A Comparison of the Efficacy of Four Repositioning Maneuvers in the Treatment of Posterior Benign Paroxysmal Positional Vertigo.

PURPOSE: The purpose of the present review was to report the effectiveness of Epley maneuver compared to other manual repositioning maneuvers (RM) for treatment of posterior benign paroxysmal positional vertigo (P-BPPV). A systematic search of PubMed, Embase, and the Cochrane Library was conducted up until June 30, 2023. RESULTS: Primary outcomes focused on complete resolution of vertiginous symptoms measured by either a Visual Analog Scale (VAS) or the Dix-Hallpike (DH) test. Secondary outcomes included conversion of a positive DH test to a negative DH test exclusively looking at positional nystagmus and assessment of side effects (cervical/back pain, posttreatment dizziness, and nausea). Both outcomes were assessed within a maximum of 4-week follow-up. Following systematic search and review, nine randomized controlled trials (RCTs; p = .413) were found. The studies reported on the effectiveness of the Epley maneuver compared to three other specific RM: Semont, Li, and Gans maneuvers. Results revealed a low to very low certainty of evidence. With the primary outcomes, Epley maneuver was superior to Gans maneuver 24-hr posttreatment but not after 1 week. No significant differences were found between the remaining maneuvers. CONCLUSIONS: In summary, evidence of low to very low certainty indicates that Epley maneuver is comparable with Semont, Gans, and Li maneuvers for vertiginous symptoms in patients with P-BPPV. Further high-quality studies are needed.

Very Early Loading of a Bone-Anchored Hearing System Is Safe.

OBJECTIVE: To investigate the feasibility of early sound processor loading with two separate bone-anchored hearing aid implants 1 to 2 weeks after implantation. Secondary endpoints included registration of any postoperative complications, skin reactions, and any adverse events. STUDY DESIGN: Prospective, nonrandomized, noncontrolled, multicenter clinical trial. SETTING: Tertiary referral center. PATIENTS: Sixty adult patients, eligible for bone-anchored hearing aid surgery, were enrolled. INTERVENTION: Implantation of the bone-anchored hearing aid implants were done using minimally invasive surgery with tissue preservation. MAIN OUTCOME MEASURE: Implant stability quotient (ISQ) values were recorded using resonance frequency analysis. Follow-ups were scheduled 5 to 12 days, 4 to 8 weeks, 6 months, and 12 months postoperatively. Differences between the lowest ISQ values (ISQ low) over time were analyzed by paired-samples t test with a significance level of 0.05. Skin and soft tissue reactions were assessed according to Holger's classification. RESULTS: Loading time of the Ponto Wide implant was 11.6 ± 1.4 days (SD) in average (median, 12 d; range, 7-19 d). Loading of the Ponto BHX implant was done 9.7 ± 3.5 days (SD) postoperatively (median, 9 d; range, 5-19 d). The implant stability increased significantly during the 12-month study period with both implants. One Ponto BHX implant was lost. Skin and soft tissue reactions were few in both groups. Across all planned follow-up visits, no skin and soft tissue reactions were observed in 86% (Ponto BHX implant) and 85% (Ponto Wide implant). CONCLUSION: Very early loading of sound processors after percutaneous bone-anchored hearing system surgery is safe already 1 to 2 weeks postoperatively.

Individualized repositioning with a mechanical rotational chair facilitates successful treatment of patients with very retractable benign paroxysmal positional vertigo.

BACKGROUND: About 12.5 % of patients diagnosed with benign paroxysmal positional vertigo (BPPV), experience persistent BPPV where it is unknown why some BPPV cases are very refractory (vrBPPV) to treatment. OBJECTIVES: The primary objective was to investigate if patients with vrBPPV could be successfully treated with a mechanical rotation chair (MRC) adjusted to the exact vertical semicircular canal (SCC) angles of the individual patient. Secondary endpoint was to determine if inner ear anomalies were predominant in these patients. METHODS: This prospective clinical trial included 20 patients (main group) who underwent computed tomography (CT) with measurements of the bony island and the width between the SCC walls of the posterior leg of the lateral SCCs. The inter-SCC angles, the angles between the sagittal plane and the vertical SCCs were compared to the presumed mean standard angles of the SCCs. Of these, 14 patients (subgroup) underwent individualized treatment with the Rotundum® repositioning chair according to their measured SCC angles. RESULTS: All measured SCC angles differed significantly (p < 0.05) from the presumed mean standard SCC angles, except the angle between the sagittal plane and the left posterior SCC (p-SCC). Three out of 14 patients experienced subjective and objective remission after treatment with this MRC. Six out of 14 patients experienced either subjective remission or objective remission. CONCLUSIONS: Patients with vrBPPV have vertical SCC angles that differ significantly from the presumed mean standard SCC angles. Individualized treatment with this MRC successfully treated 21.4 % of the patients with vrBPPV and provided subjective relief for 42.9 %.

