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Mann Ben Yehuda L, Rachima D, Katz-Leurer M. Anxiety characteristics in benign paroxysmal positional vertigo: first vs. recurrent episodes. Eur Arch Otorhinolaryngol 2024; 281:3245-3251. [PMID: 38573513 PMCID: PMC11065903 DOI: 10.1007/s00405-024-08615-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 03/11/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE To assess the difference in state and trait anxiety levels in patients with Benign Paroxysmal Positional Vertigo (BPPV) at the first episode (FE) versus recurrent episodes (RE), before and after vestibular physiotherapy. A secondary objective was to assess the difference in the prevalence of underlying health conditions between FE and RE BPPV patients. METHODS Fifty-five patients with BPPV, aged 40-70, were recruited. The diagnosis of BPPV was confirmed based on subjective complaints of vertigo and positive results from the Dix-Hallpike and Supine Roll tests. Twenty-four patients were in their FE, and 31 had RE. All patients completed the State-Trait Anxiety Inventory (STAI) questionnaire three times; before, immediately after, and a week after vestibular physiotherapy treatment. RESULTS The RE group demonstrated higher trait anxiety than the FE group in all testing points: before treatment (median value of 38 versus 29, p-value = 0.02), immediately after treatment (median value of 36 versus 28, p-value < 0.01) and a week later (median value of 38 versus 28, p-value < 0.01). State anxiety decreased immediately after treatment in both groups, but at the second session, it was significantly higher in the RE than in the FE group (median value of 38 versus 28.5, p-value = 0.03). Hypothyroidism was significantly more frequent in the RE group (RE 16%, FE 0%, p-value = 0.04). CONCLUSIONS Based on the current study's findings, we recommend assessing anxiety levels in patients with recurrent BPPV and consider referring them for appropriate treatment when necessary.
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Affiliation(s)
- Lotem Mann Ben Yehuda
- Physical Therapy Department, Faculty of Medicine, School of Health Professions, Tel-Aviv University, Tel-Aviv, Israel
- Maccabi Health Care, Kfar Saba, Israel
| | - David Rachima
- Maccabi Health Care, Kfar Saba, Israel
- Maccabi Health Care, Netanya, Israel
| | - Michal Katz-Leurer
- Physical Therapy Department, Faculty of Medicine, School of Health Professions, Tel-Aviv University, Tel-Aviv, Israel.
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Ciorba A, Tessari M, Natale E, Buzzi F, Baldazzi G, Cosacco A, Migliorelli A, Corazzi V, Bianchini C, Stomeo F, Pelucchi S, Zamboni P. Cerebral Outflow Discrepancies in Recurrent Benign Paroxysmal Positional Vertigo: Focus on Ultrasonographic Examination. Diagnostics (Basel) 2023; 13:diagnostics13111902. [PMID: 37296754 DOI: 10.3390/diagnostics13111902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 04/28/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023] Open
Abstract
This prospective pilot study aimed to evaluate whether cerebral inflow and outflow abnormalities assessed by ultrasonographic examination could be associated with recurrent benign paroxysmal positional vertigo (BPPV). Twenty-four patients with recurrent BPPV, affected by at least two episodes, and diagnosed according to American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) criteria, evaluated at our University Hospital, between 1 February 2020 and 30 November 2021, have been included. At the ultrasonographic examination, 22 of 24 patients (92%) reported one or more alterations of the extracranial venous circulation, among those considered for the diagnosis of chronic cerebrospinal venous insufficiency (CCSVI), although none of the studied patients were found to have alterations in the arterial circulation. The present study confirms the presence of alterations of the extracranial venous circulation in recurrent BPPV; these anomalies (such as stenosis, blockages or regurgitation of flow, or abnormal valves, as per the CCSVI) could cause a disruption in the venous inner ear drainage, hampering the inner ear microcirculation and then possibly causing recurrent otolith detachment.
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Affiliation(s)
- Andrea Ciorba
- ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44124 Ferrara, Italy
| | - Mirko Tessari
- Vascular Diseases Centre, University Hospital of Ferrara, 44124 Ferrara, Italy
| | - Erennio Natale
- ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44124 Ferrara, Italy
| | - Fabio Buzzi
- ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44124 Ferrara, Italy
| | - Giulia Baldazzi
- Vascular Diseases Centre, University Hospital of Ferrara, 44124 Ferrara, Italy
| | - Alessio Cosacco
- Vascular Diseases Centre, University Hospital of Ferrara, 44124 Ferrara, Italy
| | - Andrea Migliorelli
- ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44124 Ferrara, Italy
| | - Virginia Corazzi
- ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44124 Ferrara, Italy
| | - Chiara Bianchini
- ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44124 Ferrara, Italy
| | - Francesco Stomeo
- ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44124 Ferrara, Italy
| | - Stefano Pelucchi
- ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44124 Ferrara, Italy
| | - Paolo Zamboni
- Vascular Diseases Centre, University Hospital of Ferrara, 44124 Ferrara, Italy
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Evaluation of a questionnaire as a screening tool for benign paroxysmal position vertigo. Eur Arch Otorhinolaryngol 2023; 280:1919-1926. [PMID: 36422670 DOI: 10.1007/s00405-022-07744-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 11/07/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the value of a questionnaire as a screening tool for benign paroxysmal position vertigo (BPPV). STUDY DESIGN Retrospective chart review. SETTING Tertiary care centers. METHODS A total of 520 vertigo adults completed the questionnaire before the diagnosis was confirmed. After vestibular function examination and other diagnostic examination, the diagnosis of all participants was confirmed by experts. By validating valuable items from the questionnaire with 47 items, a new questionnaire of 5 items was formed to quickly diagnose BPPV. The internal consistency of the new questionnaire and validity were evaluated. The correlation between the score obtained from the new questionnaire and diagnosis was investigated. The mean score was also compared between groups with and without BPPV and diagnostic precision measures were calculated. RESULTS 520 vertigo participants answered all the question completely and BPPV was identified in 138 participants (26.5%). The responses to questionnaire revealed preferable reproducibility (r = 0.898, P < 0.05) and internal consistency (Cronbach's α = 0.702) as well as the validity (Kaiser-Meyer-Olkin, KMO = 0.731). The higher the individual score, the more likely to be BPPV (B = 2.082; P < 0.05). The mean score of answers was greater in the group with a clinical diagnosis of BPPV compared to those without BPPV (F = 58.459, P < 0.05). The sensitivity of the screening tool was 92.8% and specificity was 88.5%, with an area under the ROC curve of 0.946 (95% confidence interval 0.926-0.965; P < 0.05). CONCLUSION The questionnaire proved to be of great value to screen for individuals with possible BPPV.
