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Jafarov S, Hizal E, Bahcecitapar M, Ozluoglu LN. Upright positioning-related reverse nystagmus in posterior canal benign paroxysmal positional vertigo and its effect on prognosis. J Vestib Res 2020; 30:195-201. [DOI: 10.3233/ves-200700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Sabuhi Jafarov
- Baskent University, Faculty of Medicine, Department of Otorhinolaryngology, Ankara, Turkey
| | - Evren Hizal
- Baskent University, Faculty of Medicine, Department of Otorhinolaryngology, Ankara, Turkey
| | - Melike Bahcecitapar
- Hacettepe University, Faculty of Science, Department of Statistics, Ankara, Turkey
| | - Levent N. Ozluoglu
- Baskent University, Faculty of Medicine, Department of Otorhinolaryngology, Ankara, Turkey
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Asal S, Sobhy O, Balbaa A. oVEMP as an objective indicator of successful repositioning maneuver. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2018; 69:141-148. [DOI: 10.1016/j.otorri.2017.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 05/11/2017] [Accepted: 06/01/2017] [Indexed: 11/25/2022]
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Asal S, Sobhy O, Balbaa A. oVEMP as an objective indicator of successful repositioning maneuver. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2018. [DOI: 10.1016/j.otoeng.2017.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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von Brevern M, Bertholon P, Brandt T, Fife T, Imai T, Nuti D, Newman-Toker D. Benign paroxysmal positional vertigo: Diagnostic criteria Consensus document of the Committee for the Classification of Vestibular Disorders of the Bárány Society. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2017; 68:349-360. [PMID: 29056234 DOI: 10.1016/j.otorri.2017.02.007] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 02/28/2017] [Indexed: 11/18/2022]
Abstract
This article presents operational diagnostic criteria for benign paroxysmal positional vertigo (BPPV), formulated by the Committee for Classification of Vestibular Disorders of the Bárány Society. The classification reflects current knowledge of clinical aspects and pathomechanisms of BPPV and includes both established and emerging syndromes of BPPV. It is anticipated that growing understanding of the disease will lead to further development of this classification.
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Affiliation(s)
| | - Pierre Bertholon
- Department of Otolaryngology, Head and Neck Surgery, Bellvue Hospital, Saint-Etienne, Francia
| | - Thomas Brandt
- Institute of Clinical Neuroscience, Ludwig-Maximilian University, Múnich, Alemania
| | - Terry Fife
- Barrow Neurological Institute, University of Arizona College of Medicine, Phoenix, EE. UU
| | - Takao Imai
- Department of Otolaryngology, Head and Neck Surgery, Osaka University Graduate School of Medicine, Osaka, Japón
| | - Daniele Nuti
- Department of Otolaryngology, Head and Neck Surgery, University of Siena, Siena, Italia
| | - David Newman-Toker
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, EE. UU
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Hides JA, Franettovich Smith MM, Mendis MD, Smith NA, Cooper AJ, Treleaven J, Leung F, Gardner AJ, McCrory P, Low Choy NL. A prospective investigation of changes in the sensorimotor system following sports concussion. An exploratory study. Musculoskelet Sci Pract 2017; 29:7-19. [PMID: 28259770 DOI: 10.1016/j.msksp.2017.02.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 02/10/2017] [Accepted: 02/16/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Sports concussion is a risk for players involved in high impact, collision sports. Post-concussion, the majority of symptoms subside within 7-10 days, but can persist in 10-20% of athletes. Understanding the effects of sports concussion on sensorimotor systems could inform physiotherapy treatment. OBJECTIVE To explore changes in sensorimotor function in the acute phase following sports concussion. DESIGN Prospective cohort study. METHODS Fifty-four players from elite rugby union and league teams were assessed at the start of the playing season. Players who sustained a concussion were assessed three to five days later. Measures included assessments of balance (sway velocity), vestibular system function (vestibular ocular reflex gain; right-left asymmetry), cervical proprioception (joint position error) and trunk muscle size and function. RESULTS During the playing season, 14 post-concussion assessments were performed within 3-5 days of injury. Significantly decreased sway velocity and increased size/contraction of trunk muscles, were identified. Whilst not significant overall, large inter-individual variation of test results for cervical proprioception and the vestibular system was observed. LIMITATIONS The number of players who sustained a concussion was not large, but numbers were comparable with other studies in this field. There was missing baseline data for vestibular and cervical proprioception testing for some players. CONCLUSIONS Preliminary findings post-concussion suggest an altered balance strategy and trunk muscle control with splinting/over-holding requiring consideration as part of the development of appropriate physiotherapy management strategies.
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Affiliation(s)
- Julie A Hides
- Centre for Musculoskeletal Research, Mary MacKillop Institute for Health Research, Australian Catholic University, Brisbane, QLD, 4102, Australia.
