A comparative analysis of the clinical symptoms of benign paroxysmal positional vertigo between older and young and middle-aged patients / 中华内科杂志

Objective: To compare the differences in clinical symptoms and the time required for diagnosis of benign paroxysmal positional vertigo (BPPV) between older patients and young and middle-aged patients in the structured inquiry of dizziness history. Methods: The medical records of 6 807 patients diagnosed with BPPV from the Vertigo Database of Vertigo Clinical Diagnosis, Treatment, and Research Center of Beijing Tiantan Hospital, Capital Medical University, between January 2019 and October 2021 were retrospectively analyzed. The data included basic demographic information, clinical symptoms in a structured medical history questionnaire, and the time interval from the appearance of BPPV symptoms to diagnosis consultation. The patients were divided into the young and middle-aged group (<65 years old) and the older group (≥65 years old). The differences in clinical symptoms and consultation time were compared between these two groups. Categorical variables were represented by numbers (%), and compared using Chi-squared tests or Fisher's exact probability test for analysis; whereas, continuous variables conforming to normal distribution were represented by mean±standard deviation. Both data groups were compared and analyzed by Student's t-test. Results: The mean age of the older group was 65-92 (71±5) years, while the mean age of the middle-aged group was 18-64 (49±12) years. The incidence of vertigo (42.5% vs. 49.1%, χ2=23.69, P<0.001); vertigo triggered by changes in position of the head or body (52.4% vs. 58.7%, χ2=22.31, P<0.001); and autonomic symptoms (10.1% vs. 12.4%, χ2=7.09, P=0.008) were lower, but hearing loss (11.8% vs. 7.8%, χ2=27.36, P<0.001) and sleep disorders (18.5% vs. 15.2%, χ2=11.13, P=0.001) were higher in the older group than in the young and middle-aged group. The time from the appearance of dizziness to diagnosis was commonly longer in the older patient group than the other group (55.0% vs. 38.5%, χ2=55.95, P<0.001). Conclusions: Older patients with BPPV have more atypical symptoms and complex concomitant symptoms than young and middle-aged patients. For older patients with dizziness, positional testing is needed to confirm the possibility of BPPV even if the clinical symptoms are atypical.

The influence of additional roll test on the repositioning procedure by SRM-vertigo diagnosis system for horizontal canal benign paroxysmal positional vertigo / 临床耳鼻咽喉头颈外科杂志

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.

Efectos posturográficos de la maniobra de Epley en pacientes con vértigo posicional paroxístico del canal posterior / Posturographic effects of the Epley maneuver on patients with benign paroxysmal positional vertigo of the posterior canal

Resumen Introducción: El vértigo posicional paroxístico benigno (VPPB) es la afección periférica más común en las enfermedades otoneurológicas. Con el reposicionamiento de partículas se busca eliminar el vértigo y sus síntomas asociados como lo son el mareo residual y la inestabilidad. Objetivo: Determinar si la maniobra de reposicionamiento de Epley (MRE) produce una modificación significativa del control postural (CP) en aquellos pacientes con VPPB de canal semicircular posterior (VPPB-CSC-P). Material y Método: Se realizó un estudio descriptivo prospectivo en una muestra de 21 pacientes con diagnóstico de VPPB-CSC-P. Comparamos el desplazamiento, la velocidad y el área del centro de presión (CoP) antes y después de la MRE. Resultados: La velocidad y el área de la CoP estudiada por posturografía computarizada muestra una disminución significativa en sus valores después de la MRE, mientras que el desplazamiento de la CoP se mantuvo sin cambios. Conclusión: La MRE ejecutada en pacientes con VPPB-CSC-P produce una modulación en el control de la CoP, demostrada por la disminución de la velocidad y el área de desplazamiento de la CoP. El éxito de la MRE produce modulación del CP.

Abstract Introduction: Benign paroxysmal positional vertigo (BPPV) is the most common peripheral condition in otoneurologic diseases. With the repositioning of particles, the aim is to eliminate vertigo and its associated symptoms, such as residual dizziness and instability. Aim: To determine if the Epley repositioning maneuver (ERM) produces a significant modification of postural control (PC) in those patients with posterior semicircular canal BPPV (BPPV-CSC-P). Material and Method: A prospective descriptive study was carried out in a sample of 21 patients diagnosed with BPPV-CSC-P. We compared the displacement, velocity, and area of the center of pressure (CoP) before and after the Epley repositioning maneuver. Results: The velocity and the area of the CoP studied by computed posturography show a significant decrease in its values after the MRE, while the CoP shift remained unchanged. Conclusion: ERM performed in patients with BPPV-CSC-P produces an improvement in the control of the CoP, demonstrated by the decrease in the speed and the area of movement of the CoP. The success of the MRE produces modulation of the PC.

