Correlation between vitamin D deficiency and benign paroxysmal positional vertigo

Background: Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause of peripheral vertigo. Vitamin D3 is an indispensable part of bone mineralization and calcium homeostasis. Vitamin D3 also plays a role in BPPV and therefore may offer a therapeutic option. Aim and Objective: This study aims to evaluate the relationship of BPPV with Vitamin D deficiency. Materials and Methods: This observational case–control study was done on 80 subjects out of which 40 were confirmed cases of BPPV patients and 40 were controls. Ear, throat, and nose were examined in all patients. Measurement of Vitamin D3 was done in all subjects. Assessment of quality of life was done using Dizziness Handicap Inventory score (DHI) and Visual Vertigo Analog Scale (VVAS). Results: In our study among cases, 14 patients (35%) had normal Vitamin D levels, Vitamin D deficiency was seen in 15 cases (37.5%) and 11 patients (27.5%) had Vitamin D insufficiency. In control group, 22 patients (55%) had normal Vitamin D levels and 9 patients (22.5%) each had Vitamin D insufficiency and deficiency. Mean of Vitamin D concentration in the case group was 23.78 ± 10.43 and in the control group had 35.99 ± 15.99. The relationship between the two groups was significant (P = 0.001). The mean of body mass index in case and control group was 22.46 ± 2.48 and 23.43 ± 2.38, respectively, with P-value of 0.032 indicating significant relationship statistically. Furthermore, VVAS and DHI scores were higher in cases with deficiency and insufficiency of Vitamin D. Conclusion: The present study shows a significant relationship of reduced concentration of Vitamin D with idiopathic BPPV.

Tumarkin-like phenomenon as a sign of therapeutic success in benign paroxysmal positional vertigo / Fenômeno Tumarkin-like como sinal de sucesso terapêutico na vertigem posicional paroxística benigna

ABSTRACT Objective: To describe an unusual patient reaction to maneuvers used in the treatment of posterior canal benign paroxysmal positional vertigo (PC-BPPV) that we termed the "Tumarkin-like phenomenon". Methods: At a private practice, 221 outpatients were diagnosed and treated for PC-BPPV. The treatment consisted of performing the Epley or Semont maneuvers. At the end of these maneuvers, when assuming the sitting position, the patients' reactions were recorded. Results: Thirty-three patients showed a Tumarkin-like phenomenon described by a self-reported sensation of suddenly being thrown to the ground. In the follow-up, this group of patients remained without PC-BPPV symptoms up to at least 72 hours after the maneuvers. Conclusion: The occurrence of a Tumarkin-like phenomenon at the end of Epley and Semont maneuvers for PC-BPPV may be linked with treatment success.

RESUMO Objetivo: Descrever uma reação incomum dos pacientes às manobras utilizadas no tratamento da vertigem posicional paroxística benigna do canal posterior (VPPB-CP), a qual denominamos de fenômeno Tumarkin-like. Métodos: Em uma clínica privada, 221 pacientes ambulatoriais foram diagnosticados e tratados para VPPB-CP. O tratamento consistiu em realizar as manobras de Epley ou de Semont. Ao término da manobra, ao serem colocados na posição sentado, as reações dos pacientes foram filmadas. Resultados: Trinta e três pacientes apresentaram o fenômeno de Tumarkin-like, descrito como uma sensação súbita de ser jogado no chão. O acompanhamento mostrou que todos eles permaneceram sem sintomas de VPPB até pelo menos 72 horas após as manobras. Conclusão: A ocorrência do fenômeno Tumarkin-like no final das manobras de Epley e Semont para VPPB-CP pode estar associado ao sucesso terapêutico.

Revisión sobre los conocimientos actuales de dehiscencia del canal semicircular posterior / Review of current knowledge of the dehiscence in the semicircular posterior canal

La dehiscencia del canal semicircular posterior es una patología rara y con baja incidencia, por ello hemos realizado una revisión de los conocimientos actuales de esta entidad. Se ha realizado una búsqueda bibliográfica desde 1998 hasta diciembre de 2016 de toda la literatura publicada sobre la misma en las bases de datos Allied and Complementary Medicine Database and the Embase, Health Management Information Consortium, Scopus, Consortium, Medline, PsycINFO y Scielo. Se han encontrado y revisado 53 trabajos relacionados con el tema. La dehiscencia del canal semicircular posterior presenta una prevalencia variable; 0,3%-4,5% en adultos y 1,2%-20% en niños. Su localización puede ser hacia el golfo de la yugular o fosa cerebral posterior. Los pacientes pueden ser asintomáticos o presentar clínica auditiva y/o vestibular. La tomografía computarizada y la prueba de potenciales vestibulares miogénicos evocados permiten establecer el diagnóstico de certeza. En el tratamiento quirúrgico la vía de abordaje de elección es la transmastoidea y las técnicas del cierre del canal son el "plugging" y el "resurfacing".