| | - Melinda M Franettovich Smith
- Centre for Musculoskeletal Research, Mary MacKillop Institute for Health Research, Australian Catholic University, Brisbane, QLD, 4102, Australia
| | - M Dilani Mendis
- Centre for Musculoskeletal Research, Mary MacKillop Institute for Health Research, Australian Catholic University, Brisbane, QLD, 4102, Australia; Physiotherapy Department, Mater Health Services, South Brisbane, 4101, Australia
| | - Nigel A Smith
- Centre for Musculoskeletal Research, Mary MacKillop Institute for Health Research, Australian Catholic University, Brisbane, QLD, 4102, Australia
| | - Andrew J Cooper
- Centre for Musculoskeletal Research, Mary MacKillop Institute for Health Research, Australian Catholic University, Brisbane, QLD, 4102, Australia
| | - Julia Treleaven
- Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, 4072, Australia
| | - Felix Leung
- Centre for Musculoskeletal Research, Mary MacKillop Institute for Health Research, Australian Catholic University, Brisbane, QLD, 4102, Australia
| | - Andrew J Gardner
- Priority Research Centre for Stroke and Brain Injury, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2310, Australia; Hunter New England Local Health District Sports Concussion Program, John Hunter Hospital, New Lambton Heights, NSW, 2305, Australia
| | - Paul McCrory
- The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
| | - Nancy L Low Choy
- School of Physiotherapy, Australian Catholic University, Brisbane, QLD, 4014, Australia
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Tirelli G, Nicastro L, Gatto A, Tofanelli M. Repeated canalith repositioning procedure in BPPV: Effects on recurrence and dizziness prevention. Am J Otolaryngol 2017; 38:38-43. [PMID: 27806891 DOI: 10.1016/j.amjoto.2016.09.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 09/25/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE To evaluate whether a repeated canalith repositioning procedure (CRP) influences the residual symptoms and the rate of recurrence of benign paroxysmal positional vertigo (BPPV) in patients with post-CRP dizziness. MATERIALS AND METHODS In this retrospective study, we analyzed 292 patients at the referral center for ENT diseases with a first episode of BPPV treated with a single CRP following clinical practice guidelines. In 178 patients (67.9%) who presented dizziness after BPPV recovery at the follow-up visit, 94 patients underwent CRP (treated group) and 84 did not (non-treated group). A subjective evaluation of vertigo was made by way of a questionnaire. The rates of recurrence of BPPV and residual dizziness were statistically compared between the treated and the non-treated groups; survival analysis was carried out as well. RESULTS In an observational period ranging from 1 to 6years, BPPV recurred in 122 subjects (46.6%) of the investigated population. Among the patients with residual dizziness, the difference in rate of recurrence of BPPV between the treated group and the non-treated group was not statistically significant (p=0.84). The treated group presented a significantly higher rate of recovery from dizziness compared to the non-treated group (p<0.001). CONCLUSIONS A repeated CRP in patients with post-CRP dizziness increased the rate of recovery from dizziness but had no influence on BBPV recurrence.
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Abstract
Benign paroxysmal positional vertigo (BPPV), the most common cause of dizziness, occurs in all age groups. It presents with vertigo on head movement, but in older patients presentation may be typical and thus accounting for a low recognition rate in the primary care setting. It may be recurrent in up to 50% of cases. BPPV is associated with displacement of fragments of utricular otoconia into the semicircular canals, most commonly the posterior semicircular canal. Otoconia are composed of otoconin and otolin forming the organic matrix on which calcium carbonate mineralizes. Otoconia may fragment with trauma, age, or changes in the physiology of endolymph (e.g., pH and calcium concentration). Presentation varied because otoconia fragments can be displaced into any of the semicircular canals on either (or both) side and may be free floating (canalolithiasis) or attached to the cupula (cupulolithiasis). Most cases of BPPV are idiopathic, but head trauma, otologic disorders, and systemic disease appear to be contributory in a subset. Positional maneuvers are used to diagnose and treat the majority of cases. In rare intractable cases surgical management may be considered. A strong association with osteoporosis suggests that idiopathic BPPV may have diagnostic and management implications beyond that of a purely otologic condition.
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Oostendorp RA, VanEupen AA, VanErp JM, Elvers HW. Dizziness Following Whiplash Injury: A Neuro-Otological Study in Manual Therapy Practice and Therapeutic Implication. J Man Manip Ther 2013. [DOI: 10.1179/106698199790811609] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Porta-Etessam J, García-Cobos R, Cuadrado M, Casanova I, Lapeña T, García-Ramos R. Neuro-otological symptoms in patients with migraine. NEUROLOGÍA (ENGLISH EDITION) 2011. [DOI: 10.1016/s2173-5808(11)70020-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Porta-Etessam J, García-Cobos R, Cuadrado ML, Casanova I, Lapeña T, García-Ramos R. Neuro-otological symptoms in patients with migraine. Neurologia 2010; 26:100-4. [PMID: 21163190 DOI: 10.1016/j.nrl.2010.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Accepted: 06/21/2010] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Neurootological symptoms are common in patients with migraine, and have been reported to be associated with diverse conditions. PATIENTS AND METHODS A total of 70 patients with a diagnosis of episodic migraine, with or without aura, attending our Migraine Unit were selected. The specific variables studied were the diagnosis of instability, psycho-physiological dizziness, presyncopal symptoms, benign paroxysmal positional vertigo (BPPV), migraine associated recurrent vertigo (MARV), and Meniere's disease. RESULTS A total of 44.3% of cases had orthostatism or syncope, 15.7% with instability (possibly due to bilateral vestibular hypofunction), 14.2% with MARV and 8.6% with BPPV. The presence of BPPV was observed in older patients (40 years), whilst MARV was a condition seen in younger ones (35 years). These findings are of interest and remind us that benign paroxysmal vertigo is a childhood condition and age is a risk for BPPV. CONCLUSIONS Migraine patients often present with neuro-otological symptoms that can be classified as inter-episodic and episodic symptoms, and specific and non-specific migraine symptoms. This approach is of obvious pathophysiological interest, given that MARV and the possible vestibular hypofunction of migraine patients are symptoms that share physiological aspects with migraine, while the orthostatism symptoms and BPPV are non-specific and are seen to be associated with other conditions.