Factores asociados a falla terapéutica con maniobras de reposición canalicular en pacientes con diagnóstico de vértigo posicional paroxístico benigno en la Clínica de Otorrinolaringología de Antioquia, Medellín, Colombia / Factors associated with therapeutic failure with canalicular repositioning maneuvers in patients diagnosed with benign paroxysmal positional vertigo at Antioquia Otorhinolaryngology Clinic, Medellin, Colombia"

Introducción: múltiples factores se han relacionado con el desarrollo de la recurrencia del vértigo posicional paroxístico benigno (VPPB). Objetivo: determinar la asociación entre la falla terapéutica de las maniobras de reposición canalicular (MRC) y las variables sociodemográficas y clínicas en los pacientes con diagnóstico de VPPB. Diseño: estudio observacional de cohorte retrospectiva. Materiales y métodos: revisión de historias clínicas de la consulta de vértigo de la Clínica Orlant, Medellín, Colombia. Resultados: se incluyeron 41 pacientes con diagnóstico de VPPB a quienes se les realizó MRC y seguimiento clínico entre 1 y 8 semanas. El 90,2 % eran de sexo femenino, con una mediana de edad de 58 (±183) años; se encontró uso de vestibulosupresores en un 68,3 %, y es la betahistina el más consumido (43,9 %). El 51,2 % de pacientes presentaron falla terapéutica y se identificó una asociación con el número total de MRC realizadas y el uso de vibrador mastoideo (p < 0,001), teniendo en cuenta que los pacientes mejoraron clínicamente al final del seguimiento con una media de 77 % (p < 0,001). No se encontraron asociaciones estadísticamente significativas con el resto de variables. Conclusión: no hubo asociación entre la falla terapéutica y las variables estudiadas, excepto número de MRC, el uso del vibrador mastoideo y la mejoría clínica final, posiblemente porque el vibrador mastoideo se aplica a los pacientes en quienes hay persistencia de síntomas y signos con las maniobras desencadenantes, y por factores fisiopatológicos no esclarecidos; con esto finalmente se logra una mejoría clínica con más de dos MRC

Introduction: Multiple factors have been related to the development of recurrence of benign paroxysmal positional vertigo (BPPV). Objective: To determine the association between therapeutic failure of canalicular repositioning maneuvers (CRM) with sociodemographic and clinical variables in patients with a diagnosis of BPPV. Design: Observational retrospective cohort study. Materials and methods: Review of medical records of the vertigo clinic of the Orlant Clinic, Medellín - Colombia. Results: 41 patients with a diagnosis of BPPV who underwent CRM and clinical follow-up between 1 and 8 weeks were included. 90.2% were female, with a median age of 58 (± 18.3) years, use of vestibulosuppressants was found in 68.3%, betahistine being the most consumed (43.9%). 51.2% of patients presented therapeutic failure, identifying an association with the total number of CRMs performed and the use of a mastoid vibrator with (p < 0.001), taking into account that the patients improved clinically at the end of follow-up with a mean of 77% (p < 0.001). No statistically significant associations were found with the rest of the variables. Conclusion: There was no association between therapeutic failure and the variables studied except number of CRM, use of the mastoid vibrator and final clinical improvement, possibly because the mastoid vibrator is applied to patients in whom there are persistence of symptoms and signs with the triggering maneuvers for unclear pathophysiological factors, finally achieving clinical improvement with more than two CRMs.

Betahistine alleviates benign paroxysmal positional vertigo (BPPV) through inducing production of multiple CTRP family members and activating the ERK1/2-AKT/PPARy pathway

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.

O efeito dos exercícios vestibulares na qualidade de vida e na intensidade de tontura de idosos com hipofunção vestibular unilateral / The effect of vestibular exercises on quality of life and intensity of dizziness in the elderly with unilateral vestibular hypofunction

Objetivo: analisar o efeito dos exercícios vestibulares na qualidade de vida e na intensidade de tontura de idosos com hipofunção vestibular unilateral. Método: participaram do estudo idosos com sintomas de tontura. A qualidade de vida foi avaliada pela versão brasileira do Dizziness Handicap Inventory e a intensidade de tontura por uma escala visual analógica. Para cada participante foi desenvolvido um protocolo de exercícios personalizado de acordo com seus sintomas. Utilizou-se o teste t-Student para avaliar a intensidade de tontura e, para comparar os resultados da qualidade de vida, utilizou-se o teste não-paramétrico de Wilcoxon (p<0,05). O teste de correlação de Pearson averiguou associações entre intensidade de tontura e qualidade de vida. Resultados: verificou-se diferença estatisticamente significativa para a intensidade de tontura (p<0,0007) e para os domínios físico (p<0,0009), funcional (p<0,0009), emocional (p<0,03) e total (p<0,001) da qualidade de vida dos idosos com hipofunção vestibular unilateral. Referente à correlação, quanto mais intenso o sintoma de tontura, maiores foram os prejuízos na qualidade de vida. Conclusão: os exercícios vestibulares contribuíram para a diminuição da intensidade da tontura dos idosos com hipofunção vestibular unilateral e, consequentemente, para melhora da qualidade de vida e seus respectivos domínios. (AU)

