lary.25138] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/22/2014] [Accepted: 12/15/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Yahav Oron
- Department of Otolaryngology-Head and Neck Surgery and Tel-Aviv University Sackler School of Medicine; The Edith Wolfson Medical Center; Holon Israel
| | - Smadar Cohen-Atsmoni
- Department of Otolaryngology-Head and Neck Surgery and Tel-Aviv University Sackler School of Medicine; The Edith Wolfson Medical Center; Holon Israel
| | - Assaf Len
- Department of Otolaryngology-Head and Neck Surgery and Tel-Aviv University Sackler School of Medicine; The Edith Wolfson Medical Center; Holon Israel
| | - Yehudah Roth
- Department of Otolaryngology-Head and Neck Surgery and Tel-Aviv University Sackler School of Medicine; The Edith Wolfson Medical Center; Holon Israel
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Riga M, Korres S, Korres G, Danielides V. Apogeotropic variant of lateral semicircular canal benign paroxysmal positional vertigo: is there a correlation between clinical findings, underlying pathophysiologic mechanisms and the effectiveness of repositioning maneuvers? Otol Neurotol 2013; 34:1155-64. [PMID: 23512075 DOI: 10.1097/MAO.0b013e318280db3a] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The apogeotropic variant of horizontal semicircular canal (h-SCC) benign paroxysmal positional vertigo (BPPV) is attributed to canalithiasis of the anterior arm or cupulolithiasis. This study is an attempt to distinguish the most effective maneuvers for each case, by investigating any correlation, between the clinical findings or the treatment options and the possible location of the displaced debris. DATA SOURCES A review of the literature (1990-2012) was conducted via the PubMed database with the search terms "apogeotropic nystagmus and benign paroxysmal positional vertigo." STUDY SELECTION Articles on central nervous system lesions were excluded. DATA EXTRACTION The studies included in the analysis provided detailed diagnostic and therapeutic protocols, supported by the resolution of the signs and symptoms through repositioning maneuvers. DATA SYNTHESIS Descriptive statistics were used to summarize the findings. Intergroup and intragroup comparisons were performed through Pearson's χ or Fischer's exact test. CONCLUSION Protocols vary considerably among studies. Nystagmus from seated to supine position is the best studied secondary clinical sign and possibly a clinical indication of cupulolithiasis. In patients with symmetrical responses in the head yaw test, no significant differences can be detected in the occurrence of secondary signs of lateralization compared to patients with asymmetrical responses. The Gufoni maneuver seems to be effective in all pathophysiologic types of apogeotropic h-SCC BPPV. The Barbeque and Vannucchi-Asprella maneuvers mainly target at lithiasis of the anterior ampullary arm. The results of this analysis may imply that different clinical subgroups of h-SCC BPPV may regard to different pathophysiologic and therapeutical mechanisms.
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Boldingh MI, Ljøstad U, Mygland Å, Monstad P. Comparison of Interictal Vestibular Function in Vestibular Migraine vs Migraine Without Vertigo. Headache 2013; 53:1123-33. [DOI: 10.1111/head.12129] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2013] [Indexed: 11/29/2022]
Affiliation(s)
| | - Unn Ljøstad
- Department of Neurology; Sørlandet Hospital HF; Kristiansand; Norway
| | | | - Per Monstad
- Department of Neurology; Sørlandet Hospital HF; Kristiansand; Norway
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Abstract
OBJECTIVE To determine the incidence, cause, and prevention of horizontal canal benign paroxysmal positional vertigo (H-BPPV) and reentry into the common crus during canalith repositioning procedures (CRPs). STUDY DESIGN Prospective case series. SETTING Academic tertiary referral center. PATIENTS Forty-four patients with symptomatic posterior canalithiasis (P-BPPV) confirmed on Dix-Hallpike. INTERVENTION Up to 5 CRP for initial P-BPPV and additional maneuvers for canal conversion or reentry in 1 session. MAIN OUTCOME MEASURES Incidence and timing of onset of H-BPPV or common crus reentry and the outcome of treatment maneuvers. RESULTS H-BPPV or reentry occurred during the Dix-Hallpike after a canal-clearing CRP and affected 16% (7/44) of subjects. Approximately 87% (7/8) of reentry or conversion events occurred after the very first CRP. Geotropic H-BPPV occurred in 9% (4/44) overall but in 13% (4/30) whose P-BPPV was resolved by a single CRP. All were cleared with H-BPPV maneuvers, 3 of 4 resolving with a single Gufoni maneuver. Approximately 9% (4/44) of patients developed reentry of particles into the common crus. It was treated by raising the patient to the upright position. By waiting 15 minutes after treatment of reentry, a final normal Dix-Hallpike was obtained without causing reentry into any canal in all patients. CONCLUSION If the first CRP clears the posterior canal, there is an elevated risk of reentry or canal conversion if another Dix-Hallpike is performed immediately. These complications can be treated by additional maneuvers; if unfamiliar with these techniques, the risk can be reduced by waiting at least 15 minutes between repetitions of CRP.
