Three-dimensional exergaming conjunction with vestibular rehabilitation in individuals with Benign Paroxysmal Positional Vertigo: A feasibility randomized controlled study.

BACKGROUND: To examine the effectiveness of 3D (dimensional)-vestibular rehabilitation therapy (VRT) on gait, balance problems, processing time speed and subjective complaints in patients with Benign Paroxysmal Positional Vertigo (BPPV) compared to a control group (CG). This study aimed to test the feasibility of virtual reality-based 3D exergaming conjunction with vestibular rehabilitation. METHODS: Twenty-two patients with BPPV (negative DixHallpike/Roll test results, existing dizziness/balance complaints) were randomly allocated to the study group (SG, n:11 3D-VRT) or Control group (CG n:11, no exercise-rehabilitation) for 8 week. The SG performed 3D-VRT for 45 to 50 min/d, 3 times/wk, and the CG did receive only Canalith Repositioning Maneuver (CRM). CRM was applied in both groups before the study. Outcome measures included 10-Meter-Walk-Test (10-MWT) (with/without head turns), Dynamic Gait Index (DGI), Choice-Stepping-Reaction-Time-ped (CSRT-MAT), Fullerton Advanced Balance Scale (FAB), and Visual Analog Scale (VAS). RESULTS: The SG showed significantly improvement in 10-MWT without (p5 = 0.00,η2 = 0.49), with horizontal (p5 = 0.00,η2 = 0.57),vertical (p5 = 0.01,η2 = 0.48) head turns, DGI (p5 = 0.00,η2 = 0.74), CSRT-MAT, FAB (p5 = 0.00,η2 = 0.78) and VAS-dizziness (p5 = 0.00,η2 = 0.65), VAS-balance problem (p5 = 0.00,η2 = 0.43), VAS-fear of falling (p5 = 0.00,η2 = 0.42) compared to the CG. CONCLUSION: The 3D-VRT were effective in improving gait, balance, processing speed and resolving the subjective complaints in BPPV. The 3D-VRT method is feasible for patients who suffer from residual dizziness or balance complaints after CRM. Furthermore, the 3D-VRT is more accessible and less expensive than other virtual reality applications, which may facilitate further research or clinical use.

Paciente con lesión medular cervical y vértigo posicional paroxístico benigno tratado con maniobras de reposición de partículas / Patient with cervical spinal cord injury and benign paroxysmal positional vertigo treated with particle repositioning maneuvers

El vértigo posicional paroxístico benigno (VPPB) se caracteriza por episodios cortos y bruscos de vértigo cuando la cabeza se mueve en posiciones específicas. El tratamiento son las terapias de reposición de partículas. En general el VPPB es subdiagnosticado, no reportado y por lo tanto no es tratado de forma adecuada. Presentamos el caso de un paciente con lesión medular y VPPB. Paciente de 72 años que sufre una fractura de C5 y como resultado una lesión medular C5 AIS C que necesitó la fijación quirúrgica. En la unidad de lesionados medulares se documentó VPPB del conducto semicircular lateral izquierdo y se trató mediante el uso de terapias de reposición específicas; el paciente mejoró progresivamente y pudo concluir el tratamiento rehabilitador. Las unidades de lesión medular con acceso a unidades de rehabilitación vestibular pueden realizar el diagnóstico y tratamiento específico del VPPB, minimizando los riesgos para el paciente.(AU)

Benign paroxysmal positional vertigo (BPPV) is characterized by short, sudden episodes of vertigo when the head moves in specific positions. The treatment is particle repositioning maneuvers. BPPV usually is underdiagnosed, unreported and therefore not adequately treated. We present the case of a patient with spinal cord injury and BPPV. A 72-year-old patient who suffered a C5 fracture with spinal cord injury C5 AIS C that required surgical fixation. In the spinal cord injury unit BPPV of the left lateral semicircular canal was documented and treated using specific repositioning maneuvers, the patient progressively improved and was able to complete the rehabilitation treatment. The spinal cord injury unit with access to vestibular rehabilitation units can carry out the diagnosis and specific treatment of BPPV, minimizing the risks for the patient.(AU)

Gans repositioning maneuver for the posterior canal BPPV patients: systematic review and meta-analysis.

