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Abstract Introduction In patients with benign paroxysmal positional vertigo, BPPV; a torsional-vertical down beating positioning nystagmus can be elicited in the supine straight head-hanging position test or in the Dix-Hallpike test to either side. This type of nystagmus can be explained by either an anterior canal BPPV or by an apogeotropic variant of the contralateral posterior canal BPPV Until now all the therapeutic maneuvers that have been proposed address only one possibility, and without first performing a clear differential diagnosis between them. Objective To propose a new maneuver for torsional-vertical down beating positioning nystagmus with a clear lateralization that takes into account both possible diagnoses (anterior canal-BPPV and posterior canal-BPPV). Methods A prospective cohort study was conducted on 157 consecutive patients with BPPV. The new maneuver was performed only in those with torsional-vertical down beating positioning nystagmus with clear lateralization. Results Twenty patients (12.7%) were diagnosed with a torsional-vertical down beating positioning nystagmus. The maneuver was performed in 10 (6.35%) patients, in whom the affected side was clearly determined. Seven (4.45%) patients were diagnosed with an anterior canal-BPPV and successfully treated. Two (1.25%) patients were diagnosed with a posterior canal-BPPV and successfully treated with an Epley maneuver after its conversion into a geotropic posterior BPPV. Conclusion This new maneuver was found to be effective in resolving all the cases of torsional-vertical down beating positioning nystagmus-BPPV caused by an anterior canal-BPPV, and in shifting in a controlled way the posterior canal-BPPV cases of the contralateral side into a geotropic-posterior-BPPV successfully treated during the followup visit. Moreover, this new maneuver helped in the differential diagnosis between anterior canal-BPPV and a contralateral posterior canal-BPPV.
Resumo Introdução Em pacientes com vertigem posicional paroxística benigna, VPPB, um nistagmo vertical para baixo com componente de torção pode ser provocado no teste head hanging supino executado na posição reta ou no teste de Dix-Hallpike para qualquer um dos lados. Esse tipo de nistagmo pode ser explicado por uma VPPB do canal anterior ou por uma variante apogeotrópica da VPPB do canal posterior contralateral. Até agora, todas as manobras terapêuticas propostas abordam apenas uma possibilidade, sem antes fazer um diagnóstico diferencial claro entre elas. Objetivo Propor uma nova manobra para nistagmo vertical para baixo com componente de torção com uma lateralização clara que leve em consideração os dois diagnósticos possíveis, VPPB do canal anterior e VPPB do canal posterior. Método Um estudo de coorte prospectivo foi conduzido em 157 pacientes consecutivos com VPPB. A nova manobra foi feita apenas nos pacientes com nistagmo vertical para baixo com componente de torção, com lateralização nítida. Resultados Vinte pacientes (12,7%) foram diagnosticados com nistagmo vertical para baixo com componente de torção. A manobra foi feita em 10 (6,35%) pacientes, nos quais o lado afetado foi claramente determinado. Sete (4,45%) pacientes foram diagnosticados com VPPB do canal anterior e tratados com sucesso. Dois (1,25%) pacientes foram diagnosticados com VPPB do canal posterior e tratados com sucesso com a manobra de Epley após sua conversão para VPPB geotrópica de canal posterior. Conclusão Essa nova manobra mostrou-se eficaz na resolução de todos os casos de VPPB com nistagmo vertical para baixo com componente de torção causada por VPPB do canal anterior. E na mudança de forma controlada dos casos de VPPB do canal posterior do lado contralateral para uma VPPB geotrópica de canal posterior tratada com sucesso durante a consulta de seguimento. Além disso, essa nova manobra auxiliou no diagnóstico diferencial entre a VPPB do canal anterior e a VPPB do canal posterior contralateral.
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Background: The usage pattern and effectiveness of various treatment strategies for benign positional paroxysmal vertigo (BPPV) have not been widely reported in routine clinical settings in India. The aim of the study was to understand treatment patterns and level of symptom improvement in Indian patients presenting with symptoms of BPPV in clinical practice.Methods:A cross-sectional pan-India survey was conducted with leading neurologists and otolaryngologists. A detailed questionnaire was shared with specialists which was followed by semi-structured telephonic interviews to gather a deeper understanding of their treatment practices. The obtained data was analyzed using appropriate statistical methods.Results:A total of 5 neurologists and 8 ENT specialists completed the survey. Physicians reported that age, but not gender, was an important factor when selecting appropriate treatment. Specialists reported that in their clinical practice symptom improvement is better with betahistine plus maneuvers compared to betahistine only alone (97% verses90% cure rate) and is comparable with maneuvers (97% verses98% cure rate, respectively). Dix Hallpike and supine roll test using videonystagmography were the most recommended tests used to diagnose BPPV. Betahistine plus maneuvers was the most commonly prescribed treatment for BPPV, and clinicians observed greater decrease in the severity of BPPV symptoms with betahistine plus maneuvers versus betahistine alone or maneuvers. The Visual analog scale (VAS) was the most widely usedscale for assessing severity of BPPV symptoms.Conclusions: These findings indicate that betahistine plus maneuvers provides better control over symptom severity in patients with BPPV.