Objective: to analyze vestibular exercise in quality of life and intensity of dizziness in the elderly with unilateral vestibular hypofunction. Method: elderly with symptoms of dizziness participated in the study. The quality of life was assessed by the Dizziness Handicap Inventory and the intensity of dizziness by a visual analogical scale. For each participant a personalized treatment protocol was developed according to their symptoms. The t-Student test was used to assess the intensity of dizziness and Wilcoxon's nonparametric test to analyze the quality of life (p <0.05). The Pearson correlation test was used to verify the associations between intensity of dizziness and quality of life. Results: a statistically significant difference was observed for the intensity of dizziness (p<0.0007) and to the physical (p<0.0009), functional (p<0.0009), emotional (p<0.03) domains and total (p<0.001) of the quality of life of the elderly with unilateral vestibular hypofunction. Concerning the correlation, the more intense the symptom of dizziness, the greater the impairment in quality of life. Conclusion: the vestibular exercises contributed to decrease the intensity of dizziness in the elderly with unilateral vestibular hypofunction and, consequently, to improve the quality of life and their respective domains. (AU)

Effect of dynamic balance during the onset of benign paroxysmal positional vertigo on residual dizziness after successful repositioning: a multicenter prospective cohort study / 中华耳鼻咽喉头颈外科杂志

Objective: To explore the characteristics of dynamic balance during the onset of benign paroxysmal positional vertigo (BPPV) and its prediction of residual symptoms after successful repositioning. Methods: From January 2018 to August 2019, patients diagnosed with unilateral posterior semicircular canal or horizontal semicircular canal BPPV were consecutively enrolled from five otolaryngology clinics in Shanghai. The dynamic balance function was measured by sensory organization test (SOT) before repositioning maneuver, and the residual symptoms and its duration were followed up from one week to up to three months. Results: A total of 260 patients were recruited. After excluding 17 cases, 243 cases were successfully followed up including 89 males and 154 females, with an average age of (52.9±13.0) years. There were 175 cases of posterior semicircular BPPV, 61 cases of horizontal semicircular BPPV and 7 cases of canal conversion (from horizontal to posterior semicircular). Among 243 patients, 118 cases reported residual symptoms, with an incidence of 48.6%. The results of SOT showed that 58.0%(141/243) of the patients had abnormal vestibular input and 41.6%(101/243) were categorized as "near falls". With respect to the detailed residual symptoms, 47 cases (39.8%) reported unsteadiness or floating, 35 cases (29.7%) had fogginess/heaviness feeling, 22 cases (18.6%) had transient dizzy while head moving, and 15 cases (12.7%) reported that the symptom was too subtle to describe. Compared with the group without residual symptoms, the group with residual symptoms had more abnormal vestibular input(χ²=67.25, P<0.001) and near falls(χ²=74.78, P<0.001) as identified by SOT test. Cox proportional hazards regression failed to reveal any SOT results having significantly impact on the duration of residual symptoms [abnormal vestibular input (HR= 0.93, 95%CI: 0.48, 1.80), and near falls (HR= 0.90, 95%CI: 0.56, 1.46)]. Kaplan-Meier survival analysis showed that there was no significant difference in the duration of residual symptoms among patients with different SOT manifestations [Log rank (Mantel-Cox) test, P>0.05]. Conclusions: The impaired dynamic balance during the onset of BPPV is characterized by "abnormal vestibular input". The residual symptoms are mainly characterized by unsteadiness or floating feeling. The defect of dynamic balance function is a predictor of the residual symptoms after successful repositioning, but not for the duration of such symptoms.

The necessity of post-maneuver postural restriction in treating posterior canal benign paroxysmal positional vertigo: a Meta-analytic study / 中华耳鼻咽喉头颈外科杂志

Objective: We conducted a Meta-analysis to investigate the necessity of postural restrictions after manual reduction in the treatment of posterior canal benign paroxysmal positional vertigo (PC-BPPV). Methods: We searched PubMed, EBSCO, Proquest, Web of Science databases, Ovid, and screened eligible studies that investigated the effect of post-maneuver postural restriction in treating patients with PC-BPPV. Outcomes included the efficacy of treatment and recurrence. Meta-analysis was performed using Stata 15.0 software. Results: Studies of the single visit efficiency included 11 references, with a sample size of 1 733 cases. The Meta-analysis results showed that the difference in the efficacy between the postural restricted group and the non-postural restricted group in PC-BPPV patients was statistically significant(RR=1.12, 95%CI=1.07-1.18, P<0.001). There were 12 references included in the study on the total efficiency, with a cumulative sample size of 1763 cases. There was no statistically significant difference between the effect of postural restriction after manipulative reduction and that of simple manipulative reduction (RR=1.03, 95%CI=0.99-1.08, P=0.118). There were 5 references included in the study of recurrence rate, and the cumulative sample size was 659 cases. There was no statistically significant difference in the recurrence rate between the postural restricted group and the non-postural restricted group(RR=0.98, 95%CI=0.62-1.54, P=0.937). Conclusions: In comparison with non-postural restriction group, post-maneuver postural restriction after a single visit can improve the treatment effective rate of PC-BPPV and contribute to the improvement in the symptoms of patients in a short term. However, postural restrictions has no significant effect on the final prognosis of PC-BPPV, and it also has no significant effect on the recurrence.