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Affiliation(s)
- J Porta-Etessam
- Unidad de Cefaleas, Hospital Universitario Clínico San Carlos, Madrid, Spain.
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Cohen HS, Sangi-Haghpeykar H. Nystagmus parameters and subtypes of benign paroxysmal positional vertigo. Acta Otolaryngol 2010; 130:1019-23. [PMID: 20331407 DOI: 10.3109/00016481003664777] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Although computational models suggest the existence of canalithiasis and cupulolithiasis subtypes of benign paroxysmal positional vertigo (BPPV), these subtypes cannot be distinguished from each other based on characteristics of nystagmus. Therefore, although the subtypes probably exist more information is needed from each patient than is available without invasive procedures. Also, some patients may have clinical syndromes that include both canalithiasis and cupulolithiasis subtypes. OBJECTIVE To determine if the parameters of nystagmus provide sufficient information to determine the subtype of nystagmus in a patient with BPPV. METHODS Patients (n = 118) had unilateral BPPV of the posterior canal; 15 patients also had BPPV of the lateral canal. The main outcome measures were parameters of nystagmus in response to the Dix-Hallpike maneuver: latency to onset of nystagmus, maximum slow phase velocity, and maximum duration. RESULTS Correlations between pairs of variables showed minimal or no relationships. Also, cluster analyses showed no significant subtypes. The contralateral eye moved significantly faster than the ipsilateral eye.
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Affiliation(s)
- Helen S Cohen
- Bobby R. Alford Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, TX 77030, USA.
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Self-limiting benign paroxysmal positional vertigo following use of whole-body vibration training plate. The Journal of Laryngology & Otology 2009. [DOI: 10.1017/s0022215109992441 pmid:20003605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective:We describe a case of benign paroxysmal positional vertigo which occurred after use of a whole-body vibration training plate.Method:Case report and literature review concerning the secondary causes of benign paroxysmal positional vertigo and the physiological effects of whole-body vibration training plates.Results:A 44-year-old woman was referred with classic symptoms of benign paroxysmal positional vertigo following use of a whole-body vibration training plate, a popular form of fitness equipment widely used in sports, rehabilitation and beauty treatments. The condition resolved spontaneously after several days. There have been reports of negative side effects in users of this equipment, such as dizziness, headache and a sensation of imbalance; however, there have been no reported cases involving vertigo. Based on a literature review, this equipment may cause side effects, including vertigo, by generating forces that can increase the original amplitude of internal organs, which may potentially cause labyrinthine trauma or dislocation of otoconia, leading to benign paroxysmal positional vertigo.Conclusions:We suggest that whole-body vibration training plates may potentially induce benign paroxysmal positional vertigo. Manufacturers may need to make users of this equipment aware of this risk, and remind them to use it with caution.
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Self-limiting benign paroxysmal positional vertigo following use of whole-body vibration training plate. The Journal of Laryngology & Otology 2009; 124:796-8. [PMID: 20003605 DOI: 10.1017/s0022215109992441] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE We describe a case of benign paroxysmal positional vertigo which occurred after use of a whole-body vibration training plate. METHOD Case report and literature review concerning the secondary causes of benign paroxysmal positional vertigo and the physiological effects of whole-body vibration training plates. RESULTS A 44-year-old woman was referred with classic symptoms of benign paroxysmal positional vertigo following use of a whole-body vibration training plate, a popular form of fitness equipment widely used in sports, rehabilitation and beauty treatments. The condition resolved spontaneously after several days. There have been reports of negative side effects in users of this equipment, such as dizziness, headache and a sensation of imbalance; however, there have been no reported cases involving vertigo. Based on a literature review, this equipment may cause side effects, including vertigo, by generating forces that can increase the original amplitude of internal organs, which may potentially cause labyrinthine trauma or dislocation of otoconia, leading to benign paroxysmal positional vertigo. CONCLUSIONS We suggest that whole-body vibration training plates may potentially induce benign paroxysmal positional vertigo. Manufacturers may need to make users of this equipment aware of this risk, and remind them to use it with caution.
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Roberts RA, Gans RE, Kastner AH, Listert JJ. Prevalence of vestibulopathy in benign paroxysmal positional vertigo patients with and without prior otologic history Prevalencia de vestibulopatía en pacientes con vértigo postural paroxístico benigno (BPPV), con y sin historia previa de patología otológica. Int J Audiol 2009; 44:191-6. [PMID: 16011047 DOI: 10.1080/14992020500057715] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The purpose of this study was to determine the prevalence of reduced or absent labyrinthine reactivity (vestibulopathy) in two groups of participants with posterior canal BPPV. One group had prior diagnosis of otologic disease (positive history group). No one in the second group had ever been diagnosed with otologic disease (negative history group). Caloric responses were retrospectively analyzed for the two groups. Patients with a positive history exhibited a greater prevalence of vestibulopathy than patients with a negative history. The positive history group, on average, also exhibited a larger unilateral weakness than those patients in the negative history group. We conclude that patients with BPPV and a history of otologic disease are more likely to present with vestibulopathy, than patients with BPPV and no history of otologic disease. This finding supports the benefit of complete vestibular evaluation in patients with BPPV to ensure comprehensive and successful treatment outcome.
