Humanistic Care in Clinical Diagnosis and Treatment of Elderly Benign Paroxysmal Positional Vertigo Patients / 中国医学伦理学

Benign paroxysmal positional vertigo (BPPV) is a peripheral vestibular disease with the highest incidence rate, and the elderly are the high incidence population. Particle repositioning maneuver, simple and practicable, and has good clinical effects, is recognized as the preferred treatment method for BPPV. However, the elderly patients have a higher prevalence rate, often suffer from multiple chronic diseases, and their various bodily functions have entered a declining stage, with poor response to treatment and a tendency to recur. Based on these, medical staff should continuously improve their professional abilities, and pay attention to and implement some comprehensive and multi-dimensional humanistic care measures from physiological to psychological aspects such as verbal encouragement, behavioral support, and spiritual integration during the diagnosis and treatment process, to improve the quality of life of elderly BPPV patients, reduce medical disputes, and save medical resources.

Complex benign horizontal canal positional vertigo: new perceptual management

Abstract Objective: Horizontal semicircular canal site pathology of benign paroxysmal positional vertigo demonstrating three types of nystagmi on positional test were studied. We have attempted to design a protocol for its diagnosis and treatment. Methods: 320 patients of HSC-BPPV were subjected to two types of positional tests. Of these, patients with bilateral steady apogeotropic nysatgmus were treated with VAV modification of Semont's maneuver. Patients with unsteady or changing apo/geotropic signs were converted into steady geotropic ones by repetitive positional tests; followed by barbecue maneuver with forced prolong positioning. Results: Overall 88% of patients had a total recovery. 92% of patients with geotropic nystagmus showed no symptoms after second maneuveral sitting. 85% of patients with apogeotropic nystagmus recovered fully after third maneuveral sitting. Conclusion: Correct identification of subtypes of HSC-BPPV is based on provoked nystagmus by positional tests. After locating the site and side on the basis of nystagmic pattern, physician can apply the appropriate PRM. Level of evidence: II a.

Complex benign horizontal canal positional vertigo: new perceptual management.

OBJECTIVE: Horizontal semicircular canal site pathology of benign paroxysmal positional vertigo demonstrating three types of nystagmi on positional test were studied. We have attempted to design a protocol for its diagnosis and treatment. METHODS: 320 patients of HSC-BPPV were subjected to two types of positional tests. Of these, patients with bilateral steady apogeotropic nysatgmus were treated with VAV modification of Semont's maneuver. Patients with unsteady or changing apo/geotropic signs were converted into steady geotropic ones by repetitive positional tests; followed by barbecue maneuver with forced prolong positioning. RESULTS: Overall 88% of patients had a total recovery. 92% of patients with geotropic nystagmus showed no symptoms after second maneuveral sitting. 85% of patients with apogeotropic nystagmus recovered fully after third maneuveral sitting. CONCLUSIONS: Correct identification of subtypes of HSC-BPPV is based on provoked nystagmus by positional tests. After locating the site and side on the basis of nystagmic pattern, physician can apply the appropriate PRM. LEVEL OF EVIDENCE: II a.

Benign paroxysmal positional vertigo.

OBJECTIVES: Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular end-organ disease. This article aims to summarize research findings and key discoveries of BPPV. The pathophysiology, diagnosis, nonsurgical, and surgical management are discussed. METHODS: A comprehensive review of the literature regarding BPPV up through June 2018 was performed. RESULTS: BPPV is typified by sudden, brief episodes of vertigo precipitated by specific head movements. While often self-limited, BPPV can have a considerable impact on quality of life. The diagnosis can be established with a Dix-Hallpike maneuver for the posterior and anterior canals, or supine roll test for the horizontal canal, and typically does not require additional ancillary testing. Understanding the pathophysiology of both canalithiasis and cupulolithiasis has allowed for the development of various repositioning techniques. Of these, the particle repositioning maneuver is an effective way to treat posterior canal BPPV, the most common variant. Options for operative intervention are available for intractable cases or patients with severe and frequent recurrences. CONCLUSIONS: A diagnosis of BPPV can be made through clinical history along with diagnostic maneuvers. BPPV is generally amenable to in-office repositioning techniques. For a small subset of patients with intractable BPPV, canal occlusion can be considered. LEVEL OF EVIDENCE: N/A.

Home particle repositioning maneuver to prevent the recurrence of posterior canal BPPV.

OBJECTIVE: To check the value of home particle repositioning maneuver in the prevention of the recurrence of posterior canal benign paroxysmal positional vertigo (pc-BPPV). METHODS: In this study, patients diagnosed as unilateral posterior canal BPPV were selected following an accurate evaluation using video goggle VNG system. All patients were managed by particle repositioning maneuver (PRM). Patients were instructed to do home PRM once weekly for five years. Then, they were divided into two groups (according to choice of patient to do PRM). The first group (control group) consisted of 144 patients who did not do home PRM; whereas the second group (study group) included 165 patients who performed home PRM. All patients (control & study groups) were followed up every four months for five years. RESULTS: The study found out that the recurrence rate of pc-BPPV in control group was 33 patients in the first year (27.2%), 11 patients in second year (9%), 5 patients in third year (4%), 3 patients in fourth year (2.5%) and 3 patients in fifth year (2.5%). The recurrence of pc-BPPV in the treated side (study group) of patients was reported as 5 patients in the first year (3.5%), 3 patients in the second year (2%), 2 patients in the third year (1.4%), 2 patients in the fourth year (1.4%), and 1 patient in the fifth year (0.7%). There was statistically significant difference between the control and the study groups regarding the recurrence rates in the first year follow up which was the highest in first four months. CONCLUSION: Home particle repositioning maneuver has the capacity to prevent the recurrence of pc-BPPV. It proved to be more successful and functional in minimizing the recurrence of the disease in the study than in the control group. Hence, home particle repositioning maneuver is highly recommended for one year at least in pc-BPPV.

Risk Factors for Treatment Failure in Benign Paroxysmal Positional Vertigo / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Particular repositioning maneuver (PRM) have been recommended as a treatment of benign paroxysmal positional vertigo (BPPV). Some patients require multiple treatments for remission, although most of the patients are treated at the first trial of single maneuver. The purpose of this study was to evaluate risk factors for the treatment failure in patients with posterior canal BPPV (p-BPPV) and horizontal canal BPPV (h-BPPV). SUBJECTS AND METHOD: Retrospective review was performed for the 287 patients diagnosed as BPPV visiting the dizziness clinic between February 2011 and August 2012. The diagnostic criteria for BPPV were met by following the guidelines provided by the American Academy of Otolaryngology-Head and Neck Surgery. Patients were classified into two groups: Group 1 (treatment success) that requires only 1 PRM and Group 2 (treatment failure) that requires more than 2 PRMs. We analyzed the relationship between treatment failure and the clinical characteristics, and studied the etiology of BPPV. RESULTS: The study included 183 patients with p-BPPV, 54 patients with h-BPPV (geotropic type), and 50 patients with h-BPPV (apogeotropic type). The type of BPPV and average numbers of PRM required for remission were significantly related with treatment failure by statistical analysis (p<0.05, respectively). Statistically significant correlation was demonstrated between the history of ipsilateral inner ear viral infection (acute vestibular neuritis, sudden sensorineural hearing loss) and treatment failure (p<0.05). CONCLUSION: Multiple PRMs may be required in patients with h-BPPV (apogeotropic type) or with secondary BPPV caused by ipsilateral inner ear viral disease. Clinically, this information may be used to provide helpful information for clinicians performing PRM to treat BPPV.