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Casani AP, Gufoni M. Recurring benign paroxysmal positional vertigo after successful canalith repositioning manoeuvers. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2023; 43:S61-S66. [PMID: 37698102 PMCID: PMC10159632 DOI: 10.14639/0392-100x-suppl.1-43-2023-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 01/08/2023] [Indexed: 09/13/2023]
Abstract
Benign baroxysmal positional vertigo (BPPV) represents the most common peripheral vestibular dysfunction encountered in clinical practice. Although canalith repositioning procedures (CRPs) are a relatively successful treatment for BPPV, many patients suffer from recurrences. Several studies have demonstrated that various pathological conditions (diabetes, hypertension, endolymphatic hydrops, low vitamin D levels) as well as delayed BPPV treatment using CRP, multiple canal involvement may be associated with recurrence of BPPV. We evaluated the history of 1,428 patients (558 males and 870 females, age range 10-92 years) suffering from BPPV. Of 1,428 cases, 820 (77%) did not relapse in the following 20 years. Mean age and gender did not differ significantly between groups with and without recurrence. Regarding risk factors for BPPV recurrence, age, female gender, migraine, hypertension, diabetes mellitus, hyperlipidaemia, osteoporosis, vascular diseases, and vitamin D deficiency may be associated with recurrent BPPV and should be kept in mind. Osteoporosis, vitamin D deficiency as well as thyroid dysfunction should be evaluated in postmenopausal women. Treatment of these comorbidities may help to reduce the risk of BPPV recurrence.
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Affiliation(s)
- Augusto Pietro Casani
- Department of Medicine and Surgery, ENT Section, Pisa University Hospital, Pisa, Italy
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Picciotti PM, Anzivino R, Galli J, Franceschi F, Conti G, Simeoni B, Covino M. Clinical Evolution of Acute Vestibular Syndrome: Longitudinal Retrospective Analysis of Epidemiological Data and Prognostic Factors for Recovery. J Pers Med 2023; 13:jpm13030407. [PMID: 36983588 PMCID: PMC10059062 DOI: 10.3390/jpm13030407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 02/23/2023] [Accepted: 02/23/2023] [Indexed: 03/03/2023] Open
Abstract
We evaluated the clinical features of patients admitted to the ED with acute vertigo, verifying symptoms after one month and one year to establish epidemiological factors and predictors of resolution. We reviewed 233 records of patients admitted to ED for acute vertigo (125 F and 85 M, mean age 56.12 years). We analyzed the correlation between time of resolution (at one month and one year) and symptoms duration (subjective and/or objective vertigo, instability, cervical pain, audiological, neurological, and neurovegetative symptoms), comorbidities, and therapies, the result of the clinical and instrumental vestibular examination. Resolution of acute vertigo occurred in 81.1%, while persistence of vertigo one year after ED access was reported in 18.8%. There were 135 patients who recovered in one month. The presence of instability, auditory and neurovegetative symptoms, and neck pain represents a significant factor for recovery within one year. Age over 65 and a history of hypertension are associated with a worst recovery. Patients with spontaneous Nystagmus or positive HIT showed a significant difference in symptoms recovery within one month and one year. Presence of positional Nystagmus represents a positive prognostic factor. Our findings emphasize the importance of clinical evaluation of the acute vertigo, helping the clinicians to define central or peripheral diagnosis and predict the resolution of vertigo.
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Affiliation(s)
- Pasqualina M. Picciotti
- Department of Head and Neck, Otolaryngology Institute, Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Correspondence:
| | - Roberta Anzivino
- Otolaryngology Unit, Sensorineural Department, Di Venere Hospital, ASL BARI, 70131 Bari, Italy
| | - Jacopo Galli
- Department of Head and Neck, Otolaryngology Institute, Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Francesco Franceschi
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Guido Conti
- Department of Head and Neck, Otolaryngology Institute, Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Benedetta Simeoni
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Marcello Covino
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Zhou F, Yu B, Luo J, Ma Y, Li J, Zhang T, Yu G. Global trends in the research on benign paroxysmal positional vertigo: A 20-year bibliometric and visualization analysis. Front Neurol 2022; 13:1046257. [PMID: 36324379 PMCID: PMC9618818 DOI: 10.3389/fneur.2022.1046257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 09/29/2022] [Indexed: 11/17/2022] Open
Abstract
Background Benign paroxysmal positional vertigo (BPPV) is the most common cause of peripheral vestibular vertigo. Although BPPV is benign, its underlying mechanisms are complicated, and patients diagnosed with BPPV are significantly affected by it in their daily lives. Hence, this study's purpose was to investigate global trends and frontiers in the field of BPPV. Methods We searched the research literature published from 2002 to 2021 on BPPV using two databases from the Web of Science Core Collection, and we conducted a bibliometric and visualization analysis. Bibliometric tools were used to perform co-authorship, co-citation, and co-occurrence analyses of countries or regions, institutions, authors, journals, keywords, and references. Results In all, 1,419 publications from 4,594 authors, 1,542 institutions, and 65 countries or regions with 71 subject categories were included in the study. The number of articles increased gradually from 2002 to 2021. Seoul National University, the University of Munich, and Osaka University were among the leading institutions with the most publications, while United States of America, South Korea, and China were the leading countries. JS Kim was the most prolific author, Otology & Neurotology was the most prolific journal, and Otorhinolaryngology was the most published subject category. The five most frequently occurring keywords were BPPV, vertigo, dizziness, nystagmus, and management and the top research hot spots were osteoporosis and vitamin D. Conclusion This study systematically analyzed trends in global scientific research on BPPV. The academic understanding of BPPV has improved significantly over the last two decades, with osteoporosis and vitamin D the two main research hot spots in the field of BPPV in recent years. These findings provide direction for current research to grasp the trends and research frontiers of current research.