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Abstract Introduction Multi-canal benign paroxysmal positional vertigo is considered to be a rare and controversial type in the new diagnostic guidelines of Bárány because the nystagmus is more complicated or atypical, which is worthy of further study. Objective Based on the diagnostic criteria for multi-canal benign paroxysmal positional vertigo proposed by International Bárány Society, the study aimed to investigate the clinical characteristics, diagnosis and treatment of multi-canal benign paroxysmal positional vertigo. Methods A total of 41 patients with multi-canal benign paroxysmal positional vertigo were included and diagnosed by Roll, Dix-Hallpike and straight head hanging tests. Manual reduction was performed according to the involvement of semicircular canals. Results Among the 41 cases, 19 (46.3%) patients showed vertical up-beating nystagmus with or without torsional component and geotropic, apogeotropic horizontal nystagmus, and were diagnosed with posterior-horizontal canal. 11 (26.8%) patients showed vertical up-beating nystagmus with torsional component on one side and vertical down-beating nystagmus with or without torsional component on the other side during Dix-Hallpike test or straight head hanging test and were diagnosed with posterior-anterior canal benign paroxysmal positional vertigo 9 (26.8%) patients showed vertical down-beating nystagmus with or without torsional component and geotropic, apogeotropic horizontal nystagmus, and were diagnosed with anterior-horizontal canal 2 (4.9%) patients showed vertical geotropic torsional up-beating nystagmus on both sides and were diagnosed with bilateral posterior canal benign paroxysmal positional vertigo. High correlation between the sides with reduced vestibular function or hearing loss and the side affected by Multi-canal benign paroxysmal positional vertigo was revealed (contingency coefficient = 0.602, p = 0.010). During one-week follow up, nystagmus/vertigo has been significantly alleviated or disappeared in 87.8% (36/41) patients. Conclusion Posterior-horizontal canal benign paroxysmal positional vertigo was the most common type. Multi-canal benign paroxysmal positional vertigo involving anterior canal was also not uncommon. Caloric tests and pure tone audiometry may help in the determination of the affected side. Manual reduction was effective in most of Multi-canal benign paroxysmal positional vertigo patients.
Resumo Introdução A vertigem posicional paroxística benigna multicanal é considerada um tipo raro e controverso nas novas diretrizes de diagnóstico da Bárány Society, porque o nistagmo é mais complicado ou atípico, o que é digno de mais estudos. Objetivo Com base nos critérios diagnósticos para a vertigem posicional paroxística benigna multicanal proposta pela International Bárány Society, o estudo teve como objetivo investigar as características clínicas, o diagnóstico e o tratamento da vertigem posicional paroxística benigna multicanal. Método Foram incluídos 41 pacientes com vertigem posicional paroxística benigna multicanal e diagnosticados pelo teste de Dix-Hallpike, roll test ou e teste straight head hanging A redução manual foi feita de acordo com o envolvimento dos canais semicirculares. Resultados Entre os 41 casos, 19 (46,3%) pacientes apresentaram nistagmo de batimento ascendente vertical com ou sem componente de torção e nistagmo horizontal apogeotrópico e geotrópico e foram diagnosticados com vertigem posicional paroxística benigna de canal horizontal-posterior. Onze (26,8%) pacientes apresentaram nistagmo vertical de batimento ascendente com componente de torção de um lado e nistagmo vertical de batimento descendente com ou sem componente de torção do outro lado durante o teste de Dix-Hallpike ou teste straight head hanging e foram diagnosticados com vertigem posicional paroxística benigna do canal posterior-anterior. Nove (26,8%) pacientes apresentaram nistagmo vertical com batimento descendente com ou sem componente de torção e nistagmo horizontal apogeotrópico e geotrópico e foram diagnosticados com vertigem posicional paroxística benigna de canal anterior-horizontal. Dois (4,9%) pacientes apresentaram nistagmo de torção geotrópico vertical de batimento ascendente em ambos os lados e foram diagnosticados com vertigem posicional paroxística benigna de canal posterior bilateral. Foi revelada alta correlação entre os lados com função vestibular reduzida ou perda auditiva e o lado afetado pela vertigem posicional paroxística benigna multicanal (coeficiente de contingência = 0,602, p = 0,010). Durante o seguimento de uma semana, o nistagmo/vertigem foi significativamente aliviado ou desapareceu em 87,8% (36/41) dos pacientes. Conclusões A vertigem posicional paroxística benigna de canal horizontal e posterior foi o tipo mais comum. A vertigem posicional paroxística benigna multicanal que envolveu canal anterior também não foi incomum. Testes calóricos e audiometria tonal pura podem ajudar na determinação do lado afetado. A redução manual foi eficaz na maioria dos pacientes com vertigem posicional paroxística benigna multicanal.