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Korres S, Riga MG, Xenellis J, Korres GS, Danielides V. Treatment of the Horizontal Semicircular Canal Canalithiasis: Pros and Cons of the Repositioning Maneuvers in a Clinical Study and Critical Review of the Literature. Otol Neurotol 2011; 32:1302-8. [DOI: 10.1097/mao.0b013e31822f0bc5] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Benign paroxysmal positional vertigo (BPPV) is characterized by brief recurrent episodes of vertigo triggered by changes in head position. BPPV is the most common etiology of recurrent vertigo and is caused by abnormal stimulation of the cupula by free-floating otoliths (canalolithiasis) or otoliths that have adhered to the cupula (cupulolithiasis) within any of the three semicircular canals. Typical symptoms and signs of BPPV are evoked when the head is positioned so that the plane of the affected semicircular canal is spatially vertical and thus aligned with gravity. Paroxysm of vertigo and nystagmus develops after a brief latency during the Dix-Hallpike maneuver in posterior-canal BPPV, and during the supine roll test in horizontal-canal BPPV. Positioning the head in the opposite direction usually reverses the direction of the nystagmus. The duration, frequency, and symptom intensity of BPPV vary depending on the involved canals and the location of otolithic debris. Spontaneous recovery may be expected even with conservative treatments. However, canalithrepositioning maneuvers usually provide an immediate resolution of symptoms by clearing the canaliths from the semicircular canal into the vestibule.
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Affiliation(s)
- Seung-Han Lee
- Department of Neurology, Chonnam National University Medical School, Gwangju, Korea
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Roberts RA, Abrams H, Sembach MK, Lister JJ, Gans RE, Chisolm TH. Utility measures of health-related quality of life in patients treated for benign paroxysmal positional vertigo. Ear Hear 2009; 30:369-76. [PMID: 19322083 DOI: 10.1097/AUD.0b013e31819f316a] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Comparing the effects of different disorders and interventions on health-related quality of life (HRQoL) is important for healthcare policy and accountability. There are two basic approaches to measure HRQoL: questionnaires derived from psychometrics and preference-based measures or utilities derived from econometrics. While disease-specific HRQoL questionnaires, such as the Dizziness Handicap Inventory (DHI), are important because they focus on the impact of a specific problem and its treatments (i.e., vestibular disorders), economic comparisons of the impacts of diseases/disorders and their treatments are typically based on utility assessment. The utility measures for audiology application (UMAA) were developed to measure utilities for various audiologic conditions using a standard computer. The purpose of this study was to determine if the UMAA provides stable, valid, and sensitive utility measures of the effects of benign paroxysmal positional vertigo (BPPV) and its treatment on HRQoL. It was hypothesized that utilities, as measured by the UMAA, would indicate improvement in HRQoL post-treatment for BPPV comparable to a disease-specific health status measure (DHI). DESIGN The UMAA incorporates three techniques to measure utility: rating scale, standard gamble, and time tradeoff. A utility is a cardinal measure of strength of preference and is measured on a continuum basis from 0.0 (incapacitating dizziness) to 1.0 (no dizziness). Fifty-two adults with BPPV of the posterior semicircular canal completed the UMAA and DHI before treatment and again post-treatment. A subgroup of 15 participants completed the UMAA on two occasions before treatment to assess test-retest stability and to establish critical difference values. RESULTS Results from this investigation demonstrate that utilities as measured through the UMAA are stable, valid, and comparable to the DHI. Post-treatment utilities were also significantly higher than pretreatment utilities, indicating that the utilities, as measured through the UMAA, are sensitive to improvement in HRQoL after BPPV treatment. CONCLUSIONS Utilities as measured through the UMAA seem sensitive to changes in HRQoL after treatment of BPPV. Since the UMAA can be used to measure patient preference (i.e., utility), it may be useful for comparison of specific audiologic conditions, such as BPPV, to nonaudiologic conditions, such as cardiovascular disease and kidney disease.