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Marom T, Oron Y, Watad W, Levy D, Roth Y. Revisiting benign paroxysmal positional vertigo pathophysiology. Am J Otolaryngol 2009; 30:250-5. [PMID: 19563936 DOI: 10.1016/j.amjoto.2008.06.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2008] [Accepted: 06/05/2008] [Indexed: 11/24/2022]
Abstract
Benign paroxysmal positional vertigo is the most common peripheral cause of vertigo. Although its pathophysiologic mechanisms remain unclear, different locations have been attributed throughout the last century, from the days of Bárány. Disease was initially located by Dix and Hallpike in the utricle, but later, Schuknecht's works elicited the cupulolithiasis and canalolithiasis theories, localizing the pathology to the semicircular canal system and mainly to the posterior one. However, conflicting evidences from temporal bone studies accumulated against this theory, which suggest other explanations. Although this clinical entity is well defined, and can usually be effectively treated with certain physical maneuvers, its pathophysiology is still obscure and is being critically discussed in this article, which reviews the milestones of benign paroxysmal positional vertigo understanding.
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Ganança FF, Ganança CF, Caovilla HH, Ganança MM, Albernaz PLM. Active head rotation in benign positional paroxysmal vertigo. Braz J Otorhinolaryngol 2009; 75:586-92. [PMID: 19784430 PMCID: PMC9446005 DOI: 10.1016/s1808-8694(15)30500-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2008] [Accepted: 06/16/2008] [Indexed: 11/25/2022] Open
Abstract
Aim Study design Materials and Method Conclusion
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Celebisoy N, Bayam E, Güleç F, Köse T, Akyürekli O. Balance in posterior and horizontal canal type benign paroxysmal positional vertigo before and after canalith repositioning maneuvers. Gait Posture 2009; 29:520-3. [PMID: 19138524 DOI: 10.1016/j.gaitpost.2008.12.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2008] [Revised: 11/26/2008] [Accepted: 12/01/2008] [Indexed: 02/02/2023]
Abstract
Benign paroxysmal positional vertigo (BPPV) is characterized by acute, brief and rotatory vertigo attacks provoked by changes in head position. Most patients complain of a loss of equilibrium and unstable gait during and between the vertigo attacks. Canalith repositioning maneuvers (CRM) relieve attacks and improve postural stability. In this study balance ability of 32 patients with PC BPPV and 12 patients with HC BPPV before and after treatment with CRM was investigated. 50 healthy volunteers served as the control group. Static balance was measured as mean center of gravity sway velocity recorded in four different conditions: on a static platform and on foam with eyes open and closed. Dynamic balance was measured in tandem walk test. PC BPPV patients demonstrated greater sway velocity in stance on foam with eyes closed. After CRM the velocity decreased significantly. The results of the HC BPPV patients were not different from the healthy volunteers all through the four test conditions. Walking speed of the patients both with PC BPPV and HC BPPV was significantly low. It increased after treatment in both groups. In conclusion, patients with PC BPPV had impaired static balance ability due to a clot in the affected canal. Dynamic balance ability measured by walking speed was impaired both in PC and HC BPPV patients. Static and dynamic deficits improved significantly after CRM.
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Affiliation(s)
- Neşe Celebisoy
- Ege University, Department of Neurology, Bornova, Izmir, Turkey.
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Roa Castro FM, Durán de Alba LM, Roa Castro VH. Experiencia con la maniobra de Epley y con ejercicios de habituación vestibular en el vértigo posicional paroxístico benigno del canal semicircular posterior. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2008. [DOI: 10.1016/s0001-6519(08)73273-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Experience With Epley's Manoeuvre and Vestibular Habituation Training in Benign Paroxysmal Positional Vertigo. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2008. [DOI: 10.1016/s2173-5735(08)70201-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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López Escámez JA, Molina MI, Zapata C, Palma MJ, Gómez Fiñana M, Gámiz MJ, Fernández Pérez A. [Oculomotor response to the vertical cephalic autorotatory test in patients with benign paroxistic positional vertigo of the posterior canal]. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2007; 57:210-6. [PMID: 16768198 DOI: 10.1016/s0001-6519(06)78695-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To evaluate the eye movement response to the head auto-rotation test (HART) in the vertical plane in patients with benign paroxysmal positional vertigo. PATIENTS AND METHODS DESIGN A transversal, descriptive study. SETTING UP: Outpatient clinic in a general Hospital. INDIVIDUALS 34 posterior canal BPPV cases with a video-oculographic diagnosis, older than 18 years old, 7 of them were not able to perform the HART. INTERVENTION HART was performed by a an electrooculographic system with simultaneous recording of head movement by an acelerometer in the vertical plane (Vorteq, Micromedical Instruments). The HART with eyes fixation was performed 3 times to determine its reliability. MAIN OUTCOME MEASURES Gain, asymmetry and phase for the vertical VOR respectively. A statistical analysis was carried out to determine the test reliability and the number of individuals with an abnormal result. RESULTS Gain is the only variable that showed a reproducible result in the HART for the active head movement at 1-2 Hz (test-retest reliability 0.83-0.89). The values of gain showed a moderate correlation at the frequencies 1-3 Hz (correlation 0.60-0.87). Asymmetry and phase were not reproducible variables (correlation < 0.55). Thirteen of 27 (48%) patients presented a decrease of the vertical gain, another 13 showed normal values and one case showed raised values. CONCLUSION Gain is the only useful variable in the vertical HART. Forty-eight percent of patients with posterior canal BPPV have a reduced vertical gain, suggesting an impairment of inferior vestibular nerve function.