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Affiliation(s)
- Fangwei Zhou
- Department of Otorhinolaryngology Head and Neck Surgery, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Bingxi Yu
- Department of Otolaryngology, Xingyi People's Hospital, Xingyi, China
| | - Jiali Luo
- Department of Development and Planning, Guizhou Medical University, Guiyang, China
| | - Yifei Ma
- Department of Otorhinolaryngology Head and Neck Surgery, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Jianyao Li
- Department of Otorhinolaryngology Head and Neck Surgery, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Tian Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, Affiliated Hospital of Guizhou Medical University, Guiyang, China
- *Correspondence: Tian Zhang
| | - Guodong Yu
- Department of Otorhinolaryngology Head and Neck Surgery, Affiliated Hospital of Guizhou Medical University, Guiyang, China
- Guodong Yu
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Tricarico L, Di Cesare T, Galli J, Fetoni AR, Paludetti G, Picciotti PM. Benign paroxysmal positional vertigo: is hypothyroidism a risk factor for recurrence? ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2022; 42:465-470. [PMID: 35129542 PMCID: PMC9793138 DOI: 10.14639/0392-100x-n1775] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 09/27/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To investigate the relationship between risk of Benign Paroxysmal Positional Vertigo (BPPV) recurrence and hypothyroidism treated with hormone replacement therapy (HRT). METHODS 797 patients with idiopathic BPPV were divided into two groups: 250 patients with recurrence of BPPV (R-BPPV) and 547 patients without recurrence (NR-BPPV). Regarding patients with thyroid disease on HRT, we collected serum test results of thyroid-stimulating hormone (TSH), free triiodothyronine f-T3, free thyroxine f-T4, thyroglobulin antibodies (TG-Ab) and thyroid peroxidase antibodies (TPO-Ab). RESULTS Hypothyroidism in long-term HRT was found in 61/250 (24.4%) patients of the R-BPPV group vs 79/547 (14.4%) of the NR-BPPV-group (p = 0.0006). Hashimoto thyroiditis (HT) was associated with recurrence (p < 0.0001). A significant correlation was found between recurrence and level of serum TPO-Ab (p = 0.0117) and TG-Ab (p = 0.0025), but not with mean serum TSH, f-T3 and f-T4. CONCLUSIONS We assume that patients with hypothyroidism in HRT have an increased risk of BPPV recurrence, which is particularly strong for patients with HT and positive thyroid antibodies, suggesting an association between autoimmunity and recurrent vertigo.
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Affiliation(s)
- Laura Tricarico
- Correspondence Laura Tricarico Fondazione Policlinico Universitario A. Gemelli IRCSS, Clinica di Otorinolaringoiatria; Università Cattolica del Sacro Cuore largo A. Gemelli 1, 00168 Rome, Italy E-mail:
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Little CC, Schwam ZG, Campo M, Gurley J, Hujsak B, Cosetti MK, Kelly J. Immediate Improvement in Subjective Visual Vertical and Disequilibrium Predicts Resolution of Benign Paroxysmal Positional Vertigo Following Single Canalith Repositioning Maneuver. OTOLOGY & NEUROTOLOGY OPEN 2022; 2:e014. [PMID: 38516626 PMCID: PMC10950152 DOI: 10.1097/ono.0000000000000014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 05/11/2022] [Indexed: 03/23/2024]
Abstract
Objective To evaluate whether immediate post-canalith repositioning maneuver (CRM) vestibular changes are predictive of benign paroxysmal positional vertigo (BPPV) resolution. Study Design Retrospective cohort study. Setting Tertiary referral center. Patients Adults (n = 27) with posterior canal BPPV. Interventions Single CRM with Frenzel goggles. Main Outcome Measures The Visual Analog Scale (VAS) for disequilibrium, the subjective visual vertical (SVV), the subjective visual horizontal (SVH), and the Modified Clinical Test of Sensory Interaction on Balance (mCTSIB) were administered pre- and immediately following single CRM. Dix-Hallpike was performed 1-3 weeks after CRM to assess for BPPV resolution. Pre- and post-treatment vestibular assessments were compared between groups to determine if post-CRM vestibular changes could predict BPPV resolution. Results The change in VAS score following CRM treatment was statistically different between patients who responded to CRM treatment (n = 15) and those who did not (n = 12), (-0.07 points versus -2.40 points, respectively; P = 0.03). Likewise, a significantly greater improvement in SVV score was observed for CRM responders compared with CRM nonresponders (0.92° versus -0.06°, respectively; P = 0.02). Change in SVH and mCTSIB scores did not differ significantly between groups. Additionally, patient age was found to predict outcome of CRM treatment, with older patients more likely to experience persistent BPPV (P ≤ 0.01). Conclusions Immediate improvement in VAS and SVV scores following CRM may be useful in predicting resolution of BPPV and may assist in directing the timing and need for future interventions. Younger age may have a favorable predictive value for improvement following single CRM.
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Affiliation(s)
| | - Zachary G. Schwam
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Marc Campo
- Physical Therapy Program, Mercy College, Dobbs Ferry, NY
| | - James Gurley
- Physical Therapy Program, Mercy College, Dobbs Ferry, NY
| | - Bryan Hujsak
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY
- Ear Institute, New York Eye and Ear Infirmary of Mount Sinai, New York, NY
| | - Maura K. Cosetti
- Icahn School of Medicine at Mount Sinai, New York, NY
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jennifer Kelly
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY
- Ear Institute, New York Eye and Ear Infirmary of Mount Sinai, New York, NY
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Onset and resolution failure of recurrent benign paroxysmal positional vertigo: the role of cervical range of motion. Eur Arch Otorhinolaryngol 2022; 279:2183-2192. [DOI: 10.1007/s00405-021-07226-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 12/17/2021] [Indexed: 11/03/2022]
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Teggi R, Guidetti R, Gatti O, Guidetti G. Recurrence of benign paroxysmal positional vertigo: experience in 3042 patients. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2021; 41:461-466. [PMID: 34734582 PMCID: PMC8569667 DOI: 10.14639/0392-100x-n1233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 05/10/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Benign paroxysmal positional vertigo (BPPV) is a disorder of the inner ear with a high rate of recurrence. Vascular disorders, migraine and autoimmune disorders have been considered facilitating factors for relapsing episodes. Our aim was to assess the role of vascular disorders, migraine and anti-thyroid antibodies in patients with recurrences. METHODS We retrospectively analysed records of 3042 patients treated for BPPV without other lifetime vertigo. Clinical data included previous vascular disorders of the central nervous system, heart disorders, migraine and recent head trauma. The presence of anti-thyroid autoantibodies was assessed in all patients. RESULTS Mean age of the first BPPV was 52.8 ± 14.5 years; there were 2339 females (76.9%), while 2048 (67.3%) of patients presented recurrences within two years of follow-up. Previous disorders of the central nervous system, presence of anti-thyroid antibodies, head trauma and migraine showed an association with recurrences. Above all, in subjects having the first BPPV while aged between 40 and 60 years, anti-thyroid antibodies were predictive for recurrences. CONCLUSIONS Our data are consistent with the hypothesis that anti-thyroid autoantibodies may play a role in recurrences in subjects with initial manifestations between 40 and 60 years.