Intervention strategies for residual dizziness after successful repositioning maneuvers in benign paroxysmal positional vertigo: a single center randomized controlled trial / 中华耳鼻咽喉头颈外科杂志

Objective: To compare the effects of different intervention strategies for the management of residual dizziness following successful canalith repositioning procedure (CRP) in patients with benign paroxysmal positional vertigo (BPPV). Methods: A total of 129 BPPV patients with residual dizziness following successful CRP were recruited during January 2019 and July 2019. They were randomly assigned into three groups with 43 cases in each group: the vestibular rehabilitation group received rehabilitation training for four weeks; betahistine group was given orally 12 mg betahistine three times a day for four weeks; and the control group had no specific treatment. The primary outcomes were daily activities and social participation assessed by the Vestibular Activities and Participation measure (VAP). Secondary outcomes includedbalance function assessed by sensory organization test (SOT) and the duration of residual symptoms. Stata15.0 software was used for statistical analysis. Results: The scores of VAP in the three groups decreased over time, but a more significant decrease was found in vestibular rehabilitation group. Further paired comparison showed that the difference between the vestibular rehabilitation group and the control group was of statistical significance (B=-3.88, χ2=18.29, P<0.01), while the difference between the betahistine group and the control group was not statistically significant (B=-0.96, χ2=1.16, P=0.28). The balance function of the three groups showed a trend of recovery over time, with no significant differences between groups (χ2=1.37, df=2, P>0.05). The median duration of residual dizziness for both vestibular rehabilitation and betahistine groups was 14 days, while that of control group was 19 days, with no significant difference between three groups[Log-rank (Mantel-Cox) test; χ2=1.82, df=2, P=0.40]. Conclusion: Vestibular rehabilitation can significantly improve the daily activities and social participation function in BPPV patients with residual symptoms following successful CRP, but its effects on shortening the duration of residual symptoms and promoting the recovery of balance function remain uncertain.

Calidad de vida en personas que padecen vértigo posicional paroxístico benigno / Quality of life in people suffering from benign paroxysmal positional vertigo

La presente investigación da a conocer el impacto de la maniobra de reposición Epley en la calidad de vida de las personas que padecen de vértigo postural paroxístico benigno, de 35 años y más. Para el conocimiento de la calidad de vida se aplicó un test de autopercepción llamado Dizziness Handicap Inventory (DHI), el cual se tomó antes y después de la maniobra de Epley, en un periodo de tres semanas, con el fin de verificar si la calidad de vida variaba en función al tratamiento. La Metodología en la investigación fue descriptiva- comparativa, ya que, busca establecer la diferencia de las personas pre y post maniobra de reposición, la dimensión fue longitudinal y la muestra fueron 12 personas escogidas de forma no aleatoria. En relación a los resultados se observa que existe una mejoría en la calidad de vida a la hora de comparar los resultados antes y después del tratamiento.

This research reveals the impact of the Epley replacement jaw on people suffering from benign paroxysmal postural vertigo, 35 years of age and older. To know the quality of life, a self-perception test called Dizziness Handicap Inventory (DHI) was applied, which must be performed before and after the Epley maneuver, in order to verify whether the quality of life varied or not depending on the treatment. The methodology in the research was descriptive-comparative, since it seeks to establish the difference of the people before and after the replacement maneuver, the dimension was longitudinal and the sample was 12 people chosen in a non-random way. Regarding the results, it is observed that there is an improvement in the quality of life when comparing the results before and after treatment

Therapeutic observation on horizontal penetration needling for residual dizziness after repositioning maneuver in patients with benign paroxysmal positional vertigo / 中国针灸

OBJECTIVE@#To observe the effect of horizontal penetration needling at vertigo auditory area and balance area on residual dizziness after successful repositioning maneuver in patients with benign paroxysmal positional vertigo (BPPV).@*METHODS@#Sixty-six patients with residual dizziness after successful repositioning maneuver for BPPV were randomly divided into an observation group (34 cases, 1 case dropped off) and a control group (32 cases, 2 cases dropped off). The patients in the observation group were treated with horizontal penetration needling at vertigo auditory area and balance area, once every other day; three times were taken as a course of treatment, and two courses of treatment were given. The patients in the control group received no acupuncture and medication. The dizziness handicap inventory (DHI) and visual analogue scale (VAS) scores were observed before treatment and after 1 and 2 courses of treatment.@*RESULTS@#Except for the emotional score of DHI in the control group after 1 course of treatment, the sub item scores and total scores of DHI and VAS scores in the two groups after treatment were lower than those before treatment (@*CONCLUSION@#Whether acupuncture or not, residual dizziness after repositioning maneuver for BPPV can be relieved within 2 weeks; horizontal penetration needling at vertigo auditory area and balance area could improve dizziness symptoms and shorten the course of disease.