BACKGROUND AND OBJECTIVES: BPPV (benign paroxysmal positional vertigo) is a syndrome marked by brief bouts of vertigo accompanied by rapid changes in head position. Recent ongoing therapeutic approaches used are vestibular rehabilitation exercises and physical maneuvers like the Epley maneuver, Semont maneuver. Gans repositioning maneuver (GRM) is a new hybrid maneuver, consisting of safe and comfortable series of postures that can be conveniently applied on patients with any spinal pathology or even in elderly. METHODS: Randomized controlled/clinical trials of the Gans maneuver were identified. The proportion of patients who improved as a result of each intervention was assessed, as well as the conversion of a 'positive' Dix-Hallpike test to a 'negative' Dix-Hallpike test. RESULTS: Improvement was seen in almost all patients with the Gans maneuver and the Epley Maneuver in three trials with the pooled estimate for random effect model is 1.12 [0.87; 1.43: 100%]. There were no significant side effects from the treatment. DISCUSSION: This study shows that the Gans maneuver is a safe and effective treatment for patients suffering from posterior canal BPPV. TRIAL REGISTRATION: The review is registered in Prospero with no. CRD42021234100.

Customised vestibular rehabilitation with the addition of virtual reality based therapy in the management of persistent postural-perceptual dizziness.

OBJECTIVE: Visual-vestibular mismatch patients experience persistent postural and perceptual dizziness. Previous studies have shown the benefit of vestibular rehabilitation for visual desensitisation using gaze stabilisation exercises and optokinetic stimulation. This study assessed the benefit of customised vestibular rehabilitation with visual desensitisation and virtual reality based therapy rehabilitation in the management of patients with persistent postural-perceptual dizziness. METHODS: This retrospective study included 100 patients with Situational Characteristic Questionnaire scores of more than 0.9. All patients received virtual reality based therapy along with usual vestibular rehabilitation using gaze stabilisation exercises with a plain background followed by graded visual stimulation and optokinetic digital video disc stimulation. Patients' symptoms were assessed before and after vestibular rehabilitation using the Situational Characteristic Questionnaire, Generalised Anxiety Disorder Assessment-7, Nijmegen Questionnaire and Dizziness Handicap Inventory. RESULTS: There were statistically significant improvements in Situational Characteristic Questionnaire scores, Nijmegen Questionnaire scores and Dizziness Handicap Inventory total score. However, there was a statistically insignificant difference in Generalised Anxiety Disorder Assessment-7 scores. There was a significant positive correlation between post-rehabilitation Situational Characteristic Questionnaire scores and other questionnaire results. CONCLUSION: Incorporating virtual reality based therapy with customised vestibular rehabilitation exercises results in significant improvement in persistent postural-perceptual dizziness related symptoms.

Clinical effect of vestibular rehabilitation on benign paroxysmal positional vertigo: A protocol for systematic review.

BACKGROUND: This study will evaluate the clinical effect of vestibular rehabilitation (VR) on benign paroxysmal positional vertigo (BPPV). METHODS: In this study, we will identify relevant trials on the topic published in MEDLINE, EBASE, Web of Science, Cochrane Library, Scopus, CINAHL, CBM, and CNKI from inception to the present. We will also search conference proceedings, thesis/dissertation, ongoing trials in clinical trial registry, and reference lists of included studies. Two researchers will independently carry out record selection, data extraction, and study quality assessment, respectively. Any disagreement will be arbitrated and solved with the help of a third researcher. If necessary, we will conduct random-effects meta-analysis to pool the effect estimates of included trials determined to be acceptable heterogeneity. RESULTS: We will summarize the latest evidence to assess the effect of VR for the treatment of patients with BPPV. CONCLUSION: The findings of this study will help determine whether or not VR is effective in treating BPPV. OSF REGISTRATION: osf.io/k83y5.

Vestibular rehabilitation in multiple sclerosis: study protocol for a randomised controlled trial and cost-effectiveness analysis comparing customised with booklet based vestibular rehabilitation for vestibulopathy and a 12 month observational cohort study of the symptom reduction and recurrence rate following treatment for benign paroxysmal positional vertigo.