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Affiliation(s)
- J A López Escámez
- Grupo de Otología y Otoneurología, CTS495, Unidad de Otorrinolaringología, Area de Cirugía, Hospital de Poniente de Almería, El Ejido.
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Fife D, FitzGerald JE. Do patients with benign paroxysmal positional vertigo receive prompt treatment? Analysis of waiting times and human and financial costs associated with current practice. Int J Audiol 2005; 44:50-7. [PMID: 15796102 DOI: 10.1080/14992020400022629] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study retrospectively analysed how 20 patients with posterior canal benign paroxysmal positional vertigo (BPPV) were managed from primary care, to treatment in tertiary care. The average time from first referral to treatment was 93 weeks, with an average of 58 weeks within primary care and 40 weeks within hospital care. At least 85% of cases had classical symptoms of BPPV and could have been easily identified by Primary Care Physicians at first referral, had they been trained to recognise and diagnose the condition. It was concluded that patients could be treated more efficiently and at less cost if the condition was identified at first referral in primary care, and treated in either primary care or dedicated BPPV clinics receiving referrals from primary care. A dedicated clinic for BPPV is recommended, which will substantially reduce waiting time for treatment and save primary care and hospitals time and money by avoiding unnecessary appointments and medication.
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Affiliation(s)
- Debbie Fife
- Audiology Department, Norfolk & Norwich University Hospital NHS Trust, Norwich, UK.
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Cohen HS, Kimball KT. Effectiveness of Treatments for Benign Paroxysmal Positional Vertigo of the Posterior Canal. Otol Neurotol 2005; 26:1034-40. [PMID: 16151355 DOI: 10.1097/01.mao.0000185044.31276.59] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
- Helen S Cohen
- Bobby R. Alford Department of Otorhinolaryngology and Communicative Sciences, Baylor College of Medicine, Houston, Texas 77030, USA.
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26
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Uneri A. Falling Sensation in Patients who Undergo the Epley Maneuver: A Retrospective Study. EAR, NOSE & THROAT JOURNAL 2005. [DOI: 10.1177/014556130508400211] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The author conducted a retrospective study to determine the prevalence of a falling sensation in patients who underwent the Epley canalith repositioning maneuver for the treatment of benign paroxysmal positional vertigo. The author studied a total of 436 maneuvers performed on 412 patients and observed 58 episodes (13%) of a strong falling sensation, some very severe. In almost every case, the sensation occurred when the patient was moved to the final (sitting) position; in 1 case, the sensation occurred nearly 30 minutes later. The author recommends that physicians who perform the Epley maneuver warn patients of the risk of a falling sensation, take steps to prevent its consequences, and monitor their patients for at least 30 minutes after the completion of the procedure.
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Affiliation(s)
- Alev Uneri
- From the Division of Neurotology and the Balance Center, Institute of Neurological Sciences, Marmara University, Istanbul
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von Brevern M, Lempert T. Benigner paroxysmaler Lagerungsschwindel. DER NERVENARZT 2004; 75:1027-35; quiz 1036-7. [PMID: 15368055 DOI: 10.1007/s00115-004-1804-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Benign paroxysmal positional vertigo is the most common vestibular disorder, accounting for about 20% of referrals in specialized dizziness clinics. Nowadays, canalolithiasis of the posterior semicircular canal has been widely accepted as the biological basis for typical benign paroxysmal positional vertigo as it is compatible with all clinical features of the disorder. Better understanding of its pathophysiological concepts has led to specific therapeutic strategies, which aim to clear the affected semicircular canal from mobile particles. After a single maneuver both Epley's and Semont's procedures lead to complete recovery in about 60% of patients and in nearly 100% when performed repeatedly. These positioning maneuvers have made benign paroxysmal positional vertigo the most successfully treatable cause of vertigo.
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Affiliation(s)
- M von Brevern
- Neurologische Klinik, Charité, Campus Virchow-Klinikum, Berlin.
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Black FO, Pesznecker SC, Homer L, Stallings V. Benign paroxysmal positional nystagmus in hospitalized subjects receiving ototoxic medications. Otol Neurotol 2004; 25:353-8. [PMID: 15129117 DOI: 10.1097/00129492-200405000-00025] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate the occurrence of benign paroxysmal positional nystagmus in subjects undergoing treatment with potentially ototoxic medications. STUDY DESIGN Prospective and retrospective record reviews. SETTING Tertiary referral neurotology clinic; clinical research and technology center. SUBJECTS Ninety-nine hospitalized subjects undergoing treatment of infectious disease or carcinoma with potentially ototoxic medications. INTERVENTIONS Records review, tests of vestibular function. MAIN OUTCOME MEASURE Results of Hallpike positional tests for benign paroxysmal positional nystagmus (electro-oculography). RESULTS Forty-one (41%) of 99 subjects were female and 58 (59%) were male. Age range was 15 to 73 years (mean, 47 years). Forty-nine (50%) of 99 subjects had an unequivocally positive Hallpike test for benign paroxysmal positional nystagmus in one or both ears. The occurrence of benign paroxysmal positional nystagmus in the Hallpike-positive population was distributed equally across age decades. Of the 49 subjects with benign paroxysmal positional nystagmus, 22 (44%) were female and 27 (56%) were male. CONCLUSIONS Benign paroxysmal positional nystagmus is the most common cause of vertigo in the general population, including subjects receiving ototoxic drugs. Complaints of vertigo in subjects receiving ototoxic drugs therefore may or may not indicate onset of ototoxicity. Occurrence of benign paroxysmal positional nystagmus in subjects receiving ototoxic drugs was independent of gender or age. The high occurrence rate of benign paroxysmal positional nystagmus in subjects receiving potentially ototoxic medications is consistent with the observation that benign paroxysmal positional nystagmus occurs in combination with many pathologic conditions. Benign paroxysmal positional nystagmus presenting in subjects receiving ototoxic drugs may complicate the clinical identification of ototoxicity and obfuscate clinical decision-making processes.