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Affiliation(s)
- Roberto Teggi
- Division of Otolaryngology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Omar Gatti
- Division of Otolaryngology, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Risk Factors for Recurrence of Benign Paroxysmal Positional Vertigo. A Clinical Review. J Clin Med 2021; 10:jcm10194372. [PMID: 34640391 PMCID: PMC8509726 DOI: 10.3390/jcm10194372] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/17/2021] [Accepted: 09/23/2021] [Indexed: 12/04/2022] Open
Abstract
Benign paroxysmal positional vertigo (BPPV) is one of the most common peripheral vestibular dysfunctions encountered in clinical practice. Although the treatment of BPPV is relatively successful, many patients develop recurrence after treatment. Our purpose is to evaluate the mean recurrence rate and risk factors of BPPV after treatment. A review of the literature on the risk factors of BPPV recurrence was performed. A thorough search was conducted using electronic databases, namely Pubmed, CINAHL, Academic Search Complete and Scopus for studies published from 2000 to 2020. Thirty studies were included in this review with 13,358 participants. The recurrence rate of BPPV ranged from 13.7% to 48% for studies with follow-up <1 year, and from 13.3% to 65% for studies with follow-up ≥2 years. Pathophysiologic mechanisms and implication of each of the following risk factors in the recurrence of BPPV were described: advanced age, female gender, Meniere’s disease, trauma, osteopenia or osteoporosis, vitamin D deficiency, diabetes mellitus, hypertension, hyperlipidemia, cardiovascular disease, migraine, bilateral/multicanal BPPV, cervical osteoarthrosis and sleep disorders. Patients with hyperlipidemia and hypertension had the highest recurrence rates of BPPV, 67.80% and 55.89%, respectively, indicating that vascular comorbidities increase the risk of BPPV recurrence. In addition, more than half of patients (53.48%) with diabetes mellitus and BPPV experienced recurrence of BPPV. Knowledge and awareness of risk factors for recurrence of BPPV are essential for the assessment and long-term prognosis of patients. Identification of these relapse risk factors may enhance the ability of clinicians to accurately counsel patients regarding BPPV and associated comorbidities.
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Recurrence Rate and Risk Factors of Recurrence in Benign Paroxysmal Positional Vertigo: a Single-Center Long-Term Prospective Study With a Large Cohort. Ear Hear 2021; 43:234-241. [PMID: 34320525 DOI: 10.1097/aud.0000000000001093] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to assess the long-term recurrence rate and correlations between recurrence and potential risk factors in patients with benign paroxysmal positional vertigo (BPPV). DESIGN A total of 548 consecutive patients who demonstrated typical posterior or horizontal BPPV between January 2010 and December 2012 were included in this prospective study. All patients were contacted by phone every 6 months for 5 years and were asked to revisit the clinic when they experienced positional vertigo to be reexamined for recurrence. Recurrence of BPPV was defined as having positional vertigo and nystagmus confirmed following a symptom-free period of at least 7 days after complete resolution. We assessed the 5-year recurrence rate of BPPV, and the time point of recurrence in all patients as well as the risk factors of BPPV recurrence, including the clinical characteristics, therapeutic results of BPPV, and various comorbidities. RESULTS Among the 548 patients, 121 (22.1 %) had at least one recurrence. Of these, 78 patients (54.5%) had only one recurrence within 5 years, while 43 (45.5%) patients experienced two or more recurrences. A recurrence occurred within 1 year in 82 patients (67.8%). The Cox proportional hazard ratio analysis found that head trauma (p = 0.015), Meniere's disease (p = 0.016), the number of canalith repositioning procedures performed (p = 0.037), and the number of previous vertigo attacks (p = 0.038) were significant risk factors of BPPV recurrence as opposed to hypertension or hyperlipidemia. CONCLUSIONS The recurrence rate of BPPV was 22.1% at 5 years after the initial treatment. About 70% of recurred patients had a recurrence within 1 year. Head trauma, ipsilateral Meniere's disease, the number of canalith repositioning procedures performed, and the number of previous vertigo attacks were significant risk factors of BPPV recurrence.
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Benign Paroxysmal Positional Vertigo and the Increased Risk of Ischemic Stroke: A Nested Case-Control Study Using a National Cohort Sample. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6629028. [PMID: 33688496 PMCID: PMC7924071 DOI: 10.1155/2021/6629028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/02/2021] [Accepted: 02/15/2021] [Indexed: 11/17/2022]
Abstract
A recent population cohort study reported that benign paroxysmal positional vertigo (BPPV) was a risk factor for ischemic stroke. This study investigated the risk of ischemic and hemorrhagic strokes in patients with BPPV. A nested case-control study used the data from the Korean National Health Insurance Service-National Sample Cohort between 2002 and 2013. We used data of patients aged ≥50 years obtained from the Korean National Health Insurance Service-National Sample Cohort between 2002 and 2013. A total of 15,610 patients with ischemic stroke and 4,923 patients with hemorrhagic stroke were matched for age, sex, income, residential location, hypertension, diabetes, and dyslipidemia with 62,440 and 19,692 controls, respectively. History of BPPV was evaluated in the stroke and control groups. Crude and adjusted odds ratios (ORs) for stroke in patients with BPPV were analyzed using stratified logistic regression analysis. Subgroup analyses were performed for age and sex. Notably, 3.7% (572/15,610) of patients with ischemic stroke and 2.7% (1,702/62,440) of the control subjects reported a history of BPPV (P < 0.001). The adjusted OR for BPPV in patients with ischemic stroke was 1.35 (95% confidence interval (CI) 1.22-1.49, P < 0.001). Patients with ischemic stroke showed higher ORs for BPPV in the subgroup of women. Patients with hemorrhagic stroke did not show a high OR for BPPV. Ischemic stroke patients demonstrated the increased OR for BPPV in subjects aged ≥50 years old.
