Benign Paroxysmal Positional Vertigo of Lateral Semicircular Canal: A Systematic Review and Meta-Analysis

Aly M Nagy El-Makhzangy

doi:10.1155/2015/465095

Abstract

Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo of peripheral origin. The lateral semicircular canal (LSCC) follows the posterior semicircular canal (PSCC) as the site of pathology in the majority of patients. Therapy, aiming at relocating particles causing aberrant LSCC stimulation has been applied by forced prolonged positioning, barbecue, and particle repositioning maneuvers. Results of the different techniques are variable. This systematic review/meta-analysis aimed to find out which therapy technique yields higher cure rates. MedLine database provided at National Library of Medicine was searched for randomized controlled trials comparing results of different therapeutic techniques for patients with LSCC BPPV. For studies included in qualitative analysis/synthesis, the following were collected independently by the author: number of participants, count of patients with geotropic and apogeotropic LSCC in each treatment group, and resolution of vertigo/nystagmus assessed by symptomatic improvement and negative supine roll test 1–24 hours following intervention considering the type of LSCC BPPV (geotropic/apogeotropic). Level Ia evidence (systematic review of RCTs) shows superiority of Gufoni maneuver over sham for both geotropic and apogeotropic LSCC BPPV. Comparisons between different therapeutic maneuvers for LSCC BPPV based on results of published RCTs could not be set.

Highlights

Benign paroxysmal positional vertigo (BPPV) is the commonest cause of peripheral vertigo [1]
Cupulolithiasis [2] and canalolithiasis [3] of the semicircular canals are the theories of the underlying mechanisms
Electronic search of MedLine database is available at the National Library of Medicine (NLM) on December, 25, 2013, using the following terms: Odds ratio (OR) in all fields limiting the type of studies to randomized clinical trials

Summary

Introduction

Benign paroxysmal positional vertigo (BPPV) is the commonest cause of peripheral vertigo [1]. Cupulolithiasis [2] and canalolithiasis [3] of the semicircular canals are the theories of the underlying mechanisms. The lateral semicircular canal (LSCC) follows (21–31%) [6,7,8]. LSCC BPPV presents with short-lived, repeating attacks of head spinning sensation on turning the head, or whole body, while lying down, nausea, and vomiting, usually with no hearing affliction or neurological manifestations. The supine roll test (SRT) [9] confirms the diagnosis, helps to determine method of treatment, and shows its success, or otherwise. The test is performed by briskly turning the head of the patient in the supine position, approximately 90∘ to each side. The examiner notes whether the resulting nystagmus beats towards or away from the ground (geotropic or apogeotropic, resp.) and to which side it is more intense, left or right

Methods

Results

Conclusion