Remote screening accuracy of first-time hearing aid users.

INTRODUCTION: Capacity constraints in Danish hearing healthcare may lead to diagnostic delays and repetitive pre-treatment audiological exams for hearing-impaired patients. This study investigated the effectiveness of remote ear-nose-throat (ENT) specialist assessments (RESA) for complicated hearing loss, comparing the accuracy of private ENT specialists and medical audiologists. METHODS: RESA screening accuracy was determined for four ENT specialists, individually and as subspecialised groups. These assessments were benchmarked against "gold standard" in-person ENT assessments for 445 potential adult first-time hearing aid users. RESULTS: Medical audiologists initially recorded lower RESA screening specificity and positive predictive values than private ENT specialists. However, after making two adjustments to the dataset, these differences were neutralised. Screening sensitivity was consistent across individual and grouped subspecialities. CONCLUSIONS: RESA screening is a promising tool for timely diagnosis and treatment. The findings reveal that both private ENT specialists and medical audiologists may conduct RESA with high consistency and uniformity. FUNDING: This research was funded by the Danish Health Data Authority and the North Denmark Region, but does not reflect their views. The study received no commercial support. TRIAL REGISTRATION: Not relevant.

Positional nystagmus is observed in the vast majority of healthy individuals.

INTRODUCTION: Benign paroxysmal positional vertigo (BPPV) is a vestibular disease characterized by brief  positional vertigo. When examined, characteristic patterns of positional nystagmus (PN) are found with specific head position changes. Previous studies have shown a high prevalence of PN among vestibular healthy subjects. Considering the current diagnostic criteria of BPPV and the potentially high prevalence of PN in healthy individuals, this raises the question of potential over diagnosing BPPV, if diagnostics are based exclusively upon objective findings. This study aims to determine the prevalence of PN within a healthy, adult population and furthermore include a characterization of the PN observed. METHODS: This is a prospective cross-sectional study. 78 subjects were included. The subjects underwent four standardized positional tests for BPPV in a mechanical rotational chair while using a VNG-goggle to monitor and record eye movements. RESULTS: Positional nystagmus was recorded in 70.5% (55/78) of the subjects. Of the 55 subjects, who presented with PN, 81.8% (45/55) had upbeating PN. The 95th percentile of the maximum a-SPV was found to be 10.4 degrees per second, with a median of 4. Five subjects (6.4%) in total presented with PN mimicking BPPV. CONCLUSION: This study found PN to be a common finding within a healthy, adult population based on the high prevalence of PN in the study population. Upbeating PN mimicking posterior canalolithiasis was found in numerous subjects. The authors recommend a cautious approach when diagnosing BPPV, especially in cases of purely vertical PN (without a torsional component) and if no vertiginous symptoms are present during Dix-Hallpike and Supine Roll Test examinations.

Auditory Profile-Based Hearing Aid Fitting: Self-Reported Benefit for First-Time Hearing Aid Users.

Background: Although hearing aids (HAs) can compensate for reduced audibility, functional outcomes and benefits vary widely across individuals. As part of the Danish 'Better hEAring Rehabilitation' (BEAR) project, four distinct auditory profiles differing in terms of audiometric thresholds and supra-threshold hearing abilities were recently identified. Additionally, profile-specific HA-fitting strategies were proposed. The aim of the current study was to evaluate the self-reported benefit of these profile-based HA fittings in a group of new HA users. Methods: A total of 205 hearing-impaired older adults were recruited from two Danish university hospitals. Participants were randomly allocated to one of two treatment groups: (1) NAL-NL2 gain prescription combined with default advanced feature settings ('reference fitting') or (2) auditory profile-based fitting with tailored gain prescription and advanced feature settings ('BEAR fitting'). Two months after treatment, the participants completed the benefit version of the short form of the Speech, Spatial, and Qualities of Hearing Scale (SSQ12-B) and the International Outcome Inventory for Hearing Aids (IOI-HA) questionnaire. Results: Overall, participants reported a clear benefit from HA treatment. However, no significant differences in the SSQ12-B or IOI-HA scores between the reference and BEAR fittings were found. Conclusion: First-time users experience clear benefits from HA treatment. Auditory profile-based HA fitting warrants further investigation.