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@#The aim of this study was to detemine the effectiveness of Customized vestibular rehabilitation (CVR) in addition to the standard Canalith repositioning maneuver (CRM) on static balance among adults with posterior canal Benign Paroxysmal Positional Vertigo (BPPV). In this randomised controlled trial, 28 adults with idiopathic unilateral posterior canal BPPV were randomized to either the control or experimental group. The experimental group (n=14, mean age: 50.71±9.88 years) received CVR in addition to CRM, and the control group (n=14, mean age: 54.36±8.55 years) received only CRM for 6 weeks. Measurements of static balance (postural sway) using a portable kinematic sensor were performed at baseline, four and six weeks after treatment for both groups while standing on firm and foam surface with eyes open (EO) and closed (EC). Only standing on foam surface with EC was observed to have a significant interaction effect, F (2, 52) =5.28, p<0.05. This suggest that the groups were affected differently by the intervention and greater improvement was demonstrated in the experimental group. Post hoc test showed that a significant difference (p<0.05) in static balance was shown between baseline and 6th week after intervention. The results of our study indicate that CVR in addition to CRM improved static balance in adults with UPC BPPV at 6th week after intervention for persons with BPPV.
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BACKGROUND: Betahistine is a clinical medication for the treatment of benign paroxysmal positional vertigo (BPPV). Otolin, a secreted glycoprotein with a C-terminal globular domain homologous to the immune complement C1q, has been identified as a biomarker for BPPV. However, the role of complement C1q/TNF-related proteins (CTRPs) with a C-terminal globular domain in BPPV is unclear, so we explored the change of CTRPs in betahistine treated BPPV. METHODS: We treated BPPV patients with Betahistine (12 mg/time, 3 times/day) for 4 weeks and observed the clinical efficacy and the expression of CTRP family members in BPPV patients. Then, we constructed a vertigo mice model of vestibular dysfunction with gentamicin (150 mg/Kg) and a BPPV model of Slc26a4loop/loop mutant mice. Adenoviral vectors for CTRP expression vector and small interfering RNA were injected via the intratympanic injection into mice and detected the expression of CTRP family members, phosphorylation levels of ERK and AKT and the expression of PPARγ. In addition, we treated mice of vestibular dysfunction with Betahistine (10 mg/Kg) and/or ERK inhibitor of SCH772984 (12 mg/Kg) and/or and PPARγ antagonist GW9662 (1 mg/Kg) for 15 days, and evaluated the accuracy of air righting reflex, the time of contact righting reflex and the scores of head tilt and swimming behavior. RESULTS: After treatment with Betahistine, the residual dizziness duration and the score of the evaluation were reduced, and the expression of CTRP1, 3, 6, 9 and 12 were significantly increased in BPPV patients. We also found that Betahistine improved the accuracy of air righting reflex, reduced the time of contact righting reflex and the scores of head tilt and swimming behavior in gentamicin-treated mice and Slc26a4loop/loop mutant mice. The expression levels of CTRP1, 3, 6, 9 and 12, phosphorylation levels of ERK and AKT, and PPARγ expression were significantly increased, and the scores of head tilt and swimming behavior were decreased in vestibular dysfunction mice with overexpression of CTRPs. Silencing CTRPs has the opposite effect. SCH772984 reversed the effect of Betahistine in mice with vestibular dysfunction. CONCLUSION: Betahistine alleviates BPPV through inducing production of multiple CTRP family members and activating the ERK1/2-AKT/PPARy pathway.
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Humans , Animals , Mice , Betahistine/therapeutic use , Betahistine/pharmacology , Benign Paroxysmal Positional Vertigo/drug therapy , MAP Kinase Signaling System , PPAR gamma , Dizziness/drug therapy , Proto-Oncogene Proteins c-aktABSTRACT
Abstract Introduction Subjective benign paroxysmal positional vertigo is a form of benign paroxysmal positional vertigo in which during the diagnostic positional maneuvers patients only present vertigo symptoms with no nystagmus. Objective To study the characteristics of subjects with subjective benign paroxysmal positional vertigo. Methods Prospective multicenter case-control study. All patients presenting with vertigo in the Dix-Hallpike test that presented to the participating hospitals were included. The patients were separated into two groups depending on whether nystagmus was present or not. An Epley Maneuver of the affected side was performed. In the follow-up visit, patients were checked to see if nystagmus and vertigo were present. Both groups of patients were compared to assess the success rate of the Epley maneuver and also to compare the presence of 19 variables. Results 259 patients were recruited, of which 64 belonged to the subjective group. Nystagmus was eliminated in 67.2% of the patients with benign paroxysmal positional vertigo. 89.1% of the patients with subjective benign paroxysmal positional vertigo remained unaffected by nystagmus, thus showing a significant difference (p = 0.001). Osteoporosis and migraine were the variables which reached the closest to the significance level. In those patients who were taking vestibular suppressors, the percentage of subjective benign paroxysmal positional vertigo was not significantly higher. Conclusions Subjective benign paroxysmal positional vertigo should be treated using the Epley maneuver. More studies are needed to establish a relationship between osteoporosis, migraine and subjective benign paroxysmal positional vertigo. The use of vestibular suppressants does not affect the detection of nystagmus.
