The BPPV-SQ: Development and Clinical Evaluation of a Brief Screening Questionnaire for Benign Paroxysmal Positional Vertigo.

Analysis of patient variables including socioeconomic indicators and their association with recurrence rates and persistence of benign paroxysmal positional vertigo: A retrospective case series.

Introduction: Benign paroxysmal positional vertigo (BPPV) stands as the most common cause of peripheral vertigo. Its treatment with repositioning maneuvers on an examination table is highly effective. However, patients with back or neck problems, paraplegia, or other conditions face challenges with these maneuvers, potentially experiencing longer healing times and creating additional difficulties for physicians diagnosing and treating BPPV in everyday practice. The emergence of mechanical rotational chairs (MRCs) offers a more convenient alternative for performing these maneuvers. Objectives: The primary objective was to compare the effectiveness of maneuvers on the examination table with those on MRCs in BPPV patients diagnosed in the emergency room and randomly classified into one of the treatment options. The secondary objectives included a comparison of patient quality of life during BPPV episodes and after their resolution and an analysis of recurrences and associated risk factors. Methods: This was a cohort study on sixty-three patients diagnosed with BPPV in the emergency department. Patients were classified into two cohorts depending on diagnostic and treatment maneuvers (MRC or conventional repositioning maneuvers (CRMs)) and received weekly follow-ups until positioning maneuvers became negative. Subsequent follow-ups were conducted at 1 month, 3 months, and 6 months after the resolution of vertigo. Patients were classified into two groups based on their assigned treatment method. Results: Thirty-one patients were treated with CRMs and 32 with TRV. Mean age was 62.29 ± 17.67 years and the most affected canal was the PSC (96.8%). The mean number of required maneuvers was two, while 55.56% only required one maneuver until resolution. Recurrence was present in 26.98% of the patients during the 6-month follow-up. Comparing both cohorts, there were no statistically significant differences between treatments (TRV vs. CRM) regarding the number of maneuvers, number of recurrences, and days until remission of BPPV. Dizziness Handicap Inventory and Visual Analogue Scale values decreased considerably after BPPV resolution, with no statistically significant differences between the groups. Age was identified as a covariable in the number of maneuvers and days until BPPV resolution, showing that an increase in age implies a greater need of maneuvers. Conclusions: There was no difference between the means of treatment for BPPV in our population ot There was no difference between the groups of treatments for BPPV in our population. The quality of life of patients improved six months after the resolution of BPPV, regardless of the treatment applied.

Dizziness can be classified mainly into 4 types: vertigo, disequilibrium, presyncope, and lightheadedness. Among these types, vertigo is a sensation of movement or motion due to various causes. The main causes of peripheral vertigo are benign paroxysmal positional vertigo (BPPV), acute vestibular neuritis (AVN), and Meniere’s disease. BPPV is one of the most common causes of peripheral vertigo. It is characterized by brief episodes of mild to intense vertigo, which are triggered by specific changes in the position of the head. BPPV is diagnosed from the characteristic symptoms and by observing the nystagmus such as in the Dix-Hallpike test. BPPV is treated with several canalith repositioning procedures. AVN is the second most common cause of peripheral vertigo. Its key symptom is the acute onset of sustained rotatory vertigo without hearing loss. It is treated with symptomatic therapy with antihistamines, anticholinergic agents, antidopaminergic agents, and gamma-aminobutyric acid-enhancing agents that are used for symptoms of acute vertigo. Meniere’s disease is characterized by episodic vertigo, fluctuating hearing loss, and tinnitus. It is traditionally relieved with life-style modification, a low-salt diet, and prescription of diuretics. However, diagnosis and treatment of the peripheral vertigo can be difficult without knowledge of BPPV, AVN, and Meniere’s disease. This article provides information on the differential diagnosis of peripheral vertigo in BPPV, AVN, and Meniere’s disease.

OPINION article Front. Neurol., 05 October 2021 | https://doi.org/10.3389/fneur.2021.738785

Benign paroxysmal positional vertigo (BPPV) is the most common cause of peripheral vertigo. There are several possible underlying causes of BPPV, although the idiopathic form is the most common. BPPV is characterized by brief recurrent episodes of vertigo that are triggered by changes in head position. Although BPPV is a benign vestibular disorder, it can be a severe and disabling problem for some of patients. The pathophysiology of BPPV is still unclear. The pathophysiology for BPPV is complex and the underlying mechanism is related to free-floating debris/otoliths in the semicircular canal (canalolithiasis) or debris/otoliths attached to the cupula (cupulolithiasis). These otolith/debris are originally accumulated after detachment from the neuroepithelium of the utricular macula secondary to degeneration. BPPV can occur following other vestibular disorders. In the majority of cases, the triggering factors are unknown. Some patients of BPPV have a history of previous inner ear diseases such as Meniere’s disease or acute unilateral peripheral vestibulopathy. This clinical entity is well-defined in medical literature and usually effectively treated by certain physical maneuvers. However, the pathophysiology is still obscure and is being critically discussed in this article, which reviews the details pathological mechanism for BPPV. This review article will discuss that aging, trauma, migraine, Meniere’s disease, vestibular neuronitis, and vitamin-D deficiency are the most commonly investigated etiopathological factors resulting in BPPV.