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Affiliation(s)
- F Owen Black
- Legacy Holladay Park Clinical Research and Technology Center, Department of Neurotology Research, Portland, Oregon 97208-3950, USA.
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29
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Frohman EM, Kramer PD, Dewey RB, Kramer L, Frohman TC. Benign paroxysmal positioning vertigo in multiple sclerosis: diagnosis, pathophysiology and therapeutic techniques. Mult Scler 2003; 9:250-5. [PMID: 12814171 DOI: 10.1191/1352458503ms901oa] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To report on the most common causes of vertigo in patients with multiple sclerosis (MS) and emphasize appropriate diagnostic techniques and treatment interventions. BACKGROUND True vertigo is estimated to occur in about 20% of MS patients. Lesions within the vestibular nuclei and in the root entry zone of cranial nerve VIII represent the most common locations where demyelinating activity can provoke vertigo in patients with MS. However, other causes of vertigo should be explored in MS patients in order to avoid unnecessary treatment with corticosteroids and vestibular suppressants. Recently, we reviewed our four-year experience with new onset vertigo in our university-based MS population and found that benign paroxysmal positioning vertigo (BPPV) to be the most common cause. All patients diagnosed with BPPV were treated successfully with particle repositioning maneuvers. The remaining patients were treated with conventional therapies appropriate for the specific diagnosis. CONCLUSIONS Empiric treatments with corticosteroids and/or vestibular suppressants should not be employed until all MS patients undergo a careful bedside examination, which includes diagnostic positional and, if indicated, particle repositioning maneuvers. Here we emphasize the pathophysiology of BPPV and illustrate the proper techniques for the diagnostic and therapeutic maneuvers.
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Affiliation(s)
- E M Frohman
- Department of Neurology, University of Texas Southwestern Medical Center at Dallas, Dallas, Texas 75235, USA.
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30
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Abstract
AIM To examine vestibular system functions in children with episodic vertigo attacks. METHODS Thirty four children (20 males) aged 4-18 years with paroxysmal dizziness and/or vertigo attacks were evaluated. A medical history for vestibular symptoms and migraine was taken. Vestibular and auditory functions were assessed. RESULTS Chronic headache attacks consistent with migraine were reported in 12 children and motion sickness was reported in 30. Family history in first degree relatives was positive for migraine in 29 children and for episodic vertigo in 22. Electronystagmography and videonystagmography showed two types of nystagmus: spontaneous vestibular nystagmus (41%) and benign paroxysmal positional nystagmus (BPPN) (59%). The first type of nystagmus was assessed as a sign of vestibulopathy and the patients with BPPN were diagnosed as having benign paroxysmal positional vertigo (BPPV). Audiometric examination in four cases revealed bilateral sensory neural hearing loss in low frequencies. Pure tone averages in 30 cases were within normal ranges; however low frequencies in 28 of them were approximately 10 dB lower than high frequencies. Unilateral caloric responses diminished in eight children. CONCLUSIONS Peripheral vestibular problems in childhood present in a wide spectrum, which varies from a short episode of dizziness to a typical vestibular attack with fluctuating sensory neural hearing loss or episodes of BPPV. A considerable number of these vestibular problems might be related to the migraine syndrome.
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Affiliation(s)
- A Uneri
- Marmara University, Institute of Neurological Sciences, Istanbul, Turkey
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31
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Humphriss RL, Baguley DM, Sparkes V, Peerman SE, Moffat DA. Contraindications to the Dix-Hallpike manoeuvre: a multidisciplinary review. Int J Audiol 2003; 42:166-73. [PMID: 12705782 DOI: 10.3109/14992020309090426] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The Dix-Hallpike manoeuvre is widely used in the diagnosis of positional vertigo and is regarded as safe. The manoeuvre involves a degree of neck rotation and extension, and consequently one might expect there to be some patients, particularly those with neck problems, in whom the manoeuvre is contraindicated. The term 'neck problem', however, encompasses a whole range of conditions, including soft tissue disorders, cervical spondylosis, prolapsed intervertebral disk, and severe rheumatoid arthritis with cervical instability. These in turn will give rise to a variety of symptoms, which will vary from minimal pain or stiffness to severe pain or complete immobility, and, in some cases, neurological deficit. Clarification is therefore needed to establish the point at which any neck pain or stiffness ceases to be a minor problem and becomes a contraindication to performing the Dix-Hallpike manoeuvre. This paper clarifies this issue by discussing the issue of absolute contraindications and proposing a simple functional assessment of neck mobility which can be performed prior to performing the Dix-Hallpike manoeuvre. Relative contraindications such as back pathology, vertebrobasilar ischaemia (posterior circulation ischaemic disease), nerve root compression and medical fitness are also discussed.
