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.

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.

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.

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.

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.

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)

Enfoque del paciente con vértigo / Approach to patients with vertigo

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.

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.

Subjective visual vertical after treatment of benign paroxysmal positional vertigo / Vertical visual subjetiva após tratamento da vertigem posicional paroxística benigna

Abstract Introduction: Otolith function can be studied by testing the subjective visual vertical, because the tilt of the vertical line beyond the normal range is a sign of vestibular dysfunction. Benign paroxysmal positional vertigo is a disorder of one or more labyrinthine semicircular canals caused by fractions of otoliths derived from the utricular macula. Objective: To compare the subjective visual vertical with the bucket test before and immediately after the particle repositioning maneuver in patients with benign paroxysmal positional vertigo. Methods: We evaluated 20 patients. The estimated position where a fluorescent line within a bucket reached the vertical position was measured before and immediately after the particle repositioning maneuver. Data were tabulated and statistically analyzed. Results: Before repositioning maneuver, 9 patients (45.0%) had absolute values of the subjective visual vertical above the reference standard and 2 (10.0%) after the maneuver; the mean of the absolute values of the vertical deviation was significantly lower after the intervention (p < 0.001). Conclusion: There is a reduction of the deviations of the subjective visual vertical, evaluated by the bucket test, immediately after the particle repositioning maneuver in patients with benign paroxysmal positional vertigo.

Resumo Introdução: A função do otólito pode ser estudada por meio de testes da vertical visual subjetiva, porque a inclinação da linha vertical além da faixa normal é um sinal de disfunção vestibular. A vertigem postural paroxística benigna é um distúrbio de um ou mais canais semicirculares labirínticos causado por frações de otólitos derivados da mácula utricular. Objetivo: Comparar a vertical visual subjetiva com o teste do balde antes e imediatamente após a manobra de reposicionamento de partículas em pacientes com vertigem posicional paroxística benigna. Método: Foram avaliados 20 pacientes. A posição estimada, onde uma linha de fluorescência dentro de um balde atingia a posição vertical, foi medida antes e imediatamente após a manobra de reposicionamento de partículas. Os dados foram tabulados e analisados estatisticamente. Resultados: Antes da manobra de reposicionamento, nove pacientes (45%) apresentaram valores absolutos de vertical visual subjetiva acima da referência padrão e dois (10%) depois da manobra; a média dos valores absolutos do desvio vertical foi significativamente mais baixa depois da intervenção (p < 0,001). Conclusão: Há uma redução dos desvios da vertical visual subjetiva, avaliada pelo teste do balde, imediatamente após a manobra de reposicionamento de partículas em pacientes com vertigem posicional paroxística benigna.

Cases requiring increased number of repositioning maneuvers in benign paroxysmal positional vertigo / Casos de vertigem posicional paroxística benigna que exigem uma série de manobras de reposicionamento

ABSTRACT INTRODUCTION: Benign paroxysmal positional vertigo (BPPV) is a clinical syndrome that is proposed to be caused by dislocated utricular debris into semicircular canals. Although the majority of patients are treated by one or two repositioning maneuvers, some of the patients need repeated maneuvers for relief. OBJECTIVE: The goal of this study was to investigate the factors associated with patients with benign paroxysmal positional vertigo who required multiple repositioning procedures for treatment. METHODS: Data were obtained from the clinical records of 153 patients diagnosed with benign paroxysmal positional vertigo. Patients were treated by repositioning maneuvers. Demographic data and the factors including age, sex, canal type, duration of symptoms, comorbidities and number of repositioning maneuvers for relief were documented for statistical analysis. RESULTS: Age, sex, canal type and the duration of symptoms had no impact on the number of maneuvers. The most common comorbidity was spine problems. Hypertension was the only comorbidity that significantly associated with increased number of maneuvers. CONCLUSION: The presence of hypertension is a risk factor for repeated maneuvers in benign paroxysmal positional vertigo treatment. Physicians should be aware of the increased probability of repeated repositioning maneuvers in these group of patients. The role of comorbidities and vascular factors need to be further clarified in the course of benign paroxysmal positional vertigo.

Resumo Introdução: A vertigem posicional paroxística benigna (VPPB) é uma síndrome clínica propostamente causada por detritos utriculares desprendidos dentro dos canais semicirculares. Embora a maioria dos pacientes seja tratada com uma ou duas manobras de reposicionamento, alguns pacientes precisam de manobras repetidas para o alívio dos sintomas. Objetivo: O objetivo deste estudo foi investigar os fatores associados a pacientes com VPPB que precisam de vários procedimentos de reposicionamento para o tratamento. Método: Os dados foram obtidos a partir de prontuários médicos de 153 pacientes diagnosticados com VPPB e tratados. Os pacientes foram tratados com manobras de reposicionamento. Os dados demográficos e fatores, incluindo idade, sexo, tipo de canal, duração dos sintomas, comorbidades e número de manobras de reposicionamento para alívio, foram registrados para análise estatística. Resultados: Idade, sexo, tipo de canal e a duração dos sintomas não tiveram impacto sobre o número de manobras. A comorbidade mais comum foi problemas de coluna. Hipertensão foi a única comorbidade significantemente associada ao aumento do número de manobras. Conclusão: A presença de hipertensão é um fator de risco para necessidade de manobras repetidas no tratamento da VPPB. Os médicos devem estar cientes do aumento da probabilidade de manobras de reposicionamento repetidas nesse grupo de pacientes. O papel das comorbidades e dos fatores vasculares precisa ser mais bem esclarecido no curso da VPPB.

Vertiginous Symptoms and Objective Measures of Postural Balance in Elderly People with Benign Paroxysmal Positional Vertigo Submitted to the Epley Maneuver

Introduction Benign Paroxysmal Positional Vertigo (BPPV) is one of themost common and treatable causes of peripheral vestibular vertigo in adults. Its incidence increases with age, eventually leading to disability and a decreased quality of life. Objective The research aims to assess short-term effects of Otolith Repositioning Maneuver (ORM) on dizziness symptoms, quality of life, and postural balance in elderly people with Benign Paroxysmal Positional Vertigo. Methods A quasi-experimental study, which evaluated 14 elderly people that underwent the Otolith Repositioning Maneuver and reevaluation after one week. The authors performed statistical analysis by descriptive analysis of central tendency and dispersion; for pre- and post-treatment conditions, the authors used the Wilcoxon test. Results All aspects of the Dizziness Handicap Inventory (physical, functional, emotional, and total scores) as well as the Visual Analogue Scale (VAS) decreased after therapy (p < 0.05 and p = 0.001, respectively). However, more than half of the elderly participants did not achieve negative Dix-Hallpike. Regarding static and dynamic balance, there were significant differences in some parameters of the modified Clinical Test of Sensory Interaction and Balance, Limits of Stability and gait assessment measured by the Dizziness Gait Index (p < 0.05). Conclusion Results reveal clinical and functional benefits in elderly people with Benign Paroxysmal Positional Vertigo submitted to Otolith Repositioning Maneuver. However, most of the participants did not overcome Benign Paroxysmal Positional Vertigo and not all aspects of postural balance improved. Therefore, a longer follow-up period and a multidisciplinary team are required to establish comprehensive care for elderly patients with dizziness complaints.

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.

Is it important to repeat the positioning maneuver after the treatment for benign paroxysmal positional vertigo? / É importante realizar o reteste da manobra de posicionamento após o tratamento da vertigem postural paroxística benigna?

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. .

Vértigo postural paroxístico benigno subjetivo / Subjective benign paroxysmal positional vertigo

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.