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Bashir K, Elsotohy HH, Elmoheen A. Do Night Shifts Increase the Risk of Benign Paroxysmal Positional Vertigo Among Doctors and Nurses? J Multidiscip Healthc 2020; 13:963-966. [PMID: 32982272 PMCID: PMC7509318 DOI: 10.2147/jmdh.s256055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 05/12/2020] [Indexed: 11/28/2022] Open
Abstract
Background Night shift work is one of the significant and most frequent reasons for circadian rhythm disruptions, resulting in the alteration of biological functions and sleep. These factors can affect the psychological and physical well-being and also negatively impact an individual’s performance at work. Sleep disturbance has been associated with increased risk of several medical conditions such as benign paroxysmal positional vertigo (BPPV), hypertension, diabetes, high cholesterol, chronic obstructive pulmonary disease, and others. Objective To determine whether the night shift increases the risk of BPPV by reviewing a 7-year retrospective data. Methods The cross-sectional research study was conducted at the emergency department of a tertiary care teaching hospital in Qatar. A total of 69 doctors and nurses who suffered from vertigo in a period of seven years were consented and considered for the study. We excluded 12 patients with vertigo due to causes rather than BPPV. Fifty-seven patients who were diagnosed with BPPV based on examination using the Dix–Hallpike bedside test. They were treated by particle repositioning maneuvers in the emergency department. Results Approximately, 93% (n = 53) of participants had posterior canal BPPV and 7% (n = 4) had lateral canal BPPV (n = 5) between 2013 and 2019. Anterior canal BPPV was not reported. Chi-square test showed that night shift was associated with a high prevalence of first BPPV episode (P ≥0.001) with less likelihood of diabetes and hypertension (P ≥0.001). Conclusion Retrospective data review indicates a possible association between night shifts and BPPV development in doctors and nurses.
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Affiliation(s)
- Khalid Bashir
- Emergency Department, Hamad General Hospital, Hamad Medical Corporation Doha, Qatar
| | - Hamdy Hamed Elsotohy
- Emergency Department, Hamad General Hospital, Hamad Medical Corporation Doha, Qatar
| | - Amr Elmoheen
- Emergency Department, Hamad General Hospital, Hamad Medical Corporation Doha, Qatar
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Di Cesare T, Tricarico L, Passali GC, Sergi B, Paludetti G, Galli J, Picciotti PM. Traumatic benign paroxysmal positional vertigo: personal experience and comparison with idiopathic BPPV. Int J Audiol 2020; 60:393-397. [PMID: 32959692 DOI: 10.1080/14992027.2020.1821253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Benign paroxysmal positional vertigo (BPPV) is the most common cause of vestibular vertigo, with post-traumatic origin in about 15% of cases. Management and prognosis of traumatic BPPV (T-BPPV) are still debated, especially about recurrence. The aim was to compare T-BPPV to idiopathic (I-BPPV). DESIGN AND STUDY SAMPLE We analysed data about 795 BPPV patients: 716 idiopathic (90%) and 79 post-traumatic (10%), evaluating clinical history and bedside-examination, treating all patients with repositioning manoeuvres and reassessing them until the resolution of symptoms and nystagmus. RESULTS Persistence rate in T-BPPV and I-BPPV patients was significantly different (p = 0.0074, OR = 2.31), respectively 12.6% and 5%. Also the rate of bilateral disease (p = 0.0063, OR = 4.72) and multicanalar involvement (p = 0.0183; OR = 4.67) were significantly higher in T-BPPV patients . There were no significant differences in age and sex distribution, side and canal interested. In T-BPPV group, the resolution rate with one manoeuvre was lower than I-BPPV (p = 0.0132: OR: 0,56). Recurrence rate was 38% in the T-BPPV group and 30.6% in the I-BPPV group, without significant difference. CONCLUSIONS T-BPPV resulted different from I-BPPV in the resolution rate, bilateral or multiple canal involvement and persistence rate. T-BPPV and I-BPPV does not differ for recurrence rate, suggesting that, after resolution, the natural course of post-traumatic and idiopathic BPPV is similar.
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Affiliation(s)
- Tiziana Di Cesare
- ENT and Head Neck Surgery Department, Catholic University, Rome, Italy
| | - Laura Tricarico
- ENT and Head Neck Surgery Department, Catholic University, Rome, Italy
| | | | - Bruno Sergi
- Otolaryngology, Catholic University, Rome, Italy
| | - Gaetano Paludetti
- ENT and Head Neck Surgery Department, Catholic University, Rome, Italy.,Otolaryngology, Catholic University, Rome, Italy
| | - Jacopo Galli
- ENT and Head Neck Surgery Department, Catholic University, Rome, Italy.,Otolaryngology, Catholic University, Rome, Italy
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Li S, Wang Z, Liu Y, Cao J, Zheng H, Jing Y, Han L, Ma X, Xia R, Yu L. Risk Factors for the Recurrence of Benign Paroxysmal Positional Vertigo: A Systematic Review and Meta-Analysis. EAR, NOSE & THROAT JOURNAL 2020; 101:NP112-NP134. [PMID: 32776833 DOI: 10.1177/0145561320943362] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Benign paroxysmal positional vertigo (BPPV) has a high recurrence rate, but the risk factor-associated recurrence are elusive. METHODS Searches were performed in PubMed, Embase, Cochrane library, Web of science, Chinese National Knowledge Infrastructure, and Sino Med up to November 3, 2019. The effect size was analyzed by odds ratio and 95% CI. Data from eligible studies were meta-analyzed using Stata version 15.0. RESULTS Our search resulted in a total of 4076 hits. Twenty-four outcomes of sixty articles were included in the meta-analysis. Risk factors for the recurrence of BPPV included female gender, age (≥65years), hyperlipidemia, diabetes, hypertension, migraine, cervical spondylosis, osteopenia/osteoporosis, head trauma, otitis media, abnormal vestibular evoked myogenic potential, and long use of computers. No significant differences were found in side, type of the involved semicircular canals, smoking, alcohol consumption, stroke, ear surgery, duration of vertigo before treatment, the times of repositioning, Meniere disease, sleep disorders, hypercholesterolemia, and 25-hydroxy vitamin D. CONCLUSION These findings strengthen clinical awareness of early warning to identify patients with potential relapse risk of BPPV and clinicians should counsel patients regarding the importance of follow-up after diagnosis of BPPV.