Resumo Introdução A vertigem posicional paroxística benigna subjetiva é um tipo de vertigem posicional paroxística benigna na qual, durante as manobras posicionais diagnósticas, os pacientes apresentam apenas sintomas vertiginosos sem nistagmo. Objetivo Estudar as características de indivíduos com vertigem posicional paroxística benigna subjetiva. Método Estudo prospectivo multicêntrico de caso-controle. Foram incluídos todos os pacientes com vertigem no teste de Dix-Hallpike, que se apresentaram nos hospitais participantes. Os pacientes foram separados em dois grupos, dependeu da presença ou não do nistagmo. Uma manobra de Epley foi realizada no lado afetado. Na consulta de seguimento, os pacientes foram avaliados para verificar a presença ou não do nistagmo e da vertigem. Ambos os grupos de pacientes foram comparados para avaliar a taxa de sucesso da manobra de Epley e também para comparar a presença de 19 variáveis. Resultados Foram recrutados 259 pacientes, dos quais 64 pertenciam ao grupo subjetivo. O nistagmo foi eliminado em 67,2% dos pacientes com vertigem posicional paroxística benigna. Em 89,1% dos casos, os pacientes com vertigem posicional paroxística benigna subjetiva mantiveram-se não afetados pelo nistagmo, mostraram uma diferença significativa (p = 0,001). Osteoporose e enxaqueca foram as variáveis que atingiram o nível mais próximo ao de significância. Nos pacientes que tomavam supressores vestibulares, a porcentagem de vertigem posicional paroxística benigna subjetiva não foi significativamente maior. Conclusões A vertigem posicional paroxística benigna subjetiva deve ser tratada com a manobra de Epley. Mais estudos são necessários para estabelecer uma relação entre osteoporose, enxaqueca e vertigem posicional paroxística benigna subjetiva. O uso de supressores vestibulares não afeta a detecção do nistagmo.
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Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Adult , Middle Aged , Young Adult , Osteoporosis/physiopathology , Benign Paroxysmal Positional Vertigo/physiopathology , Migraine Disorders/physiopathology , Osteoporosis/complications , Posture/physiology , Sulpiride/therapeutic use , Betahistine/therapeutic use , Nystagmus, Physiologic/physiology , Case-Control Studies , Prospective Studies , Physical Therapy Modalities , Benign Paroxysmal Positional Vertigo/complications , Benign Paroxysmal Positional Vertigo/drug therapy , Migraine Disorders/complicationsABSTRACT
El paciente que consulta por mareos o vértigo es sin duda un desafío para el médico que trabaja en un servicio de urgencia. Esto se da en parte por la dificultad de los pacientes de definir el síntoma, a la amplia gama de diagnósticos diferenciales y su potencial riesgo de desenlace negativo, como en el caso del accidente cerebrovascular de fosa posterior. En esta revisión narrativa, el objetivo: es explicar el enfrentamiento inicial del paciente con mareos y vértigo, describir las pruebas y métodos diagnósticos complementarios, distinguir los diagnósticos diferenciales más frecuentes y explicar el manejo inicial. Método:se realizó una revisión bibliográfica de literatura científica sobre esta patología, basado en la propuesta de Edlow (2016), donde se enfatiza en un enfoque basado en temporalidad, factores desencadenantes y contexto del síntoma.(AU)
The patient who consults for dizziness or vertigo is undoubtedly a challenge for the emergency physician. This is partly due to the difficulty of the patients to define the symptom, the wide range of differential diagnoses and their potential risk of negative outcome, as in the case of posterior circulation stroke. In this narrative review, the objective is to explain the initial approach of the patient with dizziness and vertigo, describe the tests and complementary diagnostic methods, distinguish the most frequent differential diagnoses and explain the initial management. A bibliographic review of the scientific literature on this pathology was carried out, based on the proposal of Edlow (2016), which emphasizes an approach based on temporality, trigger factors and context of the symptom. (AU)
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Humans , Male , Female , Vertigo , Dizziness , Vestibular Neuronitis , Stroke , Emergency Service, Hospital , LabyrinthitisABSTRACT
