Management of Bilateral Benign Paroxysmal Positional Vertigo

Bilateral simultaneous presentation of posterior canal benign paroxysmal positional vertigo

OBJECTIVE

To outline the clinical picture of bilateral posterior canal benign paroxysmal positional vertigo.

METHODS

A total of 573 patients with posterior canal benign paroxysmal positional vertigo were classified as having unilateral, or true or pseudo bilateral, posterior canal benign paroxysmal positional vertigo, and were treated with the Epley manoeuvre. Statistical significance was set at p < 0.05.

RESULTS

Of the patients, 483 had unilateral and 90 (15.7 per cent) had bilateral presentation. Of the latter, 72 patients had pseudo bilateral posterior canal benign paroxysmal positional vertigo. Comparisons of site of involvement, male to female ratio and the incidence of associated problems in unilateral, and true and pseudo bilateral posterior canal benign paroxysmal positional vertigo did not reveal any statistically significant differences (p = 0.828, p = 0.200, p = 0.142). Comparisons of the number of manoeuvres required to provide symptom relief and the rate of recurrence were significant (p < 0.05).

CONCLUSION

Identification of true and pseudo bilateral posterior canal benign paroxysmal positional vertigo is important given the differences in aetiology and treatment outcome. Treatment of patients with true bilateral posterior canal benign paroxysmal positional vertigo requires several therapeutic manoeuvre attempts, and patients should be warned about recurrence.

Treatment efficacy of repositioning maneuvers in multiple canal benign paroxysmal positional vertigo: a systematic review and meta-analysis

Introduction

Benign paroxysmal positional vertigo (BPPV) involving the posterior canal is more common than other canals; however, simultaneous involvement of multiple canals can be seen up to 20% of all BPPV cases. The diagnosis and management of multiple canal BPPV can be quite challenging due to the complexity of findings. Therefore, this systematic review and meta-analysis aimed at unveiling the most effective repositioning strategy for the treatment of multiple canal BPPV.

Methods

A literature search through PubMed, Scopus, and Web of Science databases was conducted using search terms such as BPPV, multiple canals, bilateral BPPV, repositioning maneuvers etc. After duplicate removal, the retained articles underwent various stages of elimination by two independent reviewers, and a third reviewer resolved the discrepancy between them.

Results

A total of 22 articles were included in the systematic review. These publications documented 5,196 patients diagnosed with BPPV, of which 513 had multiple canal BPPV. Of 295 individuals with multiple canal BPPV, 58.9% were effectively treated in 1 session, whereas 18.3 and 4.4% achieved a symptom-free state after two and three sessions, respectively. Failure of treatment using repositioning maneuvers was found in 18.4%.

Possible implications

This study offers insight into the real world of BPPV management in single and multiple canal BPPV. It is evident that repositioning maneuvers provide rapid and long-lasting relief of BPPV in most single canal BPPV patients; however, multiple canal BPPV often requires repeated treatment, and the risk of recurrence is higher in this variety than the single canal BPPV.

Systematic Review of Bilateral Benign Paroxysmal Positional Vertigo

OBJECTIVES

To evaluate the success rates of canalith repositioning maneuvers (CRM) in the treatment of patients diagnosed with bilateral benign paroxysmal positional vertigo (BiBPPV).

STUDY DESIGN

Systematic review.

METHODS

A comprehensive search of only English studies in PubMed, Ovid (1946 to the present), and Embase (1974 to the present) databases was done up until January 1, 2021. Studies that diagnosed patients with BiBPPV specifically and evaluated the CRM success from all published years were included. Studies were excluded if follow-up was less than 6 months or if they failed to distinguish BiBPPV from ipsilateral multi-canal BPPV. A total of nine studies were included with a total study population of 325 patients. Included studies were evaluated for bias with the National Institutes of Health (NIH) Study Quality Assessment Tool. Success rates of CRM, number of treatments required, and disease recurrence rates were extracted.

RESULTS

The overall success rate was compiled using a fixed-effect binary inverse variance model and was 95.2% (CI: 92.9%-97.5%). A qualitative review suggested treating the more affected side first on separate visits until resolved, followed by contralateral treatment (recommendation). The mean number of treatments was 2.9 (CI: 2.4-3.4), and the recurrence rate was 19.8% (CI: 11.7%-27.9%). There was a higher proportion of trauma etiology of BiBPPV compared to unilateral, with an odds ratio of 8.9 (CI: 5.1-15.3).