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Affiliation(s)
- Shichang Li
- Department of Otorhinolaryngology Head and neck surgery, 71185Peking University People's Hospital, Beijing, China
| | - Zijing Wang
- Department of Otorhinolaryngology Head and neck surgery, 71185Peking University People's Hospital, Beijing, China
| | - Yan Liu
- Department of Otorhinolaryngology Head and neck surgery, 71185Peking University People's Hospital, Beijing, China
| | - Jie Cao
- Department of Otorhinolaryngology Head and neck surgery, 71185Peking University People's Hospital, Beijing, China
| | - Hongwei Zheng
- Department of Otorhinolaryngology Head and neck surgery, 71185Peking University People's Hospital, Beijing, China
| | - Yuanyuan Jing
- Department of Otorhinolaryngology Head and neck surgery, 71185Peking University People's Hospital, Beijing, China
| | - Lin Han
- Department of Otorhinolaryngology Head and neck surgery, 71185Peking University People's Hospital, Beijing, China
| | - Xin Ma
- Department of Otorhinolaryngology Head and neck surgery, 71185Peking University People's Hospital, Beijing, China
| | - Ruiming Xia
- Department of Otorhinolaryngology Head and neck surgery, 71185Peking University People's Hospital, Beijing, China
| | - Lisheng Yu
- Department of Otorhinolaryngology Head and neck surgery, 71185Peking University People's Hospital, Beijing, China
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Is drug consumption correlated with benign paroxysmal positional vertigo (BPPV) recurrence? Eur Arch Otorhinolaryngol 2020; 277:1609-1616. [DOI: 10.1007/s00405-020-05855-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 02/06/2020] [Indexed: 10/25/2022]
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18
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Singh JM, Corser WD, Monsell EM. Cardiovascular Risk Factors and Benign Paroxysmal Positional Vertigo in Community Otolaryngology-Head and Neck Surgery. Otolaryngol Head Neck Surg 2020; 162:283-289. [PMID: 32013711 DOI: 10.1177/0194599820902116] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Cardiovascular risk factors have been associated with benign paroxysmal positional vertigo (BPPV), possibly causing degeneration of the utricular epithelium and subepithelium, but supportive evidence is mixed. This is the first study to examine the association between cardiovascular risk factors and BPPV as they present in the community practice of comprehensive otolaryngology-head and neck surgery. STUDY DESIGN Cross-sectional case-matched case-control series. SETTING A community practice of otolaryngology-head and neck surgery with 3 clinical offices and a socioeconomically diverse patient population. SUBJECTS AND METHODS Clinical data were collected retrospectively from the electronic health records of a continuous 4-year series of 628 patients with BPPV and age- and sex-matched controls. RESULTS There were no statistically significant associations found between BPPV and diabetes, hypertension, dyslipidemia, or body mass index in the study population in pairwise comparisons or multivariable modeling. CONCLUSION This study suggests that BPPV as encountered in a community ear, nose, and throat practice is not generally associated with cardiovascular risk factors. The possibility that these or other cardiovascular risk factors may be causative in some cases cannot be excluded, though most cases of BPPV appear to be caused primarily by shedding of otoconia from the utricle that is idiopathic or at least in part by unconfirmed noncardiovascular factors.
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Affiliation(s)
- Jeffrey M Singh
- McLaren Health System, Pontiac, Michigan, USA.,College of Osteopathic Medicine, Statewide Campus System, School of Medicine, Michigan State University, East Lansing, Michigan, USA
| | - William D Corser
- College of Osteopathic Medicine, Statewide Campus System, School of Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Edwin M Monsell
- McLaren Health System, Pontiac, Michigan, USA.,Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Wayne State University, Detroit, Michigan, USA
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Abstract
The pathophysiological mechanism underlying benign paroxysmal positional vertigo (BPPV) is related to free-floating debris/otoliths in the semicircular canal (canalolithiasis) or debris/otoliths attached to the cupula (cupulolithiasis). These debris/otoliths are considered to originally accumulate after detachment from the neuroepithelium of the utricular macula secondary to a type of degeneration. An idiopathic form, which is assumed to occur spontaneously, is diagnosed when the causative pathology is obscure. However, an association between various other systemic or inner ear conditions and BPPV has been reported, indicating the existence of secondary BPPV. This study was performed to present the first review of the pathology underlying BPPV following a complete PubMed/Medline search. In total, 1932 articles published from 1975 to 2018 were reviewed. The articles were classified according to 17 potentially causative factors (aging; migraine; Meniere's disease; infection; trauma; idiopathic sudden sensorineural hearing loss; sleeping habits; osteoporosis and vitamin D insufficiency; hyperglycemia and diabetes mellitus; chronic head and neck pain; vestibule or semicircular canal pathology; pigmentation disorders; estrogen deficiency; neurological disorders; autoimmune, inflammatory, or rheumatologic disorders; familial or genetic predisposition; and allergy). A discussion of the underlying cause of BPPV for each factor is presented.
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Affiliation(s)
- Sertac Yetiser
- Department of Otolaryngology-Head and Neck Surgery, Anadolu Medical Center, Gebze, Kocaeli, Turkey
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20
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Abstract
Purpose
Sport-related concussion is a significant public health concern that requires a multidisciplinary team to appropriately manage. Athletes often report dizziness and imbalance following concussion, and these symptoms can predict increased time to recover. Vestibular diagnostic evaluations provide important information regarding the athlete's oculomotor, gaze stability, and balance function in order to identify deficits for rehabilitation. These measures also describe objective function helpful for determining when an athlete is ready to return to play. The purpose of this clinical focus article is to provide background on the current understanding of the effects of concussion on the peripheral and central vestibular system, as well as information on a protocol that can be used for acute concussion assessment. Case studies describing 3 common postconcussion presentations will highlight the usefulness of this protocol.
Conclusion
Sport-related concussion is a highly visible disorder with many symptoms that may be evaluated in the vestibular clinic. A thoughtful protocol evaluating the typical presentation of these patients may help guide the multidisciplinary team in determining appropriate management and clearance for return to sport.
