Horizontal canal benign paroxysmal positional vertigo: diagnosis and treatment of 37 patients / Vertigem posicional paroxística benigna do canal horizontal: diagnóstico e tratamento de 37 pacientes

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.

The Effect of Early Repositioning Therapy in Patients with Benign Paroxysmal Positional Vertigo

PURPOSE: Benign paroxysmal positional vertigo (BPPV), the most common cause of vertigo, can be treated with a simple repositioning maneuver. But there are few reports about the underlying mechanism of this problem or about prognostic factors for recurrent BPPV, which is frequently encountered after symptoms have subsided. Among reported prognostic factors in BPPV, repositioning timing in the treatment of BPPV has been considered by some physicians to be an important one, especially for recurrence. Our study was done to demonstrate, in patients with BPPV, the effect of early repositioning therapy on disease recurrence. METHODS: We enrolled consecutive 73 patients who had been diagnosed BPPV in the department of emergency and otolaryngology in Seoul Samyook hospital between January 2009 and June 2009. All patients who were diagnosed with BPPV immediately had appropriate canalith repositioning maneuvers (CRM) done (depending on the type of BPPV) by emergency department or otolaryngology department doctors. Patients were classified according to the timing of treatment after onset (within 24 hours, after 24 hours). We prospectively compared recurrence rates between the two groups. RESULTS: Of the 73 patients, recurrence was seen in 16 (22.2%): 4(11%) of 36 patients in the early treatment group (within 24 hours), and 12(31.4%) of 37 patients in the delayed group (after 24 hours). The between group difference in recurrence rates was significant (p0.1). CONCLUSION: Recurrence of BPPV is affected by early CRM after symptom onset. Doing CRM as soon as possible after symptom onset is important