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Bertholon P, Bronstein AM, Davies RA, Rudge P, Thilo KV. Positional down beating nystagmus in 50 patients: cerebellar disorders and possible anterior semicircular canalithiasis. J Neurol Neurosurg Psychiatry 2002; 72:366-72. [PMID: 11861698 PMCID: PMC1737794 DOI: 10.1136/jnnp.72.3.366] [Citation(s) in RCA: 171] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To clarify the clinical significance of positional down beat nystagmus (pDBN). METHODS A discussion of the neuro-otological findings in 50 consecutive patients with pDBN. RESULTS In 38 patients there was evidence of CNS disease (central group) but in 12 there was not (idiopathic group). In the CNS group, presenting symptoms were gait, speech, and autonomic dysfunction whereas in the idiopathic group patients mostly reported positional vertigo. The main neurological and oculomotor signs in the CNS group were explained by cerebellar dysfunction, including 13 patients with multiple system atrophy. In patients with multiple system atrophy with a prominent extrapyramidal component, the presence of pDBN was helpful in the differential diagnosis of atypical parkinsonism. No patient with pDBN had the Arnold-Chiari malformation, a common cause of constant down beat nystagmus (DBN). In the idiopathic group, the pDBN had characteristics which suggested a peripheral labyrinthine disorder: vertigo, adaptation, and habituation. In six patients an additional torsional component was found (concurrently with the pDBN in three). Features unusual for peripheral disorder were: bilateral positive Dix-Hallpike manoeuvre in nine of 12 patients and selective provocation by the straight head-hanging manoeuvre in two. CONCLUSION It is argued that some patients with idiopathic pDBN have benign paroxysmal positional vertigo (BPPV) with lithiasis of the anterior canal. The torsional component may be weak, because of the predominantly sagittal orientation of the anterior canal, and may not be readily seen clinically. Nystagmus provocation by bilateral Dix-Hallpike and straight head-hanging may be explained by the vertical upwards orientation of the ampullary segment of the anterior canal in the normal upright head position. Such orientation makes right-left specificity with the Dix-Hallpike manoeuvre less important than for posterior canal BPPV. This orientation requires a further downwards movement of the head, often achieved with the straight head-hanging position, to provoke migration of the canaliths. The straight head-hanging manoeuvre should be carried out in all patients with a history of positional vertigo and a negative Dix-Hallpike manoeuvre.
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Affiliation(s)
- P Bertholon
- CHU de Saint Etienne, Hopital Bellevue, Saint Etienne, France
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33
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Abstract
Benign paroxysmal positional vertigo can be diagnosed with great certainty, and treated effectively at the bedside using one of the canalith repositioning procedures described in this paper. This treatment has been shown effective in properly controlled trials, has a rational basis, and has minimal risk.
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Froehling DA, Bowen JM, Mohr DN, Brey RH, Beatty CW, Wollan PC, Silverstein MD. The canalith repositioning procedure for the treatment of benign paroxysmal positional vertigo: a randomized controlled trial. Mayo Clin Proc 2000; 75:695-700. [PMID: 10907384 DOI: 10.4065/75.7.695] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To compare the canalith repositioning procedure (CRP) with a sham maneuver for the treatment of benign paroxysmal positional vertigo. PATIENTS AND METHODS We recruited 50 patients with a history of positional vertigo and unilateral positional nystagmus on physical examination (Dix-Hallpike maneuver). Patients were randomized to either the CRP (n = 24) or a sham maneuver (n = 26). Measured outcomes included resolution of vertigo and positional nystagmus at follow-up examination. RESULTS The mean duration of follow-up was 10 days for both groups. Resolution of symptoms was reported by 12 (50%) of the 24 patients in the CRP group and by 5 (19%) of the 26 patients in the sham group (P = .02). The results of the Dix-Hallpike maneuver were negative for positional nystagmus in 16 (67%) of 24 patients in the CRP group and in 10 (38%) of 26 patients in the sham group (P = .046). CONCLUSION The CRP is effective treatment of benign paroxysmal positional vertigo, and this procedure can be performed by general internists on outpatients with this disorder.
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Affiliation(s)
- D A Froehling
- Division of Area General Internal Medicine, Mayo Clinic, Rochester, Minn. 55905, USA
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35
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Abstract
Although the symptom of vertigo had been well-recognized for several thousand years, it was not until the pioneering work of Prosper Ménière in the mid-19th century that it was appreciated that vertigo could originate from damage to the inner ear. Before that time, patients with vertigo (regardless of the cause) were said to have "cerebral congestion," a condition resulting from excessive blood filling the brain. Bloodletting and leeches to relieve the congestion were the treatment of choice. The discovery of endolymphatic hydrops in temporal bone specimens from patients with Ménière's disease by Hallpike and Cairns in 1938 marked the beginning of modern neurotology. For the first time, vertigo was correlated with specific pathophysiology. Propelled by his temporal bone work, Charles Hallpike received an appointment at the National Hospital at Queen Square, where he developed an internationally renowned neurotology clinic. His bithermal caloric test and positional tests are still routinely used in evaluation of the vertiginous patient.
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Affiliation(s)
- R W Baloh
- Department of Neurology, UCLA School of Medicine, Los Angeles, CA 90095-1769, USA.