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Kutlubaev MA, Zamergrad MV. [A role of vascular risk factors in the development of peripheral vestibulopathy]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:85-89. [PMID: 31825395 DOI: 10.17116/jnevro201911909285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The development of peripheral vestibular disorders are often thought to be associated with vascular mechanisms, taking into account terminal type of inner ear blood supply and other predisposing factors. A number of studies indicates a high frequency of vascular risk factors in the patients with vestibular neuronitis and benign paroxysmal positional vertigo (BPPV). According to other results, migraine is widely spread among patients with Meniere's disease and BPPV. However currently there is no evidence for casual relationship between vascular factors and development of peripheral vestibulopathy. The only exclusion is labyrinthine infarction, which develops as a result of posterior circulation disorder. More research is needed in this area.
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Affiliation(s)
- M A Kutlubaev
- Kuvatov Republican Clinical Hospital, Ufa, Russia; Bashkir State Medical University, Ufa, Russia
| | - M V Zamergrad
- Russian Medical Aacademy for Contuning Postgraduate Education, Moscow, Russia
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Sreenivas V, Sima NH, Philip S. The Role of Comorbidities in Benign Paroxysmal Positional Vertigo. EAR, NOSE & THROAT JOURNAL 2019; 100:NP225-NP230. [PMID: 31565984 DOI: 10.1177/0145561319878546] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To assess the correlation between the comorbidities, such as hypertension, diabetes, thyroid disorders, hearing loss, hyperlipidemia, and vitamin D deficiency and benign paroxysmal positional vertigo (BPPV) and to determine the high-risk groups for recurrence of symptoms. DESIGN Descriptive analytical study. MATERIALS AND METHODS Patients who met the inclusion criteria underwent complete ear, nose, and throat examination, including Dix-Hallpike test and roll-over test and blood pressure recording. Investigations included pure tone audiometry, random blood sugar/fasting blood sugar, serum thyroid-stimulating hormone, fasting serum total cholesterol, and serum vitamin D levels. Patients were followed up for a period of 6 months to 1 year. RESULTS Older age-group has an increased risk of BPPV and recurrence of symptoms. About 45.1% of the patients with BPPV who were detected to have symptoms of hypertension were also more common with hypertensive. Diabetes mellitus was found to have an increased risk of BPPV and its recurrence. The presence of other comorbidities, such as abnormal thyroid function test (9%), sensorineural hearing loss (14%), hypercholesterolemia (46%), and vitamin D deficiency (79%) didn't show any significant risk for recurrence. CONCLUSION The presence of comorbidities worsens the status of BPPV, causing more frequent otolith detachment. Hence, it increases the risk of recurrence even after successful repositioning maneuver. Patients presenting with BPPV should therefore be evaluated and treated for these comorbidities along with the repositioning maneuvers.
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Affiliation(s)
- V Sreenivas
- Department of Otorhinolaryngology-Head and Neck Surgery, St. Johns Medical College, Bangalore, Karnataka, India
| | - Natashya H Sima
- Department of Otorhinolaryngology-Head and Neck Surgery, St. Johns Medical College, Bangalore, Karnataka, India
| | - Sumy Philip
- Department of Otorhinolaryngology-Head and Neck Surgery, Raihan Institute of Medical Sciences, Eratupeta, Kottayam, Kerala
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Burulday V, Doğan A, Akgül MH, Alpua M, Çankaya I. Is there a relationship between basilar artery tortuosity and vertigo? Clin Neurol Neurosurg 2019; 178:97-100. [DOI: 10.1016/j.clineuro.2019.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 11/01/2018] [Accepted: 02/05/2019] [Indexed: 10/27/2022]
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Analysis of Risk Factors for Recurrence of Benign Paroxysmal Positional Vertigo: An 11-Year Nationwide Population-Based Study. ACTA ACUST UNITED AC 2019. [DOI: 10.3342/kjorl-hns.2017.00899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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25
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Wang Y, Xia F, Wang W, Hu W. Assessment of sleep quality in benign paroxysmal positional vertigo recurrence. Int J Neurosci 2018; 128:1143-1149. [PMID: 29883234 DOI: 10.1080/00207454.2018.1486835] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Yun Wang
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Fei Xia
- Department of Otorhinolaryngology, Head and Neck Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing China
| | - Wei Wang
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Wenli Hu
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Akin FW, Murnane OD, Hall CD, Riska KM. Vestibular consequences of mild traumatic brain injury and blast exposure: a review. Brain Inj 2017; 31:1188-1194. [DOI: 10.1080/02699052.2017.1288928] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Faith W. Akin
- Vestibular Laboratory, James H. Quillen VA Medical Center, Mountain Home, Tennessee, USA
- Department of Audiology and Speech Language Pathology, East Tennessee State University, Johnson City, Tennessee, USA
| | - Owen D. Murnane
- Vestibular Laboratory, James H. Quillen VA Medical Center, Mountain Home, Tennessee, USA
- Department of Audiology and Speech Language Pathology, East Tennessee State University, Johnson City, Tennessee, USA
| | - Courtney D. Hall
- Gait and Balance Laboratory, James H. Quillen VA Medical Center, Mountain Home, Tennessee, USA
- Department of Physical Therapy, East Tennessee State University, Johnson City, Tennessee, USA
| | - Kristal M. Riska
- Vestibular Laboratory, James H. Quillen VA Medical Center, Mountain Home, Tennessee, USA
- Department of Audiology and Speech Language Pathology, East Tennessee State University, Johnson City, Tennessee, USA
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Tan F, Bartels C, Walsh RM. Our experience with 500 patients with benign paroxysmal positional vertigo: Reexploring aetiology and reevaluating MRI investigation. Auris Nasus Larynx 2017; 45:248-253. [PMID: 28943053 DOI: 10.1016/j.anl.2017.05.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 05/16/2017] [Accepted: 05/29/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To explore the aetiology of and to evaluate the importance of MRI investigation on the posterior semicircular canal benign paroxysmal positional vertigo in an Irish population. METHODS A retrospective observational study of 500 patients with posterior semicircular canal benign paroxysmal positional vertigo, diagnosed and treated by the senior author over a 10-year period. Most patients underwent an MRI brain and inner ear, following the same scan protocol. This included T1 weighted sagittal IR-FSPGR volume, axial T2 weighted, gradient echo T2 weighted and FLAIR sequences plus time of flight cerebral angiography. RESULTS The average age of presentation was 56 years; with the overall female to male ratio was 1.6:1, which was largely the net results of 2 age groups. Over 30% of our patients recalled distinct aetiological triggers, of which the top 3 were trauma, infection, and surgery. These accounted for 16%, 6%, and 5%, respectively. More than 25% of the patients were discovered to have abnormal intracranial findings on MRI. The 2 most common non-infarct incidental findings were neoplasia and vascular abnormalities. Although fewer than 20 patients had acute intracranial haemorrhage or malignant tumours, most of them were urgently referred to neurosurgeon due to the life-threatening nature of the condition. One round of particle repositioning manoeuver was successful in treating 84% of the patients, and the 2-year recurrence rate was only 2.2%. CONCLUSION The diagnosis of posterior semicircular canal benign paroxysmal positional vertigo is thought to be relatively easy to make, and the treatment is highly effective. Clinicians should be fully aware of and prepared for the diverse aetiology, and thus have no hesitation in requesting MRI scan as an important investigation.
