ABSTRACT
Objective:To evaluate the influence of an additional roll test on the repositioning procedure by SRM-vertigo diagnosis system for horizontal canal benign paroxysmal positional vertigo（HC-BPPV）. Methods:A total of 713 patients diagnosed with HC-BPPV in Department of Otolaryngology Head and Neck Surgery，the First Affiliated Hospital of Xi'an Jiaotong University from Jan 2020 to Feb 2022 were enrolled. The patients were divided into two groups by hospital card numbers, in which the number is odd were considered as group A, and the number is even were considered as group B. The group A underwent two circles of Barbecue repositioning procedure by SRM-vertigo diagnosis system, while the group B first performed an additional roll test and then underwent two circles of Barbecue repositioning procedure by SRM-vertigo diagnosis system, to observe the cure rate and compare influence of HC-BPPV by an additional roll test. The quality of life and sleep of patients before and one-month after the treatment were assessed by the dizziness handicap inventory（DHI） and the pittsburgh sleep quality（PSQI）. Results:The cure rate of group A was 63.21%, and the cure rate of group B was 87.68%，the difference between the two groups was statistically significant（P<0.05）; The DHI score of patients after the repositioning was significantly lower than that before the repositioning（P<0.05）. The PSQI score after the repositioning was significantly lower than that before the repositioning（P<0.05）. The DHI and the PSQI scores after the repositioning were significantly lower than that before the repositioning, with a statistically significant difference （P< 0.05）. The total score of DHI in group B after treatment was lower than that in group A, with a statistically significant difference（P<0.05）. The total score of PSQI in group B after treatment was lower than that in group A, with non-statistically significant difference （P< 0.05）. Conclusion:An additional roll test before the repositioning procedure by SRM-vertigo diagnosis system can significantly improve the cure rate of HC-BPPV, relieve anxiety, and improve the quality of life.
Subject(s)
Humans , Benign Paroxysmal Positional Vertigo/diagnosis , Quality of Life , Patient Positioning/methods , Dizziness , Semicircular CanalsABSTRACT
El vértigo es definido como la sensación de movimiento ilusorio del cuerpo o de los objetos que le rodean. Es una de las causas más comunes de consulta en los departamentos de emergencia, y 2 a 3% de la población mundial consulta anualmente por este síntoma. De acuerdo al compromiso vestibular en el oído interno o en el sistema nervioso central o ambos, puede clasificarse en vértigo periférico, central o de origen mixto, siendo la principal causa del periférico el vértigo posicional paroxístico benigno. La valoración semiológica y anamnesis es fundamental para el diagnóstico. En el examen físico inicial, la diferenciación de un vértigo de origen central de otro de origen periférico, puede realizarse mediante el análisis del nistagmo, la valoración del impulso cefálico y la desviación ocular, que se integran en un sistema denominado HINTS, por sus siglas en inglés (Head Impulse, Nystamus type, Test of Skew), y por la realización de pruebas que evalúen también la vía vestíbulo-cerebelosa. Además, la realización de una audiometría tonal, aumentaría la sensibilidad diagnóstica de 71 a 89% en la evaluación inicial. El diagnóstico apropiado es la base para el tratamiento y control de esta condición clínica en el mediano y largo plazo.
Vertigo is defined as an abnormal sensation of body motion or of its surrounding objects. It is a common chief complaint in emergency departments comprising 2 to 3% of these consultations worldwide. Vertigo is classified as peripheral or central, according to its origin, and can also be occasionally mixed, the most common cause of peripheral involvement being benign paroxysmal positional vertigo. The initial findings on clinical evaluation of patients are the clues for making a correct diagnosis. The differentiation between central and peripheral vertigo can be optimized by analysing nystagmus, by using the skew test and the head impulse test (HINTS), as also by performing the appropriate tests to evaluate the integrity of the vestibular-cerebellar pathway. In addition, tonal threshold audiometry could raise the diagnostic sensibility from 71 to 89% on initial approach. Appropriate diagnosis is the principal key for managing this clinical condition.
