Effect of applying head-shaking maneuver before Epley maneuver in BPPV / Efeito da aplicação da manobra de balanço da cabeça antes da manobra de Epley na VPPB

Abstract Introduction: The Epley maneuver is applied in the treatment of benign paroxysmal positional vertigo, the BPPV. However, dizziness and balance problems do not improve immediately after the treatment. Objective: In this study, the effectiveness of the head-shaking maneuver before the Epley maneuver was investigated in the treatment of BPPV. Methods: Between March 2020 and August 2020, ninety-six patients with posterior semicircular canal BPPV were analyzed prospectively. The patients were divided into two groups: patients who underwent the Epley maneuver only in the treatment (Group 1) and patients who underwent the Epley maneuver after the head-shaking maneuver (Group 2). The results of the Berg balance scale and dizziness handicap index were evaluated before the treatment and at the first week after the treatment. Results: The improvement in functional, emotional, and physical dizziness handicap index and Berg balance scale values after the treatment was found to be statistically significant in both groups. It was determined that the change in functional and physical dizziness handicap index and Berg balance scale values of the patients in Group 2 was statistically higher than those in Group 1. Although, the change in emotional dizziness handicap index values in Group 2 was higher than those in Group 1, no statistical significance was found between the groups. Conclusion: As a result of our hypothesis, we think that in the treatment of posterior semicircular canal BPPV, the otoliths adhered to the canal can be mobilized by the head-shaking maneuver, and this will contribute to the increase of the effectiveness of the Epley maneuver.

Resumo Introdução: A manobra de Epley é aplicada no tratamento da vertigem posicional paroxística benigna (VPPB). Entretanto, a tontura e os problemas de equilíbrio não melhoram imediatamente após o tratamento. Objetivo: Investigar a eficácia da manobra de balançar a cabeça antes da manobra de Epley no tratamento da VPPB. Método: De março de 2020 a agosto de 2020, 96 pacientes com VPPB de canal semicircular posterior foram analisados prospectivamente. Os pacientes foram divididos em dois grupos: pacientes que foram submetidos apenas à manobra de Epley no tratamento (Grupo 1) e pacientes que foram submetidos à manobra de Epley após a manobra de balanço da cabeça (Grupo 2). Os resultados da escala de equilíbrio de Berg e do dizziness handicap index foram avaliados antes do tratamento e na primeira semana após o tratamento. Resultados: A melhoria nos valores funcionais, emocionais e físicos do dizziness handicap index e da escala de equilíbrio de Berg após o tratamento foi estatisticamente significante em ambos os grupos. Foi determinado que a alteração nos valores funcionais e físicos do dizziness handicap indexe da escala de equilíbrio de Berg dos pacientes do Grupo 2 foi significantemente maior do que aqueles do Grupo 1. Embora a alteração nos valores do dizziness handicap index emocional no Grupo 2 tenha sido maior do que no Grupo 1, não houve significância estatística entre os grupos. Conclusão: Como resultado de nossa hipótese, acreditamos que no tratamento da VPPB do canal semicircular posterior os otólitos aderidos ao canal podem ser mobilizados através da manobra de balanço da cabeça, o que contribuirá para o aumento da eficácia da manobra de Epley.

Multicanal Benign Paroxysmal Positional Vertigo: Concurrent Bilateral Posterior Canalolithiasis and Unilateral Lateral Cupulolithiasis / 대한평형의학회지

Multicanal BPPV (benign paroxysmal positional vertigo), especially BPPV affecting both labyrinths, is uncommon. A review of the literature revealed that the majority of reported cases of multiple BPPV either involved a combination of two different canals limited to one labyrinth or two different canals in both labyrinths, although one case of multicanal BPPV was reported to involve three canals bilaterally. Here, the authors report a case of bilateral posterior canalolithiasis and unilateral horizontal canal cupulolithiasis in a 54-year-old man, and include a review of the literature.

Bilateral Multiple Benign Paroxysmal Positional Vertigo Combined with Vestibular Neuritis

Although classical benign paroxysmal positional vertigo (BPPV) has generally been resolvable by routine manual repositioning maneuvers, nevertheless resistant cases and variant remain a significant problem. Recently, we experienced a case of posterior semicircular canal BPPV combined with changes to various types of BPPV during manual reposition maneuver and vestibular neuritis. We examined her brain MRI due to low response of routine manual reposition maneuvers and frequently recurrence of BPPV. In brain MRI, we found 1.3cm sized mass in hypoglossal canal. It seemed to be neuroma on hypoglossal nerve. A refractory BPPV poses problems of pathophysiogenetic interpretation, differential diagnosis with a CNS lesion and therapeutic strategy. We thought that refractory BPPV should be treated with more frequently examination and manual repositional maneuver and distinguished from CNS lesion.

Bilateral Multiple Benign Paroxysmal Positional Vertigo Combined with Vestibular Neuritis

Although classical benign paroxysmal positional vertigo (BPPV) has generally been resolvable by routine manual repositioning maneuvers, nevertheless resistant cases and variant remain a significant problem. Recently, we experienced a case of posterior semicircular canal BPPV combined with changes to various types of BPPV during manual reposition maneuver and vestibular neuritis. We examined her brain MRI due to low response of routine manual reposition maneuvers and frequently recurrence of BPPV. In brain MRI, we found 1.3cm sized mass in hypoglossal canal. It seemed to be neuroma on hypoglossal nerve. A refractory BPPV poses problems of pathophysiogenetic interpretation, differential diagnosis with a CNS lesion and therapeutic strategy. We thought that refractory BPPV should be treated with more frequently examination and manual repositional maneuver and distinguished from CNS lesion.

Direction Changing Positional Nystagmus from Canalolithiasis and Cupulolithiasis of Lateral Semicircular Canal / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Clinical features of positional nystagmus may be different according to the etiology. Thus, efforts have been made to find out etiologies of various positional nystagmus. Until recently, positional vertigo was thought to arise from lesions of central nervous system. However, more recent investigations suggest that the peripheral lesion may be the main cause. Moreover, there have been some reports suggesting that directional changing positional nystagmus occurs due to canalolithiasis and cupulolithiasis of the lateral semicircular canal. The objectives of the study were to investigate the etiologies and clinical aspects of DCPN (direction changing positional nystagmus) from canalolithiasis and cupulolithiasis of the lateral semicircular canal, and to assess the effectiveness of the treatment. MATERIALS AND METHODS: Among 15 patients with DCPN, 9 patients showed nystagmus compatible with canalolithiasis of lateral semicircular canal and 6 patients with cupulolithiasis of lateral semicircular canal. Patients with cupulolithiasis and canalithiasis of the lateral semicircular canal did not respond to physical therapy for posterior semicircular canal. However, they were completely recovered by reposition maneuver for the lateral semicircular canal with or without using vibrator although 3 of them had recurred symptom. Four patients had BPPV of the posterior semicircular canal prior to the development of DCPN and 3 patients underwent the treatment of previous Meniere's disease. CONCLUSION: The patients with DCPN were due to canalithiasis and cupulolithiasis of the lateral semicircular canal, and physical therapy for lateral semicircular canal was rewarding.