CONCLUSIONS

Overall, this meta-analysis shows high success rates for CRM in the treatment of BiBPPV. Rates are similar to CRM efficacy for unilateral BPPV. Laryngoscope, 2021.

Climatic variations and benign paroxysmal positional vertigo

Benign paroxysmal positional vertigo (BPPV) is probably the most common diagnosis at vertigo clinics. Seasonal cycles of several human illnesses could be attributed variously to changes in atmospheric or weather conditions. In this retrospective study, patients with BPPV from January 2010 to December 2012 were studied, and their charts were reviewed. Statistical analysis revealed a statistically significant difference in patients' numbers among different months of the year. Also there is a significant statistical correlation between the numbers of patients with climatic variations especially the temperature. The present paper discusses the possible explanations for these results which confirms the seasonal variations in BPPV, together with a review of literature to view the possible associations with other disorders that causes such seasonality.

Postural Control in Older Patients with Benign Paroxysmal Positional Vertigo

Objective. To evaluate the effectiveness of a canalith-repositioning procedure in postural control of older patients with idiopathic benign paroxysmal positional vertigo (BPPV).

Study Design. Prospective clinical trial.

Setting. A tertiary referral center.

Methods. A 9-month follow-up survey with a prospective design was conducted among 33 older patients with BPPV. Patients underwent static posturography (Balance Rehabilitation Unit [BRU]) and were administered the Dizziness Handicap Inventory (DHI) before and after the maneuver. After the treatment, they were compared with 33 healthy older subjects. The posturography parameters were the limit of stability (LOS), the center of body-pressure area (COP), and the velocity of oscillation (VOS) under conditions of visual, somatosensory, and visual-vestibular conflict.

Results. One canalith-repositioning procedure relieved most patients’ complaints (54.5%), and 100% were relieved with 1 to 3 maneuvers. Total DHI score and all subscales improved after treatment ( P < .01). The LOS values pretreatment (mean [SD] 134.27 [55.32] cm2) and posttreatment (181.03 [47.79] cm2) were significantly different ( P < .01). Comparative analysis of COP values showed a relevant statistical difference in 8 of 10 postmaneuver conditions ( P < .01). The postmaneuver VOS showed a significant difference under 7 conflict conditions. There were no differences between the healthy older subjects and treated patients for all VOS values under all conditions and for COP values under 9 conditions.

Conclusion. The canalith-repositioning procedure promotes remission of symptoms, an increase in LOS, and improvement in postural control under conditions of somatosensory and visual conflict and visual-vestibular interaction.

Benign paroxysmal positional vertigo after radiologic scanning: a case series

Introduction

Benign paroxysmal positional vertigo (BPPV) is the most common type of vertigo. It is frequently seen in elderly patients, and the course of the attack may easily mimic cerebrovascular disease. A BPPV attack after a radiologic examination has not been reported previously. We report the cases of two patients who had BPPV attacks after radiologic imaging.

Case presentation

The first patient with headache and tremor was admitted to the radiology department for cranial computed tomography (CT) imaging. During scanning, she was asked to lie in the supine position with no other head movements for approximately 10 minutes. After the cranial CT imaging, she stood up rapidly, and suddenly experienced a vertigo attack and nausea. The second patient was admitted to the radiology department for evaluation of his renal arteries. During the renal magnetic resonance angiography, he was in the supine position for 20 minutes and asked not to move. After the examination, he stood up rapidly with the help of the technician and suddenly experienced a vertigo attack with nausea and vomiting. The results of standard laboratory analyses and their neurologic examinations were within normal limits and Dix-Hallpike tests showed rotatory nystagmus in both cases. An Epley maneuver was performed to the patients. The results of a control Dix-Hallpike tests after 1 Epley maneuver were negative in both patients.

Conclusion

Radiologists and clinicians must keep in mind that after radiologic imaging in which the patient is still for some time in the supine position and then helped to stand up rapidly, a BPPV attack may occur.