Efectividad de los ejercicios de Brandt-Daroff en pacientes con vértigo posicional paroxístico benigno / Effectiveness of the Brandt-Daroff Exercises in Patients with Benign Paroxysmal Positional Vertigo

El vértigo posicional paroxístico benigno se caracteriza por episodios breves pero intensos de vértigo con los cambios de postura, en su tratamiento pueden utilizarse ejercicios específicos. Objetivo: Evaluar la efectividad de los ejercicios de Brandt-Daroff en el tratamiento del vértigo posicional paroxístico benigno y su relación con los grupos de edades y sexo. Métodos: Se aplicó un método descriptivo, con una muestra de 62 pacientes adultos que presentaban diagnóstico de vértigo paroxístico posicional benigno. Se utilizó la escala dicotómica con presencia o ausencia de vértigo, al inicio y final del tratamiento con estos ejercicios. Se analizaron las variables: edad, sexo y mejoría clínica de la enfermedad. Para el análisis estadístico se utilizó la Prueba de homogeneidad λ2 con un nivel de significación de ά 0,05. Resultados: Se observó evolución favorable para el tratamiento de este trastorno mediante los ejercicios de Brandt-Daroff con el 87,09 por ciento en la eliminación del vértigo a las 7 sesiones de tratamiento, un 90 por ciento de efectividad en edades de 25 a 59 años y el 76,19 por ciento del sexo femenino, de ellas el 91,66 por ciento no presentó vértigos a final del tratamiento. Conclusiones: Se señala la efectividad de los ejercicios de Brandt-Daroff en el tratamiento del vértigo paroxístico posicional benigno con diferencias estadísticamente significativas en comparación con el tratamiento convencional. Mayor efectividad en edades de 25 a 59 años y el predominio del sexo femenino(AU)

Benign paroxysmal positional vertigo is characterized by brief but intense episodes of vertigo with changes in posture. Specific exercises can be used for its treatment. Objective: To evaluate the effectiveness of Brandt-Daroff exercises in the treatment of benign paroxysmal positional vertigo and its relationship with age and sex groups. Methods: A descriptive method was applied, with a sample of 62 adult patients who had a diagnosis of benign positional paroxysmal vertigo. The dichotomous scale with presence or absence of vertigo was used at the beginning and at the end of treatment with these exercises. The variables analyzed were age, sex, and clinical improvement of the disease. For statistical analysis, the chi-square homogeneity test was used with a significance level of 0.05. Results: A favorable evolution was observed for the treatment of this disorder by means of the Brandt-Daroff exercises, with 87.09 percent in the elimination of vertigo after seven treatment sessions, 90 percent effective in ages 25-59 years, and 76.19 percent corresponding to the female sex, of which 91.66 percent did not present vertigo at the end of treatment. Conclusions: The effectiveness of the Brandt-Daroff exercises is highlighted for the treatment of benign positional paroxysmal vertigo, with statistically significant differences compared to conventional treatment. Greater effectiveness in ages 25-59 years and the predominance of the female sex(AU)

Mareo residual, una condición clínica frecuente posterior a maniobra de reposición exitosa en vértigo posicional paroxístico benigno: una revisión / Residual dizziness, a frequent clinical condition following successful repositioning maneuver for benign paroxysmal positional vertigo: a review

El vértigo posicional paroxístico benigno (VPPB) es reconocido como la principal causa de vértigo de origen periférico en adultos, ya que, si bien la etiología del VPPB aún no se ha demostrado plenamente y se clasifica como la mayoría de los casos, se puede identificar el desprendimiento de otolitos y su desplazamiento en uno de los tres canales semicirculares. Una anamnesis cuidadosa puede abordar el diagnóstico clínico del VPPB, pero la confirmación se obtendrá por medio de maniobras de diagnóstico especificas de acuerdo a cuál de los canales está involucrado. Este trastorno altera la capacidad de llevar a cabo actividades de la vida cotidiana que determinan un aumento significativo en el riesgo de caídas y las consiguientes lesiones. La mayoría de los pacientes se recuperan después del tratamiento, sin embargo, hasta dos tercios de éstos pueden percibir inestabilidad prolongada, aturdimiento y malestar definidos como mareo residual. Esta sintomatología residual después de la resolución del VPPB es variable entre los pacientes, siendo el tiempo de duración de los síntomas residuales de aproximadamente de 1 a 3 semanas, existiendo algunos pacientes que pueden recuperarse más tardíamente. En esta revisión analizaremos el mareo residual, describiendo su expresión clínica, diagnóstica, fisiopatológica y tratamientos actuales de esta entidad clínica.

Benign paroxysmal positional vertigo (BPPV) is recognized as the main cause of peripheral vertigo in adults, although the etiology of BPPV has not yet been fully demonstrated and is classified as idiopathicin most cases, detachment of otoliths and their displacement in one of the three semicircular canals can be identifie. A careful history can address the clinical diagnosis of BPPV, but confirmation will be obtained through specific diagnostic maneuvers according to which canal is involved. This disorder alters the ability to carry out activities of daily living that determine a significant increase in the risk of falls and consequent injuries. Most patients recover after treatment, however, up to two thirds of these patients may perceive prolonged instability, dizziness and discomfort defined as residual dizziness. This residual symptomatology following BPPV resolution is variable among patients, the duration of residual symptoms can last 1 to 3 weeks, with some patients may recover later on. In this review, we will analyze residual dizziness, describing its clinical presentation, diagnosis, pathophysiology and current treatments of this clinical entity.