The posterior semicircular canal dehiscence is a rare pathology and it has a low incidence. We have realized a review about the current knowledge of this entity. We have performed a bibliographic research from 1998 to 2016 December about the literature published in this subject, in the data basis Allied and Complementary Medicine Database and the Embase, Health Management Information Consortium, Scopus, Consortium, Medline, PsycINFO y Scielo. I thas been found and reviewed 53 papers about the topic. The posterior semicircular canal dehiscence has a variable prevalence: 0,3%-4-5% in adults and 1,2%-20% in children. The location can be in the jugular bulb or in the posterior brain fossa. Some patients can be asymptomatic, whereas others can have auditory and/or vestibular signs and symptoms. Computed tomography and test of vestibular evoked myogenic potentials allow the diagnosis of certainty. In the surgical treatment the approach of choice is transmastoid and techniques to close the canal are plugging and resurfacing.

A Patient with Sudden Hearing Loss with Vertigo Showing Exclusive Posterior Semicircular Canal Abnormality / 대한평형의학회지

It is known that about 30% of patients with sudden hearing loss present with vertigo or dizziness. In clinical practice, this is called sudden hearing loss with vertigo (SHLV) although definite diagnostic criteria have not been established. Dizziness in SHLV is known to be caused by the dysfunction of the vestibular end-organs as well as the superior vestibular nerve or both vestibular nerve divisions. Lesions of the inferior vestibular nerve or a single semicircular canal have also been reported in these patients. Herein we report a 71-year-old male patient with SHLV who demonstrated vestibular dysfunction involving only the posterior semicircular canal. The patient showed normal results in the bithermal caloric test and the cervical vestibular evoked myogenic potentials test as well as positional test. Video head impulse test showed decreased gain only in the posterior semicircular canal. This case is significant in showing that dizziness in SHLV patients can occur by an abnormality involving only a single semicircular canal.

Epley maneuver associated with vertigo calming for treating posterior semicircular canal benign paroxysmal positional vertigo in young / 中国综合临床

Objective To analyze the efficacy of epley maneuver associated with vertigo calming for treating posterior semicircular canal benign paroxysmal positional vertigo (PC-BPPV) in young.Methods Two hundred and fifty-eight cases(age was 18-50 years old) with PC-BPPV were randomly divided into maneuver group(86 cases),betahistine group(86 cases) and vertigo calming group(86 cases).The maneuver group was treated by epley maneuver associated with placebo,2 pills per time,3 times daily for one month and follow up one month.The betahistine group and vertigo calming group were treated by epley maneuver with betahistine(12 mg/ time,Tid) or vertigo calming(2 piles/time,Tid),the same dose,period of treatment and follow-up as maneuver group.Results After one time treatment,199 cases were cured in 258 patients,including 68 cases in maneuver group,66 cases in betahistine group,65 cases in vertigo calming group,and the difference between groups was not statistically significant(x2 =0.308,P＞0.05).After treatments and followed up for one month,72 cases were cured,3 cases were effective,11 cases were invalid in maneuver group;74 cases were cured,3 cases were effective,9 cases were invalid in betahistine group;81 cases were cured,4 cases were effective,1 cases were invalid in vertigo calming group.Efficient of betahistine group,maneuver group and vertigo calming group were 89.5％,87.2％ and 98.8％,and the difference between maneuver group and betahistine group was not statistically significant(x2=58.65,P＞0.05),the difference of vertigo calming group between with other groups was statistically significant(P＜0.05).Conclusion The effects of vertigo calming in addition to Epley maneuver is significantly better than both Epley maneuver and Epley maneuver combined with betahistine in young PC-BPPV,while the effects of Epley maneuver combined with betahistine isn't better than Epley maneuver.

