Optimal management of benign paroxysmal positional vertigo patients: An unmet need.

Heena Naqash,S Bashir Ahmad,Sheikh Hilal Ahmad,Tak Sajad

doi:10.33883/jms.v22i1.419

Abstract

Background Benign paroxysmal positional vertigo (BPPV) is considered to be the most common type of vertigo. There is strong evidence supporting the role of Dix Hallpike maneuver in diagnosing BPPV, and canalith repositioning maneuver CRM in managing it; but these maneuvers are underutilized. Material and methods: A prospective study was conducted in the Department of Neurology in a tertiary care center referral hospital in Kashmir, north India. All the patients of vertigo diagnosed as BPPV were included in study. History and examination was done and patients were followed to see the response of treatment. There referrals notes, previous records were checked for the diagnosis, treatment and investigations done for managing their complaints were studied and recorded. Results: Out of total of 101 patients diagnosed as BPPV, 77 were females and 24 were males with M:F ratio as 1: 3.2 . The frequency of various subtypes of BPPV were: posterior canal in 96 patients, horizontal canal in 4 and anterior canal in one. On reviewing records of patients only 10% of had been given diagnosis of BPPV .All patients had been treated with labyrinthine sedatives and other medications and none had been offered CRM.84% patients had undergone various unnecessary investigations . Conclusion. A vast majority of patients with BPPV don’t get an accurate diagnosis in their first contact with health care professionals. Most of the patients undergo unnecessary investigations .CRMs like Epley’s maneuver are not offered to BPPV patients even though they are the standard of care in this condition.

Highlights

Benign paroxysmal positional vertigo (BPPV) is considered to be the most common type of vertigo with a lifetime prevalence of 2.4%.1The posterior semicircular canal (PSC), being the most gravity-dependent canal, accounts for 85 to 95% of the BPPV cases.[2]
Quality of life especially if it is recurring .The diagnosis of BPPV is made by a simple bedside test known as DixHallpike maneuver (DHM). 6Despite having a strong evidence supporting the role of DHM and Canalith Repositioning Maneuvers (CRM) in managing BPPV, these maneuvers are underutilized. 7,8 MATERIALAND METHODS A prospective study was conducted in the outpatient clinic
Horizontal canal BPPV was diagnosed in 4 patients on roll test and one patient was diagnosed as having anterior canalalithiasis on head hanging test

Summary

INTRODUCTION

Benign paroxysmal positional vertigo (BPPV) is considered to be the most common type of vertigo with a lifetime prevalence of 2.4%.1The posterior semicircular canal (PSC), being the most gravity-dependent canal, accounts for 85 to 95% of the BPPV cases.[2]. Optimal management of benign paroxysmal positional vertigo patients: An unmet need. Sheikh HA; et al; Optimal management of benign paroxysmal positional vertigo patients of Department of Neurology in a tertiary care center referral hospital in Kashmir, north India. Patients having physical disabilities in which it was not possible to perform diagnostic and treatment maneuvers were excluded from the study. Other causes of vertigo apart from BPPV both central and peripheral were treated as per hospital protocol and were excluded from the study. Patients were reviewed after 7 days ; positional test was repeated and if symptoms persisted CRM was repeated again and patients re-examined weekly till BPPV was cured. History of previous treatment was reviewed; and following things were recorded including diagnosis made, delay between onset of symptoms and reporting to us, medications prescribed, investigations done, and any procedures attempted before being referred was recorded

RESULTS

DISCUSSION

CONCLUSION