ABSTRACT
OBJECTIVE: To determine whether, in patients with benign paroxysmal positional vertigo (BPPV), the canalith repositioning procedure performed with vibration applied over the mastoid bone of the affected ear is more effective in resolving the symptoms and preventing recurrence of BPPV than the procedure performed without vibration. DESIGN: Retrospective case review. SETTING: Tertiary referral center. PATIENTS: Ninety-four patients diagnosed as having BPPV involving the posterior semicircular canal. INTERVENTIONS: Patients were assigned to one of 2 treatment groups: the canalith repositioning procedure with vibration (n=44) and with no vibration (n=50). MAIN OUTCOME MEASURES: Effectiveness of treatment was determined through clinical reevaluation or reported through a telephone interview 1 week after treatment. Intensity of symptoms was quantified on a scale of 1 to 3 (mild, moderate, or severe); effectiveness of treatment was categorized on a scale of 1 to 4 (cure, much better, better, or no change). Rate of recurrence was determined through later clinical reevaluation or a telephone interview. RESULTS: At 1 week, 57 of the 94 patients were cured and 16 were much better, providing a 78% overall success rate. There was no significant difference in effectiveness of the treatment or the frequency of reoccurrence of BPPV between the vibration and no-vibration groups as determined from the Kaplan-Meier product-limit method and log-rank test. Rate of recurrence was 47% at a maximum follow-up of 5.25 years. CONCLUSIONS: Our results suggest that, while the canalith repositioning procedure is effective in the treatment of BPPV, vibration applied during the maneuver does not significantly affect short-term or long-term outcomes.
Subject(s)
Meniere Disease/therapy , Otolithic Membrane , Vibration/therapeutic use , Adult , Aged , Combined Modality Therapy , Female , Follow-Up Studies , Head Movements/physiology , Humans , Male , Meniere Disease/physiopathology , Middle Aged , Otolithic Membrane/physiopathology , Recurrence , Retrospective Studies , Semicircular Canals/physiopathology , Treatment FailureABSTRACT
In alert, chronically-prepared cats, we studied response characteristics of well-isolated vestibular nucleus neurons (n = 9) while pairing yaw rotation with a pitch optokinetic stimulus, resulting in cross-axis adaptation of the horizontal vestibulo-ocular reflex. Each neuron's sensitivity to whole body rotation in a variety of axes in three-dimensional space was determined. When tested in darkness following adaptation, neurons showed statistically significant increases in sensitivity to yaw but not vertical plane rotations, suggesting participation in reflex plasticity.