The co-existence of peripheral and vestibular neuropathy in diabetes: a cross-sectional study.

PURPOSE: Diabetic neuropathy can lead to decreased peripheral sensation and motor neuron dysfunction associated with impaired postural control and risk of falling. However, the relationship between decreased peripheral sensation and impaired vestibular function in diabetes mellitus is poorly investigated. Therefore, the aim of this study was to investigate the relationship between peripheral and autonomic measurements of diabetic neuropathy and measurements of vestibular function. METHODS: A total of 114 participants with type 1 diabetes (n = 52), type 2 diabetes (n = 51) and controls (n = 11) were included. Vestibular function was evaluated by video head impulse testing. Peripheral neuropathy was assessed by quantitative sensory testing and nerve conduction. Autonomic neuropathy using the COMPASS 31 questionnaire. Data were analyzed according to data type and distribution. RESULTS: Measurements of vestibular function did not differ between participants with type 1 diabetes, type 2 diabetes or controls (all p-values above 0.05). Subgrouping of participants according to the involvement of large-, small- or autonomic nerves did not change this outcome. Correlation analyses showed a significant difference between COMPASS 31 and right lateral gain value (ρ = 0.23, p = 0.02,), while no other significant correlations were found. CONCLUSION: Diabetic neuropathy does not appear to impair vestibular function in diabetes, by means of the VOR. CLINICAL TRIALS: NCT05389566, May 25th, 2022.

Effects of remote ear-nose-and-throat specialist assessment screening on self-reported hearing aid benefit and satisfaction.

OBJECTIVE: To explore the impact of remote versus in-person ear-nose-and-throat (ENT) specialist screening before hearing treatment on self-reported hearing aid (HA) benefit and satisfaction among adult first-time HA users. DESIGN: Participants were randomised to either remote or in-person ENT assessment before treatment initiation. Hearing ability, hearing quality, and treatment satisfaction were assessed pre- and post-HA treatment using the SSQ12, IOI-HA, and selected items from the 2021 Danish national Patient-Reported Experience Measures. Average daily HA usage was also recorded. STUDY SAMPLE: 751 adult potential first-time HA users with self-reported hearing impairment were included; 501 participants were remotely assessed in private or public audiological clinics, and 250 control group participants were assessed in-person by private ENT specialists. Of the 658 participants who completed the entire trial, 454 received HAs. RESULTS: No significant post-treatment HA benefit differences were found between groups. Remotely assessed HA recipients in private clinics expressed slightly higher staff and waiting time satisfaction. Participants with normal hearing and mild/moderate hearing loss reported higher pre-treatment hearing ability and quality. No significant difference in average daily HA usage was observed between groups. CONCLUSIONS: Findings suggest that remote screening does not compromise patient-reported HA benefit and satisfaction when compared to in-person screening.

Difference in SII provided by initial fit and NAL-NL2 and its relation to self-reported hearing aid outcomes.

OBJECTIVE: The speech intelligibility index (SII) is used to quantify the audibility of the speech. This study examined the relationship between self-reported hearing aid (HA) outcomes and the difference in aided SII (SIIA) calculated from the initial fit (IF) gain and that prescribed as per the second generation of National Acoustic Laboratory Non-Linear (NAL-NL2). DESIGN: A prospective observational study. STUDY SAMPLE: The study included 718 first-time and 253 experienced HA users. All users had a valid real-ear measurement (REM) at three input levels (55, 65 and 80 dB SPL). RESULTS: The gain provided by IF was lower than NAL-NL2 at 55 and 65 dB SPL. IF gain exhibited reduced compression than NAL-NL2 as input levels increased from 55 to 80 dB SPL. On average, the SIIA provided by IF was significantly lower than that for NAL-NL2 at all input levels. The difference in SIIA between IF and NAL-NL2 at 80 dB SPL input level with 0 dB signal-to-noise ratio (SNR) turned out to be a predictor for self-reported outcome for first-time HA users. CONCLUSION: The study suggests that an SIIA close to that provided by NAL-NL2 at high input levels would be preferred to obtain a better self-reported outcome. .