BACKGROUND: Symptoms arising from vestibular system dysfunction are observed in 49-59% of people with Multiple Sclerosis (MS). Symptoms may include vertigo, dizziness and/or imbalance. These impact on functional ability, contribute to falls and significant health and social care costs. In people with MS, vestibular dysfunction can be due to peripheral pathology that may include Benign Paroxysmal Positional Vertigo (BPPV), as well as central or combined pathology. Vestibular symptoms may be treated with vestibular rehabilitation (VR), and with repositioning manoeuvres in the case of BPPV. However, there is a paucity of evidence about the rate and degree of symptom recovery with VR for people with MS and vestibulopathy. In addition, given the multiplicity of symptoms and underpinning vestibular pathologies often seen in people with MS, a customised VR approach may be more clinically appropriate and cost effective than generic booklet-based approaches. Likewise, BPPV should be identified and treated appropriately. METHODS/ DESIGN: People with MS and symptoms of vertigo, dizziness and/or imbalance will be screened for central and/or peripheral vestibulopathy and/or BPPV. Following consent, people with BPPV will be treated with re-positioning manoeuvres over 1-3 sessions and followed up at 6 and 12 months to assess for any re-occurrence of BPPV. People with central and/or peripheral vestibulopathy will be entered into a randomised controlled trial (RCT). Trial participants will be randomly allocated (1:1) to either a 12-week generic booklet-based home programme with telephone support or a 12-week VR programme consisting of customised treatment including 12 face-to-face sessions and a home exercise programme. Customised or booklet-based interventions will start 2 weeks after randomisation and all trial participants will be followed up 14 and 26 weeks from randomisation. The primary clinical outcome is the Dizziness Handicap Inventory at 26 weeks and the primary economic endpoint is quality-adjusted life-years. A range of secondary outcomes associated with vestibular function will be used. DISCUSSION: If customised VR is demonstrated to be clinically and cost-effective compared to generic booklet-based VR this will inform practice guidelines and the development of training packages for therapists in the diagnosis and treatment of vestibulopathy in people with MS. TRIAL REGISTRATION: ISRCTN Number: 27374299 Date of Registration 24/09/2018 Protocol Version 15 25/09/2019.

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)

Orthotropic nystagmus in predicting the efficacy of treatment in posterior canal benign paroxysmal positional vertigo.

OBJECTIVE: To observe the type of nystagmus in each position of posterior semicircular canal benign paroxysmal positional vertigo (BPPV) after treatment with the Epley maneuver and analyze the relationship between the type of nystagmus in the second and third positions of the Epley maneuver and the effect of treatment. Then, the role of orthotropic nystagmus in predicting the success of posterior semicircular canal BPPV treatment was explored. METHODS: Two hundred seventy-six patients diagnosed with posterior semicircular canal BPPV who were admitted from September 2018 to October 2019 to Zhejiang Hospital were included. All patients were treated with BPPV diagnosis and treatment system (Epley maneuver). During the treatment, we observed and recorded the type of nystagmus in the second and third positions, including the direction and duration of nystagmus. One hour after the first treatment, all patients were evaluated by both the Dix-Hallpike and Roll tests to determine whether the treatment was successful. The difference in the success rate of treatment between different types of nystagmus was compared, and the differences in sensitivity and specificity of orthotropic nystagmus in the second and third positions in predicting the effect of treatment were compared. RESULTS: Among the 234 patients who had successful repositioning for the first time, the proportion of orthotropic nystagmus during the third position of the Epley maneuver was 88.9%, which was significantly higher than 23% in the unsuccessful group (42 cases) (P < 0.05) The proportion of patients with reversed nystagmus (4.7% vs 33.3%, P < 0.05) and no nystagmus (6.4% vs 42.9%, P < 0.05) was lower in the successful group than in the unsuccessful group. The proportion of orthotropic nystagmus during the second position of the Epley maneuver was 50.9%, which was also higher than the 19% in the unsuccessful group (P < 0.05). The proportion of reversed nystagmus (13.7% vs 31%, P < 0.05) was lower in the successful group than in the unsuccessful group. Additionally, the proportion of no nystagmus (35.5% vs 50%, P = 0.074) was lower in the successful group than in the unsuccessful group, but the difference was not statistically significant. The sensitivity of orthotropic nystagmus in the third position (88.9%) of the Epley maneuver in predicting the efficacy of treatment was higher than that of orthotropic nystagmus in the second position (50.9%), but there was no significant difference in specificity between the two. CONCLUSION: Orthotropic nystagmus during the Epley maneuver, especially in the third position, has certain value in predicting the efficacy of posterior semicircular canal BPPV repositioning, which is better than its predictive effect in the second position, whereas reversed nystagmus or no nystagmus in the third position is suggestive of unsuccessful repositioning. Therefore, clinicians can carry out individualized treatments based on nystagmus types during repositioning to improve the effect of treatment.

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.

Effectiveness of Canal Occlusion for Intractable Posterior Canal Benign Paroxysmal Positional Vertigo: A Systematic Review.