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36
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Karlberg M, Hall K, Quickert N, Hinson J, Halmagyi GM. What inner ear diseases cause benign paroxysmal positional vertigo? Acta Otolaryngol 2000; 120:380-5. [PMID: 10894413 DOI: 10.1080/000164800750000603] [Citation(s) in RCA: 110] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Benign paroxysmal positional vertigo (BPPV) originating from the posterior semicircular canal (pSCC) is a common vestibular disorder that is easy to diagnose and usually easy to treat. The majority of patients with BPPV have no known inner ear disease; they have "primary" or "idiopathic" BPPV. However, a minority does have objective evidence of an inner ear disease on the same side as the BPPV and this group has "secondary" or "symptomatic" BPPV. Previous publications differ on the prevalence of secondary BPPV and about the types of inner ear diseases capable of causing it. In order to determine what proportion of patients have secondary as opposed to primary BPPV and which inner ear diseases are capable of causing secondary BPPV, we searched our database for the 10-year period from 1988 to 1997 and found a total of 2847 patients with BPPV. Of these, 81 (3%) had definite pSCC-BPPV secondary to an ipsilateral inner ear disease. Sixteen had Menière's disease, 24 had an acute unilateral peripheral vestibulopathy, 12 had a chronic unilateral peripheral vestibulopathy, 21 had chronic bilateral peripheral vestibulopathy and 8 had unilateral sensorineural hearing loss. It seems that any inner ear disease that detaches otoconia and yet does not totally destroy pSCC function can cause BPPV and that a case can be made for audiometry and caloric testing in all patients with BPPV.
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Affiliation(s)
- M Karlberg
- Neurology Department, Royal Prince Alfred Hospital, NSW, Sydney, Australia
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37
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Abstract
Benign paroxysmal positional vertigo is a common disorder of the inner ear that should be suspected in all patients with a history of positionally provoked vertigo. The condition appears to be caused by free-floating debris in the posterior semicircular canal. The diagnosis is confirmed by eliciting characteristic symptoms and signs during the Dix-Hallpike test. Although benign paroxysmal positional vertigo is usually a self-limited disorder, treatment with a specific bedside maneuver is effective and can provide the patient immediate and long-lasting relief. Although many patients with positionally provoked vertigo have typical benign paroxysmal positional vertigo, physicians should be aware of nonbenign variants.
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Affiliation(s)
- J M Furman
- Department of Otolaryngology, University of Pittsburgh School of Medicine, PA 15213, USA.
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38
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Di Girolamo S, Fetoni AR, Di Nardo W, Paludetti G. An unusual complication of cochlear implant: benign paroxysmal positional vertigo. J Laryngol Otol 1999; 113:922-3. [PMID: 10664711 DOI: 10.1017/s0022215100145608] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Three days after the initial fitting of the cochlear device a 40-year-old woman complained of severe rotational vertigo following head movements associated with neurovegetative symptoms. Otoneurological evaluation revealed a horizontal paroxysmal positional nystagmus beating towards the lowermost ear, induced by rolling the patient's head from supine both to the right or to the left lateral position suggesting the diagnosis of benign paroxysmal positional vertigo of the left horizontal semicircular canal. The nystagmus characteristics were the same whether the cochlear device was switched on or off. The hypothesis of an otolith dislodging due to the electrical stimulation during the initial fitting is discussed.
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Affiliation(s)
- S Di Girolamo
- Department of Otorhinolaryngology, Catholic University of the Sacred Heart, Rome, Italy.
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39
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Abstract
Vertigo is a subtype of dizziness, which results from an imbalance within the vestibular system. This seminar focuses on three common presentations of vertigo: prolonged spontaneous vertigo, recurrent attacks of vertigo, and positional vertigo. The patient's history is usually the key to differentiation of peripheral and central causes of vertigo. The most common cause of vertigo, benign paroxysmal positional vertigo, can be cured with a simple positional manoeuvre. Other common causes of vertigo include vestibular neuritis, Ménière's syndrome, migraine, and vertebrobasilar insufficiency. Treatment should be directed at the underlying cause whenever possible, but antivertiginous and antiemetic drugs can suppress symptoms when a specific cause cannot be found. These drugs are generally not indicated for long-term daily use, however, since they may interfere with the normal compensation process.
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Affiliation(s)
- R W Baloh
- Department of Neurology, UCLA School of Medicine, Los Angeles, CA 90095-1769, USA.
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40
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Mira E, Mauri S. Paroxysmal positional vertigo. ITALIAN JOURNAL OF NEUROLOGICAL SCIENCES 1998; 19:150-60. [PMID: 10933470 DOI: 10.1007/bf00831565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Paroxysmal positional vertigo (PPV) is the peripheral vertiginous syndrome that is most frequently encountered in clinical practice. It is characterised by paroxysmal vertiginous attacks that are triggered by head movements and last no more than a few seconds, and is often accompanied by nausea and vomiting. The aim of this review is to provide a complete and updated description of the two principal manifestations of the syndrome: posterior semicircular canal (PSC-PPV) and horizontal semicircular canal PPV (HSC-PPV).
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Affiliation(s)
- E Mira
- Department of Otorhinolaryngology, University of Pavia, IRCCS Policlinico San Matteo, Italy
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41
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Abstract
Insight into the pathomechanisms of the benign positional vertigo syndromes has led to quick and effective treatment with positional manoeuvres. Our understanding of other causes of vertigo is progressing at a slower pace, but several recent findings regarding vestibular neuritis, vascular compression of the eighth nerve and psychogenic vertigo are of immediate clinical relevance.
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Affiliation(s)
- T Lempert
- Neurology Clinic, Virchow Hospital, Humboldt University, Berlin, Germany
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