A history of occupational noise exposure is associated with steep-slope audiograms and poorer self-reported hearing-aid outcomes.

OBJECTIVE: To investigate the effects of previous occupational noise exposure in older adults with hearing loss on (1) audiometric configuration and acoustic reflex (AR) thresholds and (2) self-reported hearing abilities and hearing aid (HA) effectiveness. DESIGN: A prospective observational study. STUDY SAMPLE: The study included 1176 adults (≥60 years) with bilateral sensorineural hearing loss. Pure-tone audiometry, AR thresholds, and responses to the abbreviated version of the Speech, Spatial, and Qualities of Hearing Scale (SSQ12) and the International Outcome Inventory for Hearing Aids (IOI-HA) questionnaire were obtained, along with information about previous occupational noise exposure. RESULTS: Greater occupational noise exposure was associated with a higher prevalence of steeply sloping audiograms in men and women and a 0.32 (95% CI: -0.57; -0.06) scale points lower mean SSQ12 total score among noise-exposed men. AR thresholds did not show a significant relation to noise-exposure status, but hearing thresholds at a given frequency were related to elevated AR thresholds at the same frequency. CONCLUSIONS: A noise exposure history is linked to steeper audiograms in older adults with hearing loss as well as to poorer self-reported hearing abilities in noise-exposed men. More attention to older adults with previous noise exposure is warranted in hearing rehabilitation.

Cross-Cultural Translation and Adaptation of the Consumer Ear Disease Risk Assessment (CEDRA) Questionnaire in Danish.

This study aimed to cross-culturally translate and adapt the Consumer Ear Disease Risk Assessment (CEDRA) questionnaire into Danish for remote ear, nose, and, throat assessments in adult, first-time hearing aid users when used in conjunction with audiometric measures and visual images of the tympanic membrane. Employing field-specific guidelines, the tool underwent a rigorous translation process. This was succeeded by field testing via cognitive debriefing with 30 intendent respondents and a pilot test involving 600 adult, potential first-time hearing aid users from 2020-2022. Test-retest reliability analysis in 113 respondents revealed high consistency and reproducibility, with most items showing Spearman's correlation coefficients of 0.82 or higher and a Pearson's correlation of 0.92 for the total score. The tool demonstrated moderate discriminative ability in identifying individuals at high and low risk of complicated hearing loss and targeted ear diseases, supported by an area under the curve of 0.82 on the receiver operating characteristics curve. Our findings suggest that the Danish-translated version of CEDRA is a reliable and effective screening instrument when used with audiometry and tympanometry, warranting further validation in a larger population.

Treatment of posterior Benign Paroxysmal Positional Vertigo is efficient and safe with a new Mechanical Rotational Chair.

Background: Benign paroxysmal positional vertigo (BPPV) is the most predominant vestibular disease. Previously, in the management of BPPV, both therapeutic and diagnostic benefits with mechanical rotation chairs (MRCs) have been reported. However, no previous studies have examined the efficacy of MRC treatment with a fairly new MRC. Methods: Randomized three-armed parallel open-labeled prospective clinical trial. One hundred and five patients diagnosed with posterior BPPV underwent diagnostics and treatment with an MRC. Patients were randomized to either a Semont maneuver, an Epley maneuver or a 360-degree backwards somersault maneuver. Primary endpoint was to evaluate the efficiency of an MRC in the treatment of posterior BPPV with three separate treatment modalities. Secondary objectives included subjective vertigo assessments. Results: BPPV treatment with this MRC is very efficient with success rates up to 97.1 percent. The number of treatments required to achieve complete resolution of both objective findings and subjective symptoms was 1.5. Almost 47 percent of patients experienced complete resolution of both subjective and objective measures following one (first) treatment. All Dizziness Handicap Inventory scores decreased significantly post-treatment. Conclusion: Treatment of posterior BPPV, with the MRC used in this study, was very efficient with both the Semont, the Epley, and the 360-degree backwards somersault maneuver. Based on the findings in this study, this fairly new MRC seems both effective and safe to use.