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Roberts RA, Gans RE, Kastner AH. Differentiation of migrainous positional vertigo (MPV) from horizontal canal benign paroxysmal positional vertigo (HC-BPPV). Int J Audiol 2009; 45:224-6. [PMID: 16684703 DOI: 10.1080/14992020500429658] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This article presents an approach to differentiation of migrainous positional vertigo (MPV) from horizontal canal benign paroxysmal positional vertigo (HC-BPPV). Such an approach is essential because of the difference in intervention between the two disorders in question. Results from evaluation of the case study presented here revealed a persistent ageotropic positional nystagmus consistent with MPV or a cupulolithiasis variant of HC-BPPV. The patient was treated with liberatory maneuvers to remove possible otoconial debris from the horizontal canal in an attempt, in turn, to provide further diagnostic information. There was no change in symptoms following treatment for HC-BPPV. This case was diagnosed subsequently as MPV, and the patient was referred for medical intervention. Treatment has been successful for 22 months. Incorporation of HC-BPPV treatment, therefore, may provide useful information in the differential diagnosis of MPV and the cupulolithiasis variant of HC-BPPV.
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Affiliation(s)
- Richard A Roberts
- The American Institute of Balance, 11290 Park Boulevard, Seminole, FL 33772, USA.
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Abstract
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.
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Affiliation(s)
- Daniele Nuti
- Department of Orthopedics, Radiology and Otolaryngology, University of Siena, School of Medicine, Siena, Italy.
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Riggio F, Dispenza F, Gallina S, Kulamarva G, Gargano R, Speciale R. Management of benign paroxysmal positional vertigo of lateral semicircular canal by Gufoni's manoeuvre. Am J Otolaryngol 2009; 30:106-11. [PMID: 19239952 DOI: 10.1016/j.amjoto.2008.03.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2008] [Revised: 03/03/2008] [Accepted: 03/08/2008] [Indexed: 11/29/2022]
Abstract
UNLABELLED Benign paroxysmal positional vertigo (BPPV) of lateral semicircular canal (LSC) is one of the rarer forms of BPPV as compared to posterior semicircular canal BPPV. Various particle repositioning manoeuvres have been described in the literature as a mode of treating this condition. PURPOSE Evaluation and discussion of the procedure of the Gufoni's manoeuvre and its advantages in the treatment of BPPV of LSC. MATERIAL AND METHODS Prospective study of 58 patients affected by LSC BPPV who were office-treated with Gufoni's manoeuvre. RESULTS Seventy-nine percent of the patients so treated had complete resolution of symptoms, and 6.9% did not show any improvement in their symptoms. The remaining 13.8% had a conversion into posterior semicircular canal BPPV during treatment and were successfully treated with Epley's or Semont's manoeuvre. CONCLUSIONS Gufoni's manoeuvre is effective in treating patients suffering from BPPV of LSC; it is simple to perform; there are not many movements to execute, it needs low time of positioning, and positions are comfortable to the patient.
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Affiliation(s)
- Francesco Riggio
- Dipartimento Scienze Otorinolaringoiatriche, Università degli Studi di Palermo, Palermo, Italy
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Crevits L. Different canalith repositioning procedures for horizontal canal benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg 2005; 133:817. [PMID: 16274821 DOI: 10.1016/j.otohns.2005.06.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2005] [Indexed: 11/27/2022]
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