Objective@#To analyze the characteristics of nystagmus of horizontal semicircular canal cupulolithiasis(HSC-Cup) in Roll test and Dix-Hallpike test.@*Methods@#Between December 2016 and December 2017, a total of 164 patients with BPPV from Tianjin First Center Hospital, 124 HSC-Can BPPV and 40 HSC-Cup BPPV, were involved.The induced nystagmus in Roll test and Dix-Hallpike test were recorded by video-nystagmograph(VNG), whose direction and intensity characteristics were compared in various BPPV.@*Results@#HSC-Can patients were induced a horizontal nystagmus with Roll test, the nystagmus intensity of the disease and healthy side were (41.3±20.1)°/s (mean standard deviation)and(21.9±9.4)°/s respectively, the difference was statistically significant (t=6.709, P<0.05). HSC-Cup patients were induced a horizontal nystagmus that was opposite to the direction of the Roll test, the nystagmus intensity of the disease and the healthy side were (12.9±6.4)°/s and(29.1±9.3)°/s respectively, with significant difference (t=9.066, P<0.05). Among 124 cases of HSC-Can patients, 120 cases of horizontal nystagmus were recorded in the left and right sides of the Dix-Hallpike test in the same direction as the turning direction, the horizontal nystagmus intensity of the disease and the healthy sides were (15.1±10.0)°/s and(9.4±7.4)°/s respectively, the difference was statistically significant (t=2.365, P<0.05). And 40 cases of HSC-Cup patients were recorded at the head of the Dix-Hallpike test in the opposite direction to the horizontal eye earthquake.The horizontal nystagmus intensity of the disease and the healthy side were (5.3±2.8)°/s and(13.9±4.4)°/s respectively, the difference was statistically significant (t=10.579, P<0.05).@*Conclusions@#Characteristic horizontal nystagmus can be induced by HSC-Cup in both roll test and Dix-Hallpike test. Preliminary localization of Dix-Hallpike Test can also be used for HSC-Cup.
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Introducción. El Vértigo Posicional Paroxístico Benigno (VPPB) del canal semicircular posterior es una enfermedad crónica que afecta severamente la calidad de vida de los pacientes que lo sufren. Para su manejo existen las Maniobras de Reposicionamiento, que son una serie de ejercicios secuenciales de la cabeza en 4 posiciones. El propósito de la maniobra es reposicionar los otolitos desde el conducto semicircular posterior dentro del vestíbulo a los sitios de donde migraron para dejar de producir vértigo. Permaneciendo en cada posición aproximadamente 30 segundos. Las maniobras han demostrado gran eficacia a corto plazo. Los resultados son medibles por medio de un cuestionario conocido como Dizziness Handicap Inventory (DHI). Objetivos: Medir el impacto de las maniobras de reposicionamiento en la discapacidad en los pacientes con Vértigo Posicional Paroxístico Benigno del conducto semicircular posterior, mediante el uso del DHI. Metodología. Es un estudio comparativo que utiliza la T de Student para muestras pareadas donde cada paciente es su propio control, se tomó una muestra de 20 pacientes diagnosticados con Vértigo Posicional Paroxístico Benigno del conducto semicircular posterior que serán tratados con maniobras de reposicionamiento, serán evaluados mediante la herramienta (DHI) que será completada por los pacientes al inicio del estudio, al día 7 y día 30, luego de realizadas las Maniobras de Reposicionamiento. Resultados: Las mujeres son las más afectadas por el (VPPB) del canal semicircular posterior en una relación de 2.1 aproximadamente. El grado de discapacidad fue medido por el resultado del DHI, el cual muestra para los días 1, 7, y 30 una media de 50.4, 30.4 y 24.2 respectivamente. La escala con mayor punteo durante los días 1, 7, y 30 fue la escala funcional mostrando una media de 20, 12.2, y 9.5 respectivamente. Las diferencias entre las medias fueron estadísticamente significativas. (p= 0.00006, 0.000002 y 0.03701). Conclusiones: El padecimiento de VPPB del conducto semicircular posterior afecta la calidad en el estilo de vida de las personas. Las maniobras de reposicionamiento son estadísticamente significativas para disminuir la incapacidad generada por el vértigo posicional paroxístico benigno del conducto semicircular posterior por lo que es importante acudir rápidamente al médico especialista cuando se manifiesten los primeros signos y evitar así aumentar la discapacidad total asociada al vértigo. Palabras Clave: Vértigo Posicional Paroxístico (VPPB), otolitos, Dizziness Handycap Inventory (DHI).
