A comparative study of two methods for treatment of benign paroxysmal positional vertigo in the emergency department.

INTRODUCTION: Posterior canal benign paroxysmal positional vertigo (PC-BPPV) is considered the most common cause of peripheral vertigo in the emergency department (ED). Although the canalith repositioning maneuver (CRM) is the standard of care, the most effective method to deliver it in the ED has been poorly studied. OBJECTIVE: To compare two protocols of the Epley maneuver for the treatment of PC-BPPV. PATIENTS AND METHODS: We prospectively recruited 101 patients with unilateral PC-BPPV on physical examination, randomizing them to either a single Epley maneuver (EM) (n = 46) or multiple maneuvers (n = 55) on the same visit. Measured outcomes included presence/absence of positional nystagmus, resolution of vertigo, and score on the dizziness handicap inventory (DHI) at follow-up evaluations. The DHI was stratified into mild (≤30) and moderate-severe (>30). RESULTS: Normalization of the Dix-Hallpike maneuver at day 5 was observed in 38% of the single EM group and 44.4% in the multiple EM group (p = 0.62). The DHI showed reduction from 42.2 (SD 18.4) to 31.9 (SD 23.7) in the single EM group and from 43.7 (SD 22.9) to 33.5 (SD 21.5) in the multiple EM group (p = 0.06). A higher number of patients improved from moderate-severe to mild DHI (p = 0.03) in the single EM group compared to the multi-EM group (p = 0.23). CONCLUSION: There was no statistically significant difference between performing a single EM versus multiple EMs for treatment of PC-BPPV in the emergency department. The single EM approach is associated with shorter physical contact between patients and examiner, which is logically safer in a pandemic context.

[The pharmacology of vestibular disorders]. / Farmacología de las alteraciones vestibulares.

INTRODUCTION: In recent years, significant advances have been made in the physiology and the pharmacology of vestibular disorders. It is now possible to elaborate an approximation of the mechanisms of action of the drugs used in the symptomatic treatment of vertigo. DEVELOPMENT: These drugs usually have a number of different pharmacological actions and overlapping effects. They can modify the intensity of the symptoms (e.g. vestibular suppressants) or prevent recurrences (e.g. calcium blockers in the case of vestibular migraine). Most of the drugs used for the acute treatment of vertigo can have a negative effect on the central compensation mechanisms. Vestibular rehabilitation exercises and certain drugs can speed up compensation. Choice of medication and the method of administration depend on the severity of the clinical symptoms, the pattern of temporal evolution, the underlying vestibular disease, the associated clinical conditions and the profile of the collateral effects of the drugs utilised. CONCLUSIONS: Vestibular suppressants and antiemetic drugs are still the basis of the acute treatment of vertigo.

[Neck vibration: usefulness in neurotology]. / Vibración cervical: utilidad neurootológica.

INTRODUCTION: Recently, mechanical vibration on the neck has begun to be used to improve diagnostic sensitivity in patients who have vestibular disorders. METHOD: We review results of studies of this stimulus in normal subjects and patients with vestibular lesions: the ocular responses, changes in the subjective straight ahead, and postural changes generated by the neck vibration. CONCLUSION: Although the underlying mechanism for the responses to neck vibration remains uncertain, it is an excellent addition to the neurotologic exam since it allows us demonstrate vestibular deficit with greater sensitivity than other maneuvers. As vibration is easy to apply it can be useful for screening in patients who complain of dizziness.