Impact of hearing aid technology level at first-fit on self-reported outcomes in patients with presbycusis: a randomized controlled trial.

To provide clinical guidance in hearing aid prescription for older adults with presbycusis, we investigated differences in self-reported hearing abilities and hearing aid effectiveness for premium or basic hearing aid users. Secondly, as an explorative analysis, we investigated if differences in gain prescription verified with real-ear measurements explain differences in self-reported outcomes. The study was designed as a randomized controlled trial in which the patients were blinded towards the purpose of the study. In total, 190 first-time hearing aid users (>60 years of age) with symmetric bilateral presbycusis were fitted with either a premium or basic hearing aid. The randomization was stratified on age, sex, and word recognition score. Two outcome questionnaires were distributed: the International Outcome Inventory for Hearing Aids (IOI-HA) and the short form of the Speech, Spatial, and Qualities of Hearing Scale (SSQ-12). In addition, insertion gains were calculated from real-ear measurements at first-fit for all fitted hearing aids. Premium hearing aid users reported 0.7 (95%CI: 0.2; 1.1) scale points higher total SSQ-12 score per item and 0.8 (95%CI: 0.2; 1.4) scale points higher speech score per item, as well as 0.6 (95%CI: 0.2; 1.1) scale points higher qualities score compared to basic-feature hearing aid users. No significant differences in reported hearing aid effectiveness were found using the IOI-HA. Differences in the prescribed gain at 1 and 2 kHz were observed between premium and basic hearing aids within each company. Premium-feature devices yielded slightly better self-reported hearing abilities than basic-feature devices, but a statistically significant difference was only found in three out of seven outcome variables, and the effect was small. The generalizability of the study is limited to community-dwelling older adults with presbycusis. Thus, further research is needed for understanding the potential effects of hearing aid technology for other populations. Hearing care providers should continue to insist on research to support the choice of more costly premium technologies when prescribing hearing aids for older adults with presbycusis. Clinical Trial Registration: https://register.clinicaltrials.gov/, identifier NCT04539847.

The effect of hearing aid treatment on health-related quality of life in older adults with hearing loss.

OBJECTIVE: To investigate the effect of hearing aid (HA) intervention on long-term health-related quality of life (HRQoL) changes in first-time and experienced HA users using the 15D questionnaire. Secondly, the study explored the relationship between clinical parameters and changes in 15D scores. DESIGN: A prospective observational study. STUDY SAMPLE: The study population included 1562 patients (1113 first-time and 449 experienced HA users) referred for HA rehabilitation. All patients responded to the 15D at baseline, two months after HA fitting, and at long-term follow-up (698 ± 298 d). RESULTS: Among both first-time and experienced HA users, significant improvements in hearing-dimension (15D-3) score were observed at two-month follow-up which sustained at long-term follow-up. 15D total scores significantly decreased at long-term follow-up. Self-reported hearing abilities, word recognition scores, and HA use time were significantly and positively correlated to increased 15D. CONCLUSIONS: Both groups of HA users reported improved hearing-related QoL after HA treatment which sustained at long-term follow-up but the improvement in total 15D total score did not sustain for either group. The results suggest that HA intervention positively affects hearing-related QoL among older adults with hearing loss, and the findings support the use of 15D as a tool for the evaluation of HA treatment effects.

Digital vs. physical ear-nose-and-throat specialist assessment screening for complicated hearing loss and serious ear disorders in hearing-impaired adults prior to hearing aid treatment: a randomized controlled trial.