Introduction. Benign Paroxysmal Positional Vertigo (BPPV) of the posterior semicircular canal is a chronic disease severely affecting quality of life. Repositioning Maneuvers is a way of relieving it, consisting of a series of sequential exercises of the head into 4 positions. The purpose of the maneuver is to reposition the otoliths from the posterior semicircular canal inside the lobby to the sites where they migrated to stop producing vertigo. Each position has to remain for approximately 30 seconds. The maneuvers have proven to be highly effective in the short term. The results are measurable by means of a questionnaire known as Dizziness Handicap Inventory (DHI). Objectives: To measure the impact of repositioning maneuvers on disability in patients with BPPV of posterior semicircular canal, using the DHI. Methods: A comparative study using T-test for paired samples where each patient is his own control was used in a sample of 20 patients diagnosed with BPPV of posterior semicircular canal were studied and treated with repositioning maneuvers. Results were evaluated by DHI and ran in day 1, day 7 and 30 after Repositioning maneuvers performed. Results: Females are most affected by BPPV in a ratio of approximately 2.1. The degree of disability was measured by the result of DHI, which shows for days 1, 7, and 30 an average of 50.4, 30.4 and 24.2 respectively. The scale with a higher score were days 1 and 7 then showing a marked decreased on day 30. Mean results were the 20, 12.2 and 9.5 respectively. The differences between the means were statistically significant. (P = 0.000062, 0.000002 and 0.037010). Conclusions: BPPV affects the quality of life. Repositioning maneuvers are statistically significant to reduce the disability caused by BPPV of the posterior semicircular canal so, it is important to quickly see a specialist when first signs manifest and that way avoid increasing the total disability associated with vertigo. Keywords: Paroxysmal Positional Vertigo (BPPV), Otolith, Dizziness Handicap Inventory (DHI)
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Objective To investigate the anxiety condition of patients with benign paroxysmal positional vertigo (BPPV) and the relationship among the different genders, ages and education levels and anxiety.Methods The general information and a history of 58 patients diagnosed as BPPV were studied.State-trait anxiety inventory (STAI) was adopted to 58 cases of BPPV and compared with the Chinese standard norm.SPSS 19.0 software was used to analyze the data.Results There was no significant difference in trait anxiety (T-AI) score (Pm:0.539;Pf:0.924) between male and female patients with BPPV and the 1998 Chinese male and female norm.The S-AI scores were significantly higher in male and female BPPV patients than that in Chinese men and women norm scores (Pm:0.033;Pf:0.01).There was no significant difference in trait anxiety (T-AI) score (P:0.674;P:0.349;P:0.077) between patients with different genders, ages and education levels.There was significant difference in state anxiety (S-AI) score (P:0.046;P:0.02;P:0.035) between patients with different genders, ages and education levels.The anxiety degrees of BPPV in man, elderly people, higher degree of education were higher than those of in woman, young and middle-age, lower degree of education.Conclusion The patients with BPPV have anxiety condition, but there is no obvious anxiety potential in T-AI.The anxiety degree of BPPV in man, elderly people, higher degree of education was higher than those of in woman, young and middle-age, lower degree of education.Therefore, the correct psychological assessment and psychological intervention were required throughout the whole course of BPPV treatment and rehabilitation.
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Objective To study the development of research about benign paroxysmal positional vertigo (BP-PV) in China and summarize certain characteristics and hot spots ,so as to provide a basis and direction for further relevant research .Methods CNKI ,CQVIP and wanfang database were used to search relevant literatures published before 2015 .The period sequence ,journal distribution ,productive authors ,research institutions ,high -frequent key words and hot spots were analyzed through bibliometric method and visualization method .Results There were 922 literatures about BPPV research from 1981 to 2015 in China ,involving 2021 authors and 309 research institu-tions ,published in 297 kinds of journal .The literature quantity showed a gradual upward trend on the whole and journals were widely distributed ;core journal group had not yet formed .Top 13 journals (4 .38% ,13/297) had published 292 relevant literatures (31 .67% ,292/922) ,major journals were relatively concentrated ;top 17 authors had published 222 relevant literatures (24 .08% ,222/922) ,top 12 research institutions had published 137 relevant literatures (14 .86% ,137/922);high productive authors mostly came from high productive authority .Through an analysis of keywords ,it is found that BPPV researches mainly focus on pathogenesis ,diagnostic method and treat-ment .New directions have emerged in recent years ,like comparative analysis of drug treatment and manual reduc-tion ,study on the secondary BPPV of sudden deafness and Meniere'sdisease .Conclusion The publishing of 2016 re-vised edition of the guidelines for BPPV diagnosis and treatment will further deepen relevant researches ;literature quantity is expected to continue to grow ;study on the secondary BPPV of sudden deafness and Meniere's disease will be a focus .