Subject(s)
Humans , Vertigo/diagnosis , Vertigo/physiopathology , Vestibular Neuronitis/diagnosis , Vestibular Neuronitis/therapy , Dizziness/diagnosis , Dizziness/physiopathology , Dizziness/therapy , Benign Paroxysmal Positional Vertigo/diagnosis , Benign Paroxysmal Positional Vertigo/physiopathology , Benign Paroxysmal Positional Vertigo/therapy , Meniere Disease/diagnosis , Meniere Disease/physiopathology , Meniere Disease/therapy , Migraine Disorders/therapyABSTRACT
Abstract Introduction: Benign Paroxysmal Positional Vertigo (BPPV) is the most common peripheral vestibular disorder. The Dix-Hallpike and Roll maneuvers are used to diagnose BPPV. Objective: This study aims to investigate the diagnostic value of repeated Dix-Hallpike and Roll maneuvers in BPPV. Methods: We performed Dix-Hallpike and roll maneuvers in patients who admitted with peripheral vertigo anamnesis and met our criteria. The present study consists of 207 patients ranging in age from 16 to 70 (52.67 ± 10.67). We conducted the same maneuvers sequentially one more time in patients with negative results. We detected patients who had negative results in first maneuver and later developed symptom and nystagmus. We evaluated post-treatment success and patient satisfaction by performing Dizziness Handicap Inventory (DHI) at first admittance and two weeks after treatment in all patients with BPPV. Results: Of a total of 207 patients, we diagnosed 139 in first maneuver. We diagnosed 28 more patients in sequentially performed maneuvers. The remaining 40 patients were referred to imaging. There was a significant difference between pre- and post-treatment DHI scores in patients with BPPV (p < 0.001). Conclusion: Performing the diagnostic maneuvers only one more time in vertigo patients in the first clinical evaluation increases the diagnosis success in BPPV. Canalith repositioning maneuvers are effective and satisfactory treatment methods in BPPV.
Resumo Introdução: Vertigem posicional paroxística benigna (VPPB) é a disfunção vestibular periférica mais comum. As manobras de Dix-Hallpike e roll-test são usadas para diagnosticar a VPPB. Objetivo: Este estudo teve como objetivo investigar o valor diagnóstico da repetição das manobras de Dix-Hallpike e roll-test na VPPB. Método: Manobras de Dix-Hallpike e Roll-test foram realizadas nos pacientes que foram internados com história de vertigem periférica e eram adequados aos nossos critérios. O presente estudo contou com 207 pacientes na faixa etária de 16-70 anos (52,67 ± 10,67). Fizemos uma vez mais as mesmas manobras sequencialmente nos pacientes com resultados negativos. Detectamos os pacientes que tiveram resultados negativos na primeira manobra e que posteriormente desenvolveram sintomas e nistagmo. Avaliamos o sucesso pós-tratamento e a satisfação do paciente mediante o Inventário da Deficiência Física na Vertigem (Dizziness Handicap Inventory - DHI) na primeira admissão e duas semanas após o tratamento em todos os pacientes com VPPB. Resultados: De 207 pacientes, 139 foram diagnosticados na primeira manobra. Diagnosticamos mais 28 pacientes nas manobras feitas consecutivamente. Os 40 pacientes restantes foram encaminhados para exames de imagem. Houve diferença significativa entre os escores do DHI pré- e pós-tratamento nos pacientes com VPPB (p < 0,001). Conclusão: A realização das manobras diagnósticas apenas mais uma vez nos pacientes com vertigem na primeira avaliação clínica aumentou o sucesso do diagnóstico em VPPB. As manobras de reposicionamento canalicular são métodos eficazes e satisfatórios de tratamento na VPPB.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Posture/physiology , Benign Paroxysmal Positional Vertigo/diagnosis , Prospective Studies , Sensitivity and Specificity , Treatment Outcome , Benign Paroxysmal Positional Vertigo/physiopathologyABSTRACT
Benign paroxysmal positional vertigo (BPPV), the most frequent cause of vertigo is associated with high morbidity in the elderly population. The most common form is linked to debris in the posterior semicircular canal. However, there has been an increasing number of reported BPPV cases involving the horizontal canals. The purpose of this article is to highlight the clinical features, diagnosis, and treatment in 37 patients with horizontal canal BPPV; twenty-six with geotropic nystagmus, and eleven with the apogeotropic form. Treatment consisted of the Gufoni manoeuver in eighteen patients (48.6%), the barbecue 360° maneuver in twelve patients (32.4%), both manoeuvers in four patients (10.8%), both manoeuvers plus head shaking in one patient (2.7%), and the Gufoni maneuver plus head shaking in two patients. Cupulolithiasis patients were asked to sleep in a forced prolonged position. We obtained a complete resolution of vertigo and nystagmus in 30 patients (81.0%) on the initial visit.