Vértigo posicional paroxístico benigno: factores de riesgo asociados y eficacia de las maniobras de reposición / Benign paroxysmal positional vertigo: associated risk factors and efficacy of particle repositioning maneuvers

INTRODUCCIÓN: El vértigo posicional paroxístico benigno (VPPB) es el vértigo periférico más frecuente. El tratamiento depende del compromiso de los canales semicirculares (CSC) y/o cúpulas, y consiste en maniobras de reposición de partículas. OBJETIVO: Evaluar los factores de riesgo asociados al VPPB en pacientes atendidos en el Servicio de Otorrinolaringología de la Red de Salud UC Christus. Evaluar la tasa de éxito de las maniobras de reposición. MATERIAL Y MÉTODO: Estudio retrospectivo. Se revisaron casos de VPPB con indicación de maniobras de reposición durante los años 2016-2017. Se obtuvo información demográfica, antecedentes médicos, la maniobra realizada y su éxito. Se evaluaron comorbilidades y temporada del año. RESULTADOS: Se incluyeron 195 consultas, realizándose 293 maniobras. La mayoría de los pacientes fueron mujeres (74%) con edad promedio de 63 años. Comorbilidades más frecuentes fueron hipertensión, dislipidemia y diabetes mellitus. El 20% presentó una hipofunción vestibular concomitante, 23% presentó antecedentes de VPPB y 8% compromiso bilateral. Canalolitiasis del CSC posterior fue predominante (90%). En el 77,3% se resuelve el caso con una maniobra. Los casos fueron más frecuentes en primavera y otoño. CONCLUSIONES: El VPPB fue más frecuente en mujeres, con una edad promedio de 63 años. La mayoría presentó canalolitiasis unilateral lográndose resolución con una maniobra de reposición.

INTRODUCTION: Benign paroxysmal positional vertigo (BPPV) is the most common cause of peripheral vertigo. The treatment depends on the semicircular canal (SCC) and/or cupula involved and consists of particle repositioning maneuvers. AIM: Analyze risk factors associated with BPPV for patients seen at the otorhinolaryngology department of the UC Christus health center. Evaluate the success rate of the repositioning maneuvers. MATERIAL AND METHODS: Retrospective study. All cases of BPPV for which a repositioning maneuver was prescribed during the years 2016-2017 were reviewed. Data obtained includes demographics, medical history, maneuver performed, and its success rate. Comorbidities and seasonality were evaluated. RESULTS: 195 cases were included; with 293 maneuvers. The majority were women (74%), and the average age was 63 years. Common comorbidities were hypertension, dyslipidemia and diabetes mellitus. Concurrently, 20% had unilateral vestibular hypofunction, 23% had a history of BPPV, and 8% had bilateral involvement. Posterior SCC canalithiasis was most common (90%). In 77.3%, the case was resolved with one maneuver. Cases were most frequent in the spring and autumn season. CONCLUSION: BPPV was more common in women with an average age of 63 years. The majority of patients presented with unilateral canalithiasis obtaining a complete recovery with a single maneuver.

Subjective benign paroxysmal positional vertigo in patients with osteoporosis or migraine / Vertigem posicional paroxística benigna subjetiva em pacientes com osteoporose ou migrânea

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.

Déficits vestibulares e vertigem posicional paroxística benigna em adultos jovens assintomáticos: um estudo transversa / Vestibular deficits and benign paroxysmal positional vertigo in young asymptomatic adults: a transversal study

Introdução: O equilíbrio corporal pode ser afetado por déficits visuais, proprioceptivos e/ou vestibulares centrais ou periféricas. Dentre as afecções vestibulares periféricos, a Vertigem Postural Paroxística Benigna apresenta grande interesse em pesquisas que buscam responder suas apresentações clínicas em adultos e sua associação com a integralidade dos demais sistemas corporais. Objetivo: Analisar as respostas de adultos jovens assintomáticos submetidos à semiologia do sistema vestibular. Metodologia: Estudo quantitativo, transversal analítico e descritivo, onde foram utilizados os testes de equilíbrio estático, dinâmico e a manobra de DixHallpike, com amostra de 30 voluntários assintomáticos recrutados em uma instituição de ensino superior do município de Parnaíba/PI. Resultados: O teste de apoio unipodal (1,87 ± 0,346) foi negativo (p < 0,001) e no teste de Fukuda (1,20 ± 0,407) grande parte tiveram resultados positivos (p < 0,001). Os testes de Romberg (2,00 ± 0,000), Romberg-Barré (1,50 ± 0,509) e Babinski-Weil (1,37 ± 0,490) não foram significantes (p = 0,001). Para a Manobra de Dix-Hallpike observamos que os movimentos de sedestação para decúbito dorsal esquerdo e de decúbito dorsal para sedestação direito e esquerdo foram significativos (p < 0,001). Conclusão: Os adultos jovens assintomáticos podem apresentar resultados positivos em teste de equilíbrio e sintomas na manobra de Dix-Hallpike, confirmando a Vertigem Postural Paroxística Benigna.(AU)