Introduction: This study introduces a digital assessment tool for asynchronous and remote ear-nose-and-throat (ENT) specialist assessment screening for complicated hearing loss and serious ear disorders in hearing-impaired adults prior to hearing aid (HA) treatment. The +60 population will nearly double from 12% to 22% between 2015 and 2050 increasing the incidence of age-induced hearing impairment and the need for hearing rehabilitation. If un-diagnosed, age-related hearing loss negatively affects quality of life by accelerating social distancing and early retirement as well as increasing risk of anxiety, depression, and dementia. Therefore, innovative measures are essential to provide timely diagnostics and treatment. Methods: A total of 751 hearing-impaired adults without previous HA usage or experience were randomly assigned to digital or physical ENT specialist assessment screening prior to HA treatment initiation in 20 public and private hearing rehabilitation and ENT specialist clinics in the North Denmark Region. A total of 501 test group participants were assigned to digital assessment screening and 250 control group participants to physical assessment screening prior to HA treatment. Results: In all, 658 (88%) participants completed the trial and were eligible for analysis. Digital screening sensitivity (0.85, 95% confidence interval (CI) 0.71-0.94) was significantly higher than physical screening sensitivity (0.2, 95% CI: 0.03-0.56). Screening specificity was high for both assessment methods. Discussion: In a setting where hearing-impaired adults were assessed for HA treatment, digital ENT specialist assessment screening did not compromise patient safety or increase the risk of misdiagnosis in patients with complicated hearing loss and/or serious ear disorders when compared to physical ENT specialist assessment screening. Clinical Trial registration: https://clinicaltrials.gov/ct2/show/NCT05154539, identifier: NCT05154539.

Transient profound hearing loss and severe facial nerve palsy in schwannomas within the internal acoustic canal: A case report.

Vestibular schwannoma is the most common intracranial schwannoma and constitutes ~8% of all intracranial tumors in adults with an estimated incidence rate of ~1.3/100.000. Facial nerve schwannomas and cochlear nerve schwannomas are rare, and information regarding incidence rates of these is still missing in the literature. All three variants of nerve origin present most frequently with unilateral hearing loss, unilateral tinnitus and disequilibrium. Facial nerve palsy is a common finding in facial nerve schwannomas but a rare finding with vestibular schwannomas. The symptoms are normally persistent and often progress over time, leading to therapeutic interventions that predispose to quality of life-reducing morbidities, e.g., deafness and/or imbalance. The case report describes a 17-year-old male who, during a 1-month period, presented with profound unilateral hearing loss and severe facial nerve palsy followed by complete remission. An MRI scan showed a 5×8-mm schwannoma within the internal acoustic canal. Profound hearing loss together with concomitant severe peripheral facial nerve palsy in small schwannomas within the internal acoustic canal may show spontaneous and total remission within weeks of symptom debut. This knowledge, as well as possible remission of objective findings, should be considered before interventions with potential severe morbidity are suggested.

Soccer and Benign Paroxysmal Positional Vertigo.

Introduction. Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo among adults. The etiology of BPPV is unknown in approximately 50 percent of cases. This condition is also termed primary BPPV, if the etiology is unknown, and secondary BPPV if patients have identified predisposing factors. A few studies suggest that there is a correlation between the development of BPPV and specific sports. Case Report. A 19-year-old male presented with recurrent episodes of vertigo during soccer play. Eight months prior to referral, the patient was involved in a car accident with a mild head trauma. The patient was later diagnosed with BPPV several times. Discussion. Soccer might be a plausible BPPV trigger, especially if there is a prehistory of head trauma. This is most likely due to the demands of the game such as the change of directions, repetitive head impacts (headers or head collisions), accelerations/decelerations, jumps, foot landings, and rapid head movements.

A mechanical rotation chair provides superior diagnostics of benign paroxysmal positional vertigo.

Background: Benign paroxysmal positional vertigo (BPPV) is the most common vestibular disease. Both therapeutic and diagnostic benefits with mechanical rotation chairs (MRCs) for management of BPPV have been reported. No previous studies have compared diagnostics in MRCs to traditional diagnostics on an examination bed. Objective: To investigate the agreement between BPPV diagnostics performed with an MRC and traditional diagnostics on an examination bed. Secondary objectives were to (1) examine if the two test modalities differ in diagnostic properties when diagnosing largely untreated patients referred from general practitioners (uncomplicated BPPV) compared to patients referred from private ENTs (complicated BPPV) and (2) examine whether impaired participant cooperation during Manual Diagnostics (MDs) alters agreement, sensitivity and specificity. Method: Prospective randomized clinical trial in which patients with a case history of BPPV were recruited by referrals from general practitioners, otorhinolaryngologists and other hospital departments in the Northern Region of Denmark. Participants underwent diagnostic examinations twice: once by traditional MDs on an examination bed and once with an MRC. Initial examiner and order of test modality were randomized. Examiners were blinded to each other's findings. Results: When testing the ability to diagnose BPPV, agreement between the two test modalities, was 0.83, Cohen's kappa 0.66. When comparing MD diagnostics to MRC diagnostics (set as gold standard diagnostics following test result interpretation), values for MDs were: sensitivity 71%, specificity 98%, Negative Predictive Value 73%, and Positive Predictive Value 97%. Agreement regarding BPPV subtype classification was found to be 0.71, and Cohen's kappa 0.58. Agreement when isolating the diagnosis to posterior canalolithiasis (p-CAN) was 0.89, Cohen's kappa 0.78. Conclusion: Diagnostics, aided by an MRC, are more sensitive than traditional manual BPPV diagnostics. The overall agreement level between test modalities was found to be weak to moderate. When isolating diagnostics to p-CAN, the level of agreement increased to "moderate-strong." Results also showed higher agreement between test modalities and a significantly higher negative predictive value for MDs when examining patients referred directly from General Practitioners following no- or a single treatment attempt. The diagnostic properties of MDs improved in patients with a higher degree of cooperation.