OBJECTIVES: A last resort for therapy for intractable benign paroxysmal positional vertigo (BPPV) is mechanical occlusion of the posterior semicircular canal. The aim of this review was to assess the effect of posterior canal occlusion for intractable posterior canal BPPV on vertigo and to determine the risk of loss of auditory or vestibular function. DATA SOURCES: A systematic literature search according to the PRISMA statement was performed on PubMed, the Cochrane Library, Embase, Web of Science, and CINAHL. The last search was conducted in June 2018. REVIEW METHODS: Cohort studies with original data and case reports describing >5 cases were included if they analyzed the effect of posterior semicircular canal obliteration in adults with intractable posterior BPPV on vertigo. Two authors screened titles and abstracts for eligibility. The first author screened full texts and analyzed the data. RESULTS: Eight retrospective studies met the eligibility criteria. The quality of all individual studies was rated fair. Canal occlusion was performed on 196 patients. All studies reported complete resolution of BPPV in all patients (100%). Among postoperatively tested patients, total loss of auditory function and vestibular function was reported in 2 of 190 (1%) and 9 of 68 (13%), respectively. CONCLUSION: Posterior semicircular canal plugging resulted in 100% resolution of BPPV in patients with intractable BPPV in all studies. However, the strength of evidence was weak. Potential serious complications, such as deafness and loss of vestibular function, should be taken into account.

Adverse effects of semicircular circle angles variation on Epley repositioning procedure: a study on reconstruction of Micro-CT images 3D.

Background: For patients with posterior semicircular canal (PSC) BPPV, Epley re-position maneuver and some improvement methods are the most efficient treatment methods. But there were still 9.43% patients who were not benefit from Epley re-position maneuver.Objective: To measure the angles of semicircular canals and evaluate its effect on Epley maneuver.Methods: Fifteen skull specimens, containing 30 temporal bone specimens were included. After Micro-CT scanning, 3D reconstruction was loaded with the CT image. The angles between each semicircular canal and each standard skull plane were measured. Furthermore, the angles' effect on Epley maneuver was evaluated according to the three-dimension (3D) model.Results: Angles of PSC plane: Frankfurt plane was 71.54 ± 6.51, sagittal plane was 53.77 ± 5.36°, and the coronal plane was 43.33 ± 3.56°. Angles between PSC and the sagittal plane of skulls had an adverse effect on Epley maneuver, when it was less than 45°.Conclusion: 1. Variation could be found in angles between the semicircular canals and the standard planes of skulls, which meant variation of semicircular canals' location existing in skulls. 2. The variation of angles between PSC and sagittal plane could have an adverse effect on the Epley maneuver when the angle was less than 45°, which may cause the Epley maneuver to be invalid.

Management of Benign Paroxysmal Positional Vertigo in an Adult With Severe Osteogenesis Imperfecta.

The purpose of this case report was to describe the evaluation and management of atypical benign paroxysmal positional vertigo (BPPV) in an adult with severe osteogenesis imperfecta. A 29-year-old male was referred to a physical therapist with extensive experience in vestibular rehabilitation who provided horizontal canal BPPV treatment with a canalith repositioning maneuver over two treatment sessions. The individual's symptoms had reduced by 65% and his nystagmus during the roll test was reduced. Extreme care is needed to safely reposition individuals living with severe osteogenesis imperfecta, but the repositioning can reduce symptoms and improve quality of life. Laryngoscope, 130:2241-2244, 2020.

Indicaciones de la rehabilitación vestibular / Indications of vestibular rehabilitation

INTRODUCCIÓN Y OBJETIVO: Desde la aplicación de la rehabilitación vestibular como tratamiento del paciente con mareo, las indicaciones han ido ampliándose en función del avance de los procedimientos aplicados, pasando de una terapia puramente física a otra en la que además, se usan instrumentos que aporta el avance tecnológico. En este capítulo, vamos a presentar las distintas indicaciones que hoy en día se han demostrado eficaces y aquellas que aún no han sido validadas a pesar de que muchos autores las defienden. MÉTODO: revisión narrativa. RESULTADOS: Además de la utilidad de la rehabilitación vestibular en el déficit vestibular agudo, también lo es en diferentes patologías crónicas, aunque siguen quedando pendientes algunas cuestiones como conocer el momento idóneo de su aplicación. DISCUSIÓN Y CONCLUSIONES: la rehabilitación vestibular es fundamental en el tratamiento de muchos tipos de patología vestibular. Es importante tener en cuenta todas las indicaciones posibles para poder ofrecer al paciente un tratamiento adecuado que conlleve un mejor resultado terapéutico