Introduction: Body balance can be affected by visual deficits, proprioceptive and/or central or peripheral vestibular. Among the peripheral vestibular disorders, the Benign Paroxysmal Positional Vertigo presents great interest in research seeking to answer clinical presentations in adults and its association with the completion of other body systems. Objective: To analyze the responses of asymptomatic young adults with symptoms of the vestibular system. Methods: This was a quantitative, descriptive analytical cross-sectional, where we used the tests of static balance, dynamic and Dix-Hallpike, with a sample of 30 asymptomatic volunteers recruited in a higher education institution in the city of Parnaíba/PI, Brazil. Results: The one-leg supporting roll 1.87 ± 0.346) was negative (p < 0.001) and the test Fukuda (1.20 ± 0.407) were largely positive (p < 0.001). The Romberg test (2.00 ± 0.000) Romberg-Barré (1.50 ± 0.509) and Babinski-Weil (1,37 ± 0.490) were not significant (p = 0.001). For the Maneuver Dix-Hallpike we observed that the movements of the sitting position to the left supine and supine to right and left sedestation were significant (p < 0.001). Conclusion: Asymptomatic young adults may have positive results on balancing test and symptoms in the Dix-Hallpike, confirming the Benign Paroxysmal Positional Vertigo. (AU)

Aspectos clínicos da vertigem posicional paroxística benigna em pacientes acompanhados no ambulatório de otoneurologia em um hospital terciário / Clinical aspects of benigin paroxystic positional vertigin in patients followed at the otoneurology outlet in a tertiary hospital

RESUMO Introdução: A vertigem posicional paroxística benigna (VPPB) é uma síndrome clínica caracterizada por episódios breves e recorrentes de vertigem provocada por certas posições da cabeça em relação à gravidade. A VPPB é a causa mais comum de vertigem secundária a uma lesão vestibular periférica. Seu tratamento baseia-se principalmente nas manobras de reposição canalicular, e devido a simplicidade dessas manobras, seu caráter nãoinvasivo, boa aceitação pelo paciente e por serem, geralmente, livres de complicações, as manobras de reposicionamento de otólitos se popularizaram. Objetivos Avaliar pacientes com vertigem posicional paroxística benigna quanto ao gênero, idade, comorbidades, tipo e localização da lesão, dados evolutivos recorrência, fatores desencadeantes e sintomas concomitantes. Métodos: Este estudo utilizou revisão de prontuários de pacientes acompanhados em hospital de nível terciário no período de janeiro de 2018 a janeiro de 2019, portadores de vertigem posicional paroxística benigno. Resultados: Verificou-se que os pacientes acompanhados no nosso serviço têm perfil epidemiológico e clínico semelhantes aos trabalhos publicados, e que dados que divergem da literatura deve-se ao fator que tal caraterísticas não foi informada pelo paciente ou não foi relatado em prontuário. Conclusão: A VPPB é mais prevalente no sexo feminino, a média de idade foi 59,2 anos, a comorbidade mais encontrada foi a hipertensão arterial sistêmica, a maioria dos casos ocorrem com vertigem e nistagmo de posicionamento por ductolitíase do canal posterior direito. A média de manobras foram 2,4 para os casos com ductolitíase e 6,7 para os casos com cupulolitíase. Três pacientes apresentaram recorrência da crise de vertigem em menos de três meses. O principal fator provocador da vertigem foi girar a cabeça e a náusea foi a manifestação neurovegetativa mais relatada pelos pacientes desse estudo. Palavras-chave: Vertigem, Vertigem posicional paroxística benigna, Doenças vestibulares.

Analysis of Risk Factors for Recurrence of Benign Paroxysmal Positional Vertigo: An 11-Year Nationwide Population-Based Study / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of dizziness with a high recurrence rate. This study aimed to analyze the recurrence rate and the risk factors for recurrence using the Korean National Health Insurance Service National Sample Cohort (NHIS-NSC 2002–2013) data. SUBJECTS AND METHOD: Patients aged 20 years or older who were diagnosed with BPPV in the period of 2002–2012 and had at least 1 year of monitoring period were included in this study. The diagnosis of BPPV was made when the code for BPPV (KCD-6 code H811) was used or when canalith reposition therapy (EDI code MX035) was entered even in cases with different diagnoses. The risk factors of BPPV recurrence were analyzed. RESULTS: Of the total of 21355 patients diagnosed with BPPV, 5876 patients (28%) demonstrated recurrence. Multiple recurrences were common. When using the univariate regression analysis, age, sex, vestibular disease, headache, osteoporosis, and ischemic heart disease were found significant. When the patients were classified into 4 groups according to age and sex, vestibular diseases were found as a common risk factor for recurrence in all groups, while headache, osteoporosis, hypertension, and ischemic heart disease were significant in females. CONCLUSION: The recurrence rate of BPPV in the Korean adult population was approximately 28% and recurrences were more common in patients aged over 65 and in females. Patients with vestibular diseases were at a higher risk of recurrence regardless of age or sex, while headache, osteoporosis, hypertension and ischemic heart disease increased the risk of recurrence in females.

