C Postural Vertigo and Positional Nystagmus

Effectiveness of Treatments for Benign Paroxysmal Positional Vertigo of the Posterior Canal

OBJECTIVE

To determine which common, nonpharmacological, nonsurgical treatments are most effective for treatment of benign paroxysmal positional vertigo (BPPV).

STUDY DESIGN

Prospective, randomized, sham-controlled.

PATIENTS

Patients (n = 124) with BPPV of the posterior semicircular canal.

SETTING

Tertiary care center.

INTERVENTIONS

Random assignment to one of five groups: modified canalith repositioning maneuver (CRP), modified liberatory maneuver (LM), sham maneuver, Brandt and Daroff's exercise, and vertigo habituation exercises. Subjects received a standard educational lecture about BPPV and the purpose of the intervention. No vestibular-suppressant medication or special instructions for head positioning were used. Post-tests were given at 1 week after treatment and at approximately 3 months and 6 months later.

MAIN OUTCOME MEASURES

Vertigo intensity and frequency.

RESULTS

Multilevel analyses showed that vertigo decreased significantly after LM, CRP, and Brandt-Daroff exercise; those three groups did not differ significantly. The habituation group did not differ from sham, Brandt-Daroff, LM, or CRP groups. Changes in scores were maintained throughout the 6-month follow-up period.

CONCLUSION

LM, CRP, and exercises are all effective interventions; patient education plus the sham maneuver, however, had some beneficial effect. These results support two possible mechanisms of BPPV: displaced otoconia and a neural mechanism affecting interpretation of semicircular canal signals.

Ablation of Posterior Semicircular Canal for Benign Paroxysmal Positional Vertigo

Obstruction of the posterior semicircular canal to prevent fluid movement without injury to the neurosensory end organ has been shown to be effective treatment for benign paroxysmal positional vertigo. Risk of Injury to the inner ear with loss of hearing has been reported with a variety of techniques. This paper will describe a modification of the procedure to ablate the posterior semicircular canal and to minimize the risk of inner ear injury. The procedure has been performed on 17 patients with prompt and lasting relief of vertigo and no hearing loss. The procedure seems to be a valuable and effective treatment for the disturbing condition of benign paroxysmal positional vertigo.

'Carrusel': an expert system for vestibular diagnosis

Neuro-otology is the only field of otolaryngology in which diagnoses are mainly deductive. Although many technological advances have indeed occurred, the patient history still remains the most important part of the evaluation of a patient complaining of vertigo and/or dizziness. The use of artificial intelligence methods as an aid for the solution of clinical problems is not new. "Carrusel" is a Prolog build-up expert system dealing with the diagnosis of vestibular disorders that achieves a success rate of 97% when compared to the human experts involved in its design.

Vestibular and oculomotor abnormalities in vertebrobasilar insufficiency

The early diagnosis of vertebrobasilar insufficiency in patients with vertigo as their only symptom was attempted using a battery of vestibulo-oculomotor tests. With this testing procedure, we were able to find abnormal vestibulo-oculomotor mechanisms that could account for the vertigo in 41 of 42 patients. These abnormalities, however, did not fall into an easily recognizable pattern that could be considered characteristic of vertebrobasilar insufficiency. The large intersubject variability probably arises from the very different and widespread lesions that occur at the vestibular and neurological levels as a consequence of vertebrobasilar insufficiency.