Adding Kinetic Energy Does Not Further Improve Treatment Outcomes With a Mechanical Reposition Chair: A Randomized Controlled Trial.

OBJECTIVE: To test if the addition of abrupt deaccelerations (kinetic energy) during treatment with a mechanical repositional chair (MRC) provides improved treatment efficacy with treatment of posterior benign paroxysmal positional vertigo (BPPV). STUDY DESIGN: Randomized two-armed parallel open-labeled clinical trial. SETTING: Tertiary referral center. PATIENTS: Seventy patients diagnosed with posterior canalolithiasis BPPV were included. INTERVENTIONS: All patients underwent diagnostics and treatment with an MRC. Patients were randomized to either a traditional Epley maneuver or a potentiated version of the Epley maneuver where kinetic energy was applied in five positions with 45-degree turns between each step. MAIN OUTCOME MEASURES: Primary endpoint was the number of treatments needed before complete resolution of both subjective symptoms and objective signs of BPPV within the semicircular canal of interest. Secondary endpoints included the following: 1) number of patients requiring more than 10 treatments, 2) length of treatment in days before treatment(s) were successful, and 3) changes in total Dizziness Handicap Inventory scores before and after treatment. RESULTS: No significant difference in the number of required treatments between the two treatment arms was found. Approximately three of four subjects were cured after two repositional maneuvers regardless of type of treatment. An equal length of treatment was seen with both groups, and the Dizziness Handicap Inventory scores were significantly lowered after treatment with no significant differences between the two types of treatment. CONCLUSIONS: Both the traditional and the potentiated Epley maneuver are efficient in treatment of canalolithiasis of the posterior semicircular canals with MRC. Addition of kinetic energy with this subgroup of BPPV patients does not seem to add further efficacy to the treatment.

Incidence of Benign Paroxysmal Positional Vertigo and Course of Treatment Following Mild Head Trauma-Is It Worth Looking For?

BACKGROUND: This study aimed to identify the incidence of benign paroxysmal positional vertigo following head trauma. METHODS: This study is a prospective cross-sectional study. Initially, a targeted search for the identification of patients with the international classification of diseases (ICD-10) diagnosis of cerebral commotio at relevant emergency units in the Northern Region of Denmark was done. This was followed by a clinical examination to determine the incidence of benign paroxysmal positional vertigo (BPPV) within this population. Of the 295 patients diagnosed with commotio cerebri during a 4-and-a-half month period, 85 patients were included. All patients underwent clinical examination in a mechanical repositional chair wearing Video Frenzel Goggles. Additional examinations included a complete video head impulse test. RESULTS: A total of six patients were identified with benign paroxysmal positional vertigo (BPPV) following minor head trauma. Bilateral BPPV, multicanal BPPV, and BPPV of a single semicircular canal were identified. All patients experienced relief of benign paroxysmal positional vertigorelated symptoms within 3 treatment sessions. Five patients were identified with a pathological video head impulse test, 54 with an inconclusive examination, and 15 with a normal video head impulse test. CONCLUSION: The incidence of benign paroxysmal positional vertigo following minor head trauma was 7%. A relatively high number of atypical subtypes of benign paroxysmal positional vertigo was found. When applying strict criteria for the interpretation of video head impulse test examination, the number of patients with inconclusive video head impulse test examination was higher than expected and 6.7% of patients had a pathological video head impulse test examination. No relationship between benign paroxysmal positional vertigo and pathological video head impulse test was observed.