Retraso en la mejoría del vértigo posicional paroxístico benigno asociado al consumo de vestibulosupresores / Delay on the improvement of Benign Paroxysmal Positional Vertigo associated with the use of vestibular suppressants

Introducción: el vértigo posicional paroxístico benigno (VPPB) constituye un motivo de consulta común. A pesar de contar con un manejo sencillo con la realización de maniobras los pacientes son tratados de una manera subóptima; secundario a esto, se observa la administración de medicamentos con los cuales no se logra determinar la causa central de su queja, aumentando el número de consultas. Objetivos: explorar la asociación del uso de vestibulosupresores con el tiempo de diagnóstico y recuperación de los pacientes con VPPB. Diseño: estudio observacional, descriptivo, retrospectivo. Metodología: se incluyeron pacientes con diagnóstico de VPPB; fueron distribuidos en dos grupos según el antecedente de consumo de vestibulosupresores en los últimos 3 meses, con lo cual se evaluó el tiempo de diagnóstico y mejoría, entre octubre 1 de 2010 y mayo 31 de 2017. Resultados: se reclutaron 109 pacientes, 18 hombres y 91 mujeres. Pacientes con uso reciente de vestibulosupresores 91 y sin uso 18. El diagnóstico en el primer grupo requirió varias consultas, el segundo grupo requirió solo una consulta. El tiempo de evolución en días del primer grupo comparado con el segundo fue de 76 y 47 días, respectivamente. El tiempo que pasó entre el diagnóstico y la mejoría sintomática completa fue de 41 y 31 días, respectivamente. Conclusiones: el antecedente de consumo de vestibulosupresoresvs. no consumo, genera un aumento en las consultas para llegar al diagnóstico de VPPB, mayor tiempo de evolución clínica, entre el diagnóstico y la mejoría de los síntomas, sin diferencias estadísticamente significativas.

Introduction: Benign Paroxysmal Positional Vertigo (BPPV) constitutes a common chief complaint during consultation. Despite having a simple management with the performance of maneuvers, patients are treated in a suboptimal manner; secondary to this, it is observed that the administration of medications makes it difficult to determine the cause of their chief complaint, increasing the number of consultations. Objectives: To explore the association of the use of vestibular suppressants with the time of diagnosis and recovery in patients with BPPV. Design: Observational, descriptive, retrospective study. Methods: It included patients with a diagnosis of BPPV; Patients were distributed into two groups based on the history of the use of vestibular suppressant in the previous 3 months. The time of diagnosis and improvement for said patients were evaluated between October 1 of 2010 and May 31 of 2017. Results: 109 patients were enrolled, 18 males and 91 females. Patients with recent use of vestibular suppressants were 91, and those with no history of use 18. Diagnosis in the first group required several consultations while only one was required in the second group. Duration of illness in days for the first group compared to the second was 76 and 47 days respectively, and the time between clinical diagnosis and complete symptomatic improvement was 41 and 31 days respectively. Conclusions: history of vestibular suppressant use, is associated with an increased frequency of consultations reaching a diagnosis of BPPV, greater duration of clinical condition and greater delay between the time of diagnosis and time of clinical improvement. However, this association was not found to be statistically significant.

Identification of factors related to cases of benign paroxysmal positional vertigo refractory to canalicular repositioning maneuvers and evaluation of the need for magnetic resonance imaging in their management: retrospective analysis of a series of 176 cases

Introduction: Benign paroxysmal positional vertigo (BPPV) is the most common form of peripheral vertigo, and, in most cases, it presents a favorable prognosis. The treatment is based on a series of specific canalicular repositioningmaneuvers that offer an efficacy close to 100%. Despite this, there are cases that are refractory to treatment, with the persistence of the vertigo symptoms. Objectives: The objective of the present paper is to analyze the factors associated with an increased risk of refractory BPPV and the importance of nuclear magnetic resonance in the study of these patients. Methods: We retrospectively reviewed the cases of 176 patients diagnosed with BPPV in our center.We divided them into two groups: responders and non-responders to the treatment, and analyzed the possible risk factors associated with a higher risk of refractory vertigo. Fischer exact test was used. Results: We found 11 cases refractory to treatment; all of them underwent magnetic resonance imaging (MRI) with gadoliniumaccording to our protocol. Of these, four had an otoneurologic background or pathology, and two other patients presented a multicanal involvement. The difference between the two groups was statistically significant (p < 0.05). Conclusion: Otoneurologic background and multicanal involvement were associated with a higher risk of refractory BPPV. When dealing with a BPPV with persistent symptomatology/nystagmus or with early relapse after an initial improvement, other entities that enter into the differential diagnosis must always be considered. We consider it essential to perform an MRI with gadolinium to rule out cases of BPPV that have a central cause (AU)