INTRODUCTION AND OBJECTIVE: Since the application of vestibular rehabilitation as a treatment for patients with dizziness, the indications have been extended according to the progress of the procedures applied, going from a purely physical therapy to another in which, in addition, instruments that provide technological advancement are used. In this chapter, we will present the different indications that have proved effective today and those that have not yet been validated despite the fact that many authors defend them. METHOD: narrative review. RESULTS: In addition to the usefulness of vestibular rehabilitation in acute vestibular deficit, it is also useful in different chronic pathologies, although some issues remain pending, such as knowing the appropriate moment of its application. Discussion/conclusions: Vestibular rehabilitation is elementary in the treatment of many types of vestibular pathology. It is important to take into account all possible indications in order to offer the patient an appropriate treatment that leads to a better therapeutic result

Effects of vestibular rehabilitation, with or without betahistine, on managing residual dizziness after successful repositioning manoeuvres in patients with benign paroxysmal positional vertigo: a protocol for a randomised controlled trial.

INTRODUCTION: Benign paroxysmal positional vertigo (BPPV) is recognised as the leading cause of peripheral vertigo in adults. The canalith repositioning procedure (CRP) can be used for effective treatment of BPPV. However, some patients experience residual dizziness (RD) even after successful CRP, resulting in a significant negative impact on their daily function and quality of life. Exercise-based vestibular rehabilitation (VR) has been proven as an effective method for managing dizziness and has been applied in patients with various vestibular disorders. However, the efficacy of VR to specifically target RD post-BPPV is unknown. This study aims to investigate the efficacy of VR, compared with betahistine or VR plus betahistine treatment, in the treatment of patients experiencing RD after successful CRP. METHODS AND ANALYSIS: A randomised single-blinded controlled trial will be carried out to determine the efficacy of VR compared with betahistine or VR plus betahistine treatment in mitigating RD and improving balance function. Patients with BPPV who experience RD after successful CRP will be recruited. Participants will be randomised into one of three groups to receive VR, betahistine or VR plus betahistine. There will be 61 participants in each group. The primary outcomes will be changes in the patient's daily function as measured by the Vestibular Activities and Participation questionnaire and balance ability assessed by computerised dynamic posturography. The secondary outcomes will be dizziness-related handicap, otolith function and duration of RD symptoms. Outcome measures will be noted at baseline and at 2, 4 and 8 weeks post-randomisation. This study has the potential to reduce unnecessary anti-vertigo drug prescriptions and may lead to a general consensus regarding the use of VR as a first-line treatment for RD in patients with BPPV. ETHICS AND DISSEMINATION: This trial received ethical approval from the Institutional Review Board of Eye and ENT Hospital of Fudan University (reference number 2017046). The study results will be disseminated via peer-reviewed journals and conferences. TRIAL REGISTRATION NUMBER: NCT03624283; Pre-results.

Vestibular Rehabilitation Therapy Outcomes in Patients With Persistent Postural-Perceptual Dizziness.

OBJECTIVES:: Persistent postural-perceptual dizziness (PPPD) represents an important category of vertigo. Medical treatment and psychotherapy provide convenient control of symptoms. However, these management strategies can have inconvenient side effects and short-term relief, respectively. Vestibular rehabilitation therapy (VRT) is a self-conducted habituation program that can be personalized to the subject's needs to give adequate symptom relief without side effects. The present study aims to test the effect of VRT on patients with PPPD. METHODS:: Participants were diagnosed as having PPPD by the exclusion of organic vestibular lesions. The study involved 2 groups with PPPD: Group I, treated with the VRT, and Group II, treated with the VRT plus placebo. The Dizziness Handicap Inventory (DHI), a self-assessment scale, was used to evaluate the VRT outcomes. RESULTS:: There was a significant decrease in functional, physical, and total scores on the DHI in both groups after VRT. Adding the placebo did not have supplementary outcomes. The patients who did not benefit from the VRT had a significantly longer duration of PPPD, more complex aggravating factors, more composite VRT exercises, and a higher DHI score than the patients who benefited from VRT. CONCLUSIONS:: Customized VRT adequately reduced symptoms and improved quality of life in subjects with PPPD.

A survey of current management of Benign Paroxysmal Positional Vertigo (BPPV) by physiotherapists' interested in vestibular rehabilitation in the UK.