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Objective To investigate the prevalence of BPPV in patients with Meniere’s Disease(MD),and to investigate the diagnostic and predictive values of VEMP in patients with MD and BPPV.Methods A total of 1 1 6 patients previously diagnosed MD were followed up through telephone about their BPPV-like attacks.We recorded the detailed history of BPPV-like attacks,and provided them with complete Dix-Hallpike and roll tests if patients were on their BPPV-like attacks.Results In all,4 patients'histories supported BPPV,and 4 patients were found with BPPV.The prevalence of BPPV in patients with MD was 3 .4%(4/1 1 6 ).Meniere's symptoms preceded the on-set of BPPV in 8 patients.In 4 confirmed BPPV patients with Meniere's disease,BPPV was limited to the same ear as the MD in 2 cases,and 1 had contralateral BPPV,and 1 was uncertain.Six histories supported or confirmed BP-PVpatients with high abnormal oVEMP rates (5/6).Four in this 5 (80%)had abnormal oVEMP of the same MD ear.The single repositioning procedures can improve vertigo and eliminated positional nystagmus in cases of BPPV associated with MD.Conclusion In the present study,the prevalence of BPPV in patients with MD was 3 .45%.De-tailed medical histories combined with Dix-Hallpike and roll tests and VEMP tests can identify BPPV in patients with MD.
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Background and Aim: Benign paroxysmal positional vertigo (BPPV)1 is considered the most common peripheral vestibular disorder, affecting 64 of every 100,000 Americans. Women are more often affected and symptoms typically appear in the fourth and fifth decades of life. In 1980, Epley proposed that free-floating densities (canaliths) located in the semicircular canals deflect the cupula creating the sensation of vertigo. This is well documented in his Canalithiasis Theory4,5. Although these canaliths are most commonly located in the posterior semicircular canal, the lateral and superior canal may also be involved Patients with BPPV complain of vertigo with change in head position, rolling over, or getting out of bed, and the vertigo is often side specific. Aim of the study is to know persons with vestibular disorders experience symptoms of dizziness and balance dysfunction, resulting in falls, as well as impairments of daily life. Various interventions provided by physical therapists have been shown to decrease dizziness and improve postural control. In the present review, we will focus on the role of physical therapy in the management of BPPV symptoms of dizziness. Methodology: In the procedure Firstly ,patients will divided into two groups Group A and Group B and all the patient were assessed the pretreatment score and post treatment i.e (0 Weeks and 3 week and 6 weeks) by using the DHI ,The Patients will be randomly allocated Group A Patients was receive exercise protocol, Group B Was given the Brandt daroff exercise .this exercises were given on daily basis .After completion of 6 weeks of the treatment ,Both Group A and Group B were compared Statistical software: statistical software namely SPSS 15.0. Results and Conclusion: The study concluded that designed exercise protocol is effective to reducing dizziness in BPPV patients by measuring the DHI Scale.
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Objective To investigate the effects of nursing intervention on the rehabilitation of patients with benign paroxysmal positional vertigo (BPPV).Methods 64 BPPV patients were randomly divided into control group and observation group, with 32 cases in each group.The control group received otorhinolaryngology routine nursing, while the observation group was managed with continuously systemic nursing interventions, including manipulative re-duction, psychological nursing intervention, health education, head nursing, follow -up and family nursing interven-tion.The Hamilton Anxiety Scale (HAMA) and Hamilton Depression Rating Scale (HDRS) were applied to evaluate the intervention effects.Results Cure rate of the observation group was significantly higher than that of the control group, and recurrence rate of the observation group was obviously lower than that of the control group(p <0.05).The anxiety and depression assessment of the observation group was significantly lower than that of the control group, with statistical difference (p <0.05).Conclusion Systemic nursing intervention can effectively improve the rehabilita-tion of patients with BPPV, and reduce recurrence rate.
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Objective This paper attempts to explore the application of dizziness handicap inventory (DHI) in evaluation of health -related quality of life (QOL ) changes of patients with benign paroxysmal positional vertigo (BPPV) before and after the treatment with canalith repositioning procedure (CRP) .Methods The DHI was em-ployed to investigate and evaluate the dizziness handicap of 120 patients with BPPV before and after 3 months of CRP treatment (treatment group) and 60 healthy controls (control group) ,while the DHI scoring results were com-pared .Results As indicated by DHI evaluation ,the scoring of each DHI items of patients with BPPV before treatment was higher than that of control group ,treatment group before treatment :functional score 22 .60 ± 6 .54 ,emotional score 18 .50 ± 8 .28 ,physical score 17 .90 ± 5 .05 ,total composite score 59 .00 ± 14 .32 .For the control group:functional score 1 .35 ± 1 .74 ,emotional score 1 .00 ± 1 .01 ,physical score 1 .37 ± 1 .86 ,total composite score 3 .72 ± 3 .46 ,with the differ-ence statistically significant (P0 .05) .Conclusion CRP is effective to treat BPPV .The DHI is available for the evaluation of QOL of BPPV patients .
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@#ObjectiveTo investigate the clinical features and the causes of misdiagnosis of benign paroxysmal positional vertigo (BPPV) in the elderly. Methods21 aged patients diagnosed with BPPV finally were analyzed retrospectively. ResultsBPPV occurred more in female and associated with the posterior semicircular canal. The symptoms of vertigo were obviously improved with the canalith repositioning. With suffering from chronic diseases such as hypertension and cervical spondylosis etc., BPPV in the aged was easily misdiagnosed. ConclusionThe main reason for the misdiagnosis of BPPV in the aged is deficiency of knowledge of vertigo. Canalith repositioning is a safe and effective treatment for the aged with BPPV.