Perioperative nursing of 18 patients with refractory paroxysmal positional vertigo treated with posterior semicircular canal occlusion / 现代临床护理

Objective To explore the perioperative nursing of patients with refractory paroxysmal positional vertigo treated with posterior semicircular canal occlusion. Method A retrospective analysis was performed to the experience of nursing 18 patients with refractory paroxysmal positional vertigo treated with posterior semicircular canal occlusion.Results The treatments for 17 cases were effective.Two of them had postoperative vertigo and then cured after further treatments.During one year follow-up,17 of them reported no occurrence of vertigo except only one care reporting paroxysmal positional vertigo. Conclusion Preoperative mental care and postoperative observation of the disease are critical for the enhanced curative effects.

The clinical study of posterior semicircular canal benign paroxysmal positional vertigo / 中国实用内科杂志

Objective To evaluate the clinical features and treatment of posterior semicircular canal benign paroxysmal positional vertigo(PC-BPPV).Methods To retrospectively analyse the clinical features and therapy results of 120 patients with PC-BPPV from January 2003 to November 2004 in the Chang Zheng Hospital of the Second Military Medical University.Results Vertigo attack of PC-BPPV had such characters as brief period,positioning,latency and fatigability.Geotropic rotatory nystagmus occurred in 108 patients and apogeotropic rotatory nystagmus in 12 patients in the test of Dix-Hallpike,and the former received the repositioning maneuver therapy of Epley and the later received the therapy of Semont maneuver.The symptoms disappeared completely in 88 patients after a single session and 12 patients after twice、6 patients after triple sessions of Epley repositioning maneuver therapy in the former,no effectiveness in 2 patients;the symptoms remitted in 8 patients after once,2 patients after twice and 1 patient after triple sessions therapy of Semont repositioning maneuver in the later,no change in 1 patient.The total success rate was 97.5%(117/120).Fifteen patients had relapse during follow-up and the recurrence rate was 12.5%(15/120).They also responded to repositioning maneuver therapy.Conclusion The diagnosis of PC-BPPV is based on the typical clinical features and the test of Dix-Hallpike.The repositioning maneuver therapy is safe and effective for PC-BPPV and should be used for all patients when the diagnosis is clearly made.

The Effect of Postural Restrictions in the Treatment of Benign Paroxysmal Positional Vertigo / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The treatment of Benign Paroxysmal Positional Vertigo (BPPV) consist of repositioning maneuver in order to remove otolithic debris, and subsequent postural restrictions to prevent debris from reentering into the canal. But, it is doubtful how much postural restrictions could have an effect on the final outcomes of BPPV. The purpose of this study is to find out the effect of postural restrictions when imposed on as one of the treatment methods of BPPV, out-broken due to otolithic debris in the posterior semicircular canal, and to find out the necessity of postural restrictions. SUBJECTS AND METHOD: Seventy cases diagnosed as BPPV of the posterior semicircular canal were studied. All the patients were treated by modified Epley Maneuver. They were divided into two groups. The first group (group A, 35 patients) was instructed to sleep in a semi-sitting position and not to move their heads forward or backward, whereas the second group (group B, 35 patients) was not taught to do any specific thing. The gathered information from all the patients was analyzed by age of onset, gender, duration of the disease, and cure rates or recurrence rates. RESULTS: In group A, the average age was 54.5 years and mean duration of symptoms was 116.5 days. On the other hands, in the group B, the average age and the mean duration was 54.8 years and 86.7 days, respectively. The cure rates of the group A and B were 91.4% and 94.3%, respectively. The recurrence rates were 12.5% and 9.1% for group A and group B patients, respectively. No statistically significant difference was found between two groups regarding patient age, duration of symptoms, and cure rates or recurrence rates. CONCLUSION: From the analysis of this study, it can be said that postural restrictions imposed after the repositioning maneuver do not have a significant effect on the final outcomes of BPPV, so they are not recommendable.

Partial Posterior Canal Labyrinthectomy for Pontine Cavernous Angioma

The transpetrosal approach to the anterior portion of a brain stem lesion with intact hearing is often limited by portions of the labyrinth. The technique of partial labyrinthectomy, by which the posterior and superior semicircular canals, maximizes surgical exposure while preserving hearing. We report the case of a patient who underwent a modified partial labyrinthectomy involving resection of the posterior semicircular canal only in the area of the labyrinth. Technical modification of the partial labyrinthectomy approach simplifies tumor removal while preserving hearing.