OBJECTIVES: Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause of dizziness. Extensive research has identified the best assessment and treatment manoeuvres for each subtype of BPPV. Education in vestibular rehabilitation (VR) is inconsistent. It is unclear if the evidence has been adopted by UK physiotherapists in clinical practice and no research has investigated this specifically. DESIGN: An online survey with closed- and open-text answers. PARTICIPANTS: A purposive sample of physiotherapists interested in VR. A response rate of 67% (100/150) was obtained, from which 20 responses were excluded. RESULTS: Participants had good evidence-based awareness in assessment (79/80, 99%) and treatment (72/80, 90%) of posterior BPPV. Horizontal BPPV assessment awareness was lower than treatment (37/80, 46% vs 60/80, 75%). Differential diagnosis was poor in subjective (20/80, 25%) and objective stages of assessment (34/80, 43%). Thirty six percent (29/80) were able to list ≥3 test precautions with all three nystagmus characteristics described by 29% (23/80). Eighty one percent (65/80) encourage activity restrictions post-treatment. Only 28% (22/80) were aware of practice guidelines or Cochrane reviews in BPPV. External courses were rated the top method for learning how to manage BPPV. Lack of peer support (26/77, 34%) was the main challenge faced whilst learning. Recommendations for improving BPPV education included more external courses (23/87, 26%) and competency guidelines (13/87, 15%). CONCLUSIONS: Good awareness of research evidence was observed in some aspects of BPPV management but many areas require development. Translation and implementation of evidence remains poor and suggests changes in education and knowledge dissemination are warranted.

Physical Therapy for Posterior and Horizontal Canal Benign Paroxysmal Positional Vertigo: Long-term Effect and Recurrence: A Systematic Review

Abstract Introduction Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo, and it is characterized by episodes of vertigo roundabout when the head is moved. A systematic review was performed using the most important scientific databases. This review included studies published in English in the last ten years, performed in adults, with emphasis on the diagnosis and treatment of BPPV. Objective To investigate the long-term effectiveness of vestibular rehabilitation (VR) in patients with BPPV and the rate of recurrence of symptoms. Data Synthesis A total of 38 studies were identified, of which only 12 met the inclusion criteria. The majority of the studies stated that VR is effective in decreasing the symptoms, with a short-term efficacy of 84.7%, and 89.2% in the long term in the reviewed studies. Conclusion Valuable studies show the beneficial effects of the maneuvers for the treatment of BPPV and their long-term effectiveness. This strengthens the conclusion that this treatment is effective in resolving symptoms and decreasing recurrences.

Therapeutic efficacy of the Galletti-Contrino manoeuvre for benign paroxysmal positional vertigo of vertical semicircular canals in overweight subjects.

OBJECTIVE: To compare the Galletti-Contrino manoeuvre with the more widely used Semont-Toupet in overweight subjects presenting with benign paroxysmal positional vertigo (BPBV) of vertical semicircular canals (posterior and anterior canals). STUDY DESIGN: Prospective cohort study. PATIENTS: 204 patients (BMI range 25-30) with a diagnosis of BPPV of vertical semicircular canals were randomly divided in two groups treated with two different maneuvers: Galletti-Contrino (Group A) and Semont-Toupet manoeuvre (Group B). The results were compared with those obtained from a control group (204 non-overweight subjects with BPV of vertical semicircular canals.) INTERVENTION: Galletti Contrino/ Semont Toupet manoeuvres. MAIN OUTCOME MEASURE(S): Liberatory nystagmus or vertigo after maximum 2 maneuvers. Vertigo and dizziness intensity scores (Visual analogue scale VAS 0-10) from day 0 to day 5 following the repositioning manoeuvre were also recorded in responsive patients. RESULTS: While in non-overweight subjects no significant difference comparing the effectiveness of the two manoeuvres was found, liberatory nystagmus and vertigo were more frequently observed after Galletti Contrino manoeuvre in overweight subjects; this difference was statistically significant when posterior canals were involved (P < 0.03). Vertigo and dizziness VAS scores reduced significantly from day 0 to day 5 after therapy in all groups. A more significant reduction of dizziness VAS was recorded in patients undergoing Galletti-Contrino manoeuvre at days 4-5 (P < 0.005). CONCLUSION: Galletti-Contrino manoeuvre seems to be significantly more effective than Semont-Toupet manoeuvre in the treatment of BPPV of posterior semicircular canal and may be preferential in patients with limited body movements.

Comentario sobre «Vértigo posicional paroxístico benigno y su tratamiento con maniobras de reposicionamiento: revisión sistemática» / Comments on «Benign paroxysmal postional vertigo and its treatment with repositioning manoeuvres: a systematic review»

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