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Benign paroxysmal positional vertigo is the most common vestibular disorder and it has a significant impact in health-related quality of life. The disease is probably caused by the accumulation of lithiasis material from the otolithic membrane of the utricle. Patients experience multiple short crises of vertigo lasting seconds when they lay or turn in bed. There are several clinical variants affecting posterior, horizontal or anterior canal and in some cases vestibular lithiasis can occur in two canals simultaneously. The diagnosis is performed by video-oculographic recording of positional nystagmus during positional testing to identify the canal affected. There are specific treatment maneuvers for each clinical variant, which are highly effective at short term
El vértigo posicional paroxístico benigno es el trastorno vestibular más frecuente y tiene un impacto significativo sobre la calidad de vida relacionada con la salud. La enfermedad se origina probablemente por la acumulación de un material litiásico procedente de la membrana otolítica del utrículo. Los pacientes sufren múltiples crisis de vértigo cortas que duran segundos cuando se acuestan o se dan la vuelta en la cama. Existen varias formas clínicas que pueden afectar los conductos posterior, horizontal o anterior y que en algunos casos afectan dos conductos simultáneamente. El diagnóstico se realiza mediante el registro videooculográfico del nistagmo posicional al realizar las pruebas posicionales para localizar el conducto afectado. Existen maniobras terapeúticas específicas para cada variante clínica, las cuales presentan una elevada efectividad a corto plazo
Subject(s)
Quality of Life , Vertigo , Vestibule, Labyrinth , Benign Paroxysmal Positional VertigoABSTRACT
The interrelations of migraine and vertigo are complex, eluding a simple localization either centrally or peripherally. Spontaneous episodic vertigo, benign paroxysmal positional vertigo, and Meniere's disease all occur more frequently in patients with migraine than in those without. Family studies support a hereditary predisposition to migraine associated vertigo. In this review, we discuss definitions, epidemiology, associated syndromes, neurootological abnormalities, genetics and treatment for patients with migraine and vertigo.
Subject(s)
Humans , Dizziness , Epidemiology , Genetics , Meniere Disease , Migraine Disorders , Motion Sickness , VertigoABSTRACT
BACKGROUND AND OBJECTIVES: Benign paroxysmal positional vertigo (BPPV) is one of the most common clinical entities encountered in a dizziness clinic. Treatment of this disease, canalith repositioning procedures, have been reported to be successful in 44-90%. Treatment requires only one treatment visit in most patients. However, there are significant numbers of patients who require multiple treatment visits for relief. The goal of this study is to identify variables that may be associated with these difficult to treat cases. METHODS: Retrospective review was performed for the patients diagnosed as BPPV at Samsung medical center. Variables for statistical analysis included age, sex, involved canal, presence of bilateral disease, involvement of unilateral multiple canals, presence of recent head trauma, presence of chronic otitis media, history of middle ear surgery, history of otologic surgery, unilateral vestibular loss, accompanying sudden SNHL, underlying disease such as hypertension or diabetes, change of involved canal during treatment course and number of treatment visits. Statistical analysis using Pearson chi-square test was performed. RESULTS: Three hundred thirty-one patients with BPPV who received treatment were identified from 2001 to 2005. 85.2% required one treatment visit, 12.4% required a second treatment visit, and 98.2% were successfully treated after three treatment visits. Variables such as bilateral disease, anterior canal BPPV, post-traumatic BPPV, duration of symptom before treatment and change of involved canal during treatment were significantly related with number of treatments. CONCLUSION: Patients with anterior semicircular canal BPPV or bilateral BPPV or with recent head trauma or longer duration of symptom are more likely to require multiple visits for canalith repositioning.
Subject(s)
Humans , Craniocerebral Trauma , Dizziness , Ear, Middle , Hypertension , Otitis Media , Retrospective Studies , Semicircular Canals , VertigoABSTRACT
BACKGROUND AND OBJECTIVES : Ageotrophic nystagmus in the horizontal canal BPPV has been explained as a result of cupulolithiasis theory, and has been reported to have the less therapeutic response to conservative rehabilitations than the other type BPPV . Though methods to detach the debris with vibrator have been introduced, the effect has been questioned and it's not physiologic. MATERIALS AND METHOD : We introduce a new head shaking-forced prolonged position method as a more convenient method, and report typical 2 cases of ageotrophic horizontal canal BPPV managed with it and analyzed results of 25 cases all told. RESULTS AND CONCLUSION : The average number of rehabilitation was less than two, and loss of direction changing positional nystagmus could be observed immediately after rehabilitation.