Vertigem posicional paroxística benigna (VPPB) é a causa mais frequente de vertigem e promove alta morbidade na população idosa. A forma mais comum está relacionada com otoconias no canal semicircular posterior. Entretanto, nos últimos anos identifica-se cada vez mais casos de VPPB dos canais horizontais. Os principais objetivos deste artigo são destacar as características clínicas, diagnóstico e tratamentos aplicados em 37 pacientes com VPPB do canal horizontal; vinte e seis com nistagmo geotrópico, e onze com nistagmo apogeotrópico. O tratamento consistiu na manobra de Gufoni em dezoito pacientes (48,6%) manobra do churrasco 360° em doze pacientes (32,4%) ambas as manobras em quatro pacientes (10,8%) ambas as manobras mais a manobra de sacudir a cabeça (MSC) em um paciente (2,7%), e manobra de Gufoni mais MSC em dois pacientes (2,7%). Pacientes com cupulolitíase dormiram uma noite na posição forçada prolongada. Em 30 pacientes (81,0%) o sucesso terapêutico ocorreu na primeira consulta.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Benign Paroxysmal Positional Vertigo/diagnosis , Benign Paroxysmal Positional Vertigo/therapy , Exercise Therapy/methods , Patient Positioning/methods , Benign Paroxysmal Positional Vertigo/physiopathology , Head Movements/physiology , Nystagmus, Pathologic/physiopathology , Nystagmus, Pathologic/therapy , Semicircular Canals/physiopathology , Supine Position/physiology , Time Factors , Treatment OutcomeABSTRACT
INTRODUCTION: Benign paroxysmal positional vertigo (BPPV) is the most common cause of peripheral vestibular dysfunction. OBJECTIVE: To assess whether the performance of the Dix-Hallpike maneuver after the Epley positioning maneuver has prognostic value in the evolution of unilateral ductolithiasis of posterior semicircular canal. METHODS: A prospective cohort study in monitored patients at otoneurology ambulatory with a diagnosis of BPPV; they were submitted to the therapeutic maneuver and then to a retest in order to evaluate the treatment effectiveness; all cases were reassessed one week later and the retest prognostic value was evaluated. RESULTS: A sample of 64 patients which 47 belonging to negative retest group and 17 belonging to positive retest. Performed the maneuver in all patients, the retest presented 51.85% sensitivity, 91.89% specificity, 82.35% positive predictive value and 72.34% negative predictive value. CONCLUSION: The study shows that doing the retest after repositioning maneuver of particles in BPPV is effectual, since it has high specificity. .
INTRODUÇÃO: A vertigem posicional paroxística benigna (VPPB) é a causa mais comum de disfunção vestibular periférica. OBJETIVO: Avaliar se a realização do reteste de Dix-Hallpike após a manobra de posicionamento de Epley tem valor prognóstico na evolução da vertigem posicional da ductolitíase paroxística benigna de canal semicircular posterior unilateral. MÉTODO: Estudo prospectivo do tipo coorte de pacientes em acompanhamento no ambulatório de otoneurologia com diagnóstico de VPPB; foram submetidos a manobra terapêutica e posteriormente ao reteste para avaliar a eficácia do tratamento; todos os casos foram reavaliados em uma semana e analisado o valor prognostico do reteste. RESULTADOS: Amostra de 64 pacientes, 47 do grupo reteste negativo e 17 do reteste positivo; realizada manobra de Epley em todos os pacientes. O reteste apresentou sensibilidade de 51,85%; especificidade de 91,89%; valor preditivo positivo de 82,35% e valor preditivo negativo de 72,34%. CONCLUSÃO: O estudo mostra que é válido realizar o reteste após a manobra de reposicionamento de partículas na VPPB, visto que possui alta especificidade. .
Subject(s)
Humans , Male , Female , Middle Aged , Benign Paroxysmal Positional Vertigo/diagnosis , Diagnostic Techniques, Otological , Physical Therapy Modalities , Benign Paroxysmal Positional Vertigo/therapy , Epidemiologic Methods , Patient Positioning , Semicircular Canals/physiopathology , Treatment OutcomeABSTRACT
El vértigo postural paroxístico benigno (VPPB) es el trastorno vestibular más frecuente y se asocia a alto grado de morbilidad, impacto psicosocial y gastos médicos. El diagnóstico se basa en la anamnesis y examen físico incluyendo maniobras específicas para desencadenarlo. En algunos casos, podemos observar pacientes que presentan clínica de VPPB pero al realizar la maniobra de Dix-Hallpike no presentan nistagmo observable a simple vista, ni medible con lentes de frenzel ni videonistagmografía, pese a que manifiestan vértigo con o sin síntomas neurovegetativos. A estos casos Haynes los denominó "VPPB subjetivo" y representan entre el 11,5% y 48% del total de los VPPB. Estos pacientes también se beneficiarían de maniobras de reposición, con similares tasas de recurrencia que aquellos VPPB considerados objetivos dada la presencia de nistagmo con las maniobras de provocación.
Benign paroxysmal positional vertigo (BPPV) is the most common vestibular disorder and is associated with high morbidity, psychosocial impact and medical expenses. Diagnosis is based on history and physical examination including specific maneuvers to trigger it. In some cases, patients with BPPV do not present observable nystagmus to the naked eye, or measureable with frenzel lenses or videonystagmography with the Dix-Hallpike test, although they manifested vertigo with or without autonomic symptoms. Haynes et al called this entity "subjective BPPV". They represent between 11.5 and 48% of all BPPV. These patients can benefit from repositioning maneuvers, with similar rates of recurrence than those considered objective BPPV.