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Affiliation(s)
- Fei Tan
- Department of Otorhinolaryngology and Head and Neck Surgery, St. James's Hospital, Dublin 8, Ireland.
| | - Constantin Bartels
- Department of Otorhinolaryngology and Head and Neck Surgery, Waterford Regional Hospital, Waterford, Ireland
| | - Rory McConn Walsh
- Department of Otorhinolaryngology and Head and Neck Surgery, Beaumont Hospital and Blackrock Clinic, Dublin, Ireland
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Messina A, Casani A, Manfrin M, Guidetti G. Italian survey on benign paroxysmal positional vertigo. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2017; 37:328-335. [PMID: 28872163 PMCID: PMC5584106 DOI: 10.14639/0392-100x-1121] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 03/21/2017] [Indexed: 12/20/2022]
Abstract
Benign paroxysmal positional vertigo (BPPV) is the most common type of peripheral vertigo. BPPV often relapses after the first episode, with a recurrence rate between 15% and 50%. To date both the aetiopathogenetic processes that lead to otoconia detachment and the factors that make BPPV a relapsing disease are still unclear, but recent epidemiological studies have shown a possible association with cardiovascular risk factors. The aim of the present study (Sesto Senso Survey) was to evaluate in the Italian population through an observational survey, the main demographic and clinical characteristics of patients with BPPV (first episode or recurrent) with particular focus on the potential cardiovascular risk factors. The survey was conducted in 158 vestibology centres across Italy on 2,682 patients (mean age 59.3 ± 15.0 years; 39.1% males and 60.9% females) suffering from BPPV, from January 2013 to December 2014. The results showed a high prevalence of cardiovascular risk factors such as high blood pressure (55.8%), hypercholesterolaemia (38.6%) and diabetes (17.7%), as well as a family history of cardiovascular disease (49.4%). A high percentage of patients also had hearing loss (42.9%), tinnitus (41.2%), or both (26.8%). The presence of hypertension, dyslipidaemia and pre-existing cardiovascular comorbidities were significantly related to recurrent BPPV episodes (OR range between 1.84 and 2.31). In addition, the association with diabetes and thyroid/autoimmune disease (OR range between 1.73 and 1.89) was relevant. The survey results confirm the significant association between cardiovascular comorbidities and recurrent BPPV and identify them as a potential important risk factor for recurrence of BPPV in the Italian population, paving the way for the evaluation of new therapeutic strategies in the treatment of this disease.
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Affiliation(s)
- A. Messina
- Otoneurology and Tinnitus Unit, Chair of Audiology, P. Giaccone University Hospital, Palermo
| | - A.P. Casani
- Department of Surgical, Medical and Critical Care Pathology, University of Pisa
| | - M. Manfrin
- ENT Clinic, IRCCS Policlinico San Matteo, Pavia
| | - G. Guidetti
- Vertigo Center, Poliambulatorio Chirurgico Modenese, Modena
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Cha WW, Song K, Yu IK, Choi MS, Chang DS, Cho CS, Lee HY. Magnetic resonance imaging predicts chronic dizziness after benign paroxysmal positional vertigo. Am J Otolaryngol 2017; 38:428-432. [PMID: 28390809 DOI: 10.1016/j.amjoto.2017.04.001] [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] [Received: 11/29/2016] [Revised: 03/01/2017] [Accepted: 04/04/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVES We aimed to evaluate the clinical implications of magnetic resonance imaging (MRI) findings in patients with benign paroxysmal positional vertigo (BPPV). METHODS A total of 120 patients diagnosed with BPPV completed MRI at the emergency room between December 2012 and June 2015 and met our criteria for inclusion in this study. Epidemiologic characteristics, the results of audio-vestibular testing, and MRI findings were retrospectively analyzed. RESULTS The most common findings were white matter hyperintensities (70.0%), sinusitis (34.2%), and brain atrophy (25.0%). There were no significant differences in MRI findings or epidemiologic characteristics according to BPPV subtype (p>0.05). A multiple regression analysis revealed that BPPV recurrence (odds ratio, 6.88; 95% confidence interval, 1.67-34.48; p=0.009) and brain atrophy (odds ratio, 4.39; 95% confidence interval, 1.11-21.28; p=0.036) were positively associated with dizziness lasting longer than 3months. CONCLUSION Brain atrophy was independently associated with long-lasting dizziness after BPPV. Although the mechanism is unclear, brain atrophy may have relevance to otoneurotologic disease-related changes in brain structure.
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Affiliation(s)
- Wang Woon Cha
- Department of Otorhinolaryngology, Eulji University Medical Center, Eulji University School of Medicine, Daejeon, Republic of Korea
| | - Kudamo Song
- Department of Otorhinolaryngology, Eulji University Medical Center, Eulji University School of Medicine, Daejeon, Republic of Korea
| | - In Kyu Yu
- Department of Diagnostic Radiology, Eulji University Medical Center, Eulji University School of Medicine, Eulji University, Daejeon, Republic of Korea
| | - Myoung Su Choi
- Department of Otorhinolaryngology, Eulji University Medical Center, Eulji University School of Medicine, Daejeon, Republic of Korea
| | - Dong Sik Chang
- Department of Otorhinolaryngology, Eulji University Medical Center, Eulji University School of Medicine, Daejeon, Republic of Korea
| | - Chin-Saeng Cho
- Department of Otorhinolaryngology, Eulji University Medical Center, Eulji University School of Medicine, Daejeon, Republic of Korea
| | - Ho Yun Lee
- Department of Otorhinolaryngology, Eulji University Medical Center, Eulji University School of Medicine, Daejeon, Republic of Korea.
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