BackgroundAlthough previous studies have reported general inexperience with the Epley manoeuvre (EM) among general physicians, no report has evaluated the effect of EM on benign paroxysmal positional vertigo (BPPV) in primary care by using point estimates or certainty of evidence. We conducted this systematic review and meta-analysis and clarified the efficacy of EM for BPPV, regardless of primary-care and subspecialty settings.MethodsSystematic review and meta-analysis of randomised sham-controlled trials of EM for the treatment of posterior canal BPPV in primary-care and subspecialty settings. A primary-care setting was defined as a practice setting by general practitioners, primary-care doctors, or family doctors. A systematic search was conducted in January 2022 across databases, including Cochrane Central Resister of Controlled Trial, MEDLINE, Embase, Cumulative Index of Nursing and Allied Health Literature, World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov. Primary outcomes were the disappearance of subjective symptoms (vertigo), negative findings (Dix–Hallpike test), and all adverse events. We evaluated the certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluation approach.ResultsTwenty-seven randomised controlled trials were identified. In primary-care settings, EM reduced the subjective symptoms [risk ratio (RR), 3.14; 95% confidence interval (CI), 1.96–5.02]; however, there was no applicable article for all adverse events. In the subspeciality setting, EM reduced the subjective symptoms (RR, 2.42; 95% CI, 1.64–3.56), resulting in an increase in negative findings (RR, 1.81; 95% CI, 1.40–2.34). The evidence exhibited uncertainty about the effect of EM on negative findings in primary-care settings and all adverse events in subspecialty settings.ConclusionsRegardless of primary-care and subspecialty settings, EM for BPPV was effective. This study has shown the significance of performing EM for BPPV in primary-care settings. EM for BPPV in a primary-care setting may aid in preventing referrals to higher tertiary care facilities and hospitalisation for follow-up.Trial registrationThe study was registered in protocols.io (PROTOCOL INTEGER ID: 51,464) on July 11, 2021.

Benign paroxysmal positional vertigo (BPPV) is the most common cause of peripheral vertigo. It can have a significant impact on quality of life, with individuals often seeking information online for reassurance and education. The aim of this study is to assess the readability and quality of online information on BPPV. The terms 'benign paroxysmal positional vertigo' and 'BPPV' were entered into Google. The first 50 websites generated for each search term were screened. Readability was assessed using the Flesch-Kincaid Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL), Simple Measure of Gobbledygook (SMOG) Index and Gunning Fog Index (GFOG). Quality was assessed using the DISCERN instrument. Spearman's correlation between quality and readability was calculated. A total of 39 websites met the inclusion criteria. The mean and 95% confidence intervals for the FRES, FKGL, SMOG, GFOG and DISCERN scores were 50.2 (46.1-54.3), 10.6 (9.87-11.4), 10.1 (9.5-10.7), 13.6 (12.7-14.4) and 36.7 (34.6-38.7), respectively. Weak correlation was noted between DISCERN and FRES (rs = -0.23, p = 0.17). Online information on BPPV is generally of poor quality and low readability. It is essential that healthcare professionals inform their patients of this limitation and advocate for improved online patient education resources that are both high quality and easy to comprehend.

Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause of peripheral vertigo, characterized by brief episodes of vertigo due to otoconia displacement. Although most previous studies have focused on intrinsic factors such as age, gender, osteoporosis, and metabolic disorders, evidence regarding the role of environmental factors, particularly occupational noise exposure, is limited. Chronic noise has the potential to affect vestibular function through both sensory and vascular mechanisms. This study aims to narratively review the effect of occupational noise exposure on the risk of BPPV by integrating clinical, epidemiological, and experimental findings. The method used is a literature-based narrative review of the PubMed, Scopus, Web of Science, and Google Scholar databases without year restrictions, using the keywords "BPPV", "occupational noise exposure", "vestibular dysfunction", "VEMP", and "otoconia displacement". The search results obtained 25 relevant articles linking BPPV to otolith, hormonal, vascular, lifestyle factors, and occupational noise exposure. The results indicate that chronic noise can cause sensory damage (otoconia and vestibular hair cells), vascular disorders (hypertension, cardiovascular disorders, and inner ear microvascular circulation disorders), and exacerbate lifestyle comorbidities (sedentary lifestyle, osteoporosis, hypertension, diabetes). The discussion confirms that these multifactorial mechanisms explain the susceptibility of industrial workers to BPPV despite normal hearing function. The conclusion of this study is that workplace noise exposure has been shown to play a significant role as a risk factor for BPPV, therefore, prevention strategies, vestibular health monitoring, and healthy lifestyle interventions need to be optimized in occupational health programs.

Dizziness and vertigo are among the most frequently encountered symptoms in primary care, with benign paroxysmal positional vertigo (BPPV) being the commonest type of vertigo. Its clinical course may vary considerably from a self-treatable to a persisting and/or recurrent disabling problem, with as yet unidentified prognostic factors. Although it is named as such, there are a considerable number of patients who do not perceive it as a benign disease, but rather as an incapacitating condition that restricts their routine activities and has a significant impact on their quality of life [1, 2]. Current Diagnosis and Management Until the theories of canalithiasis and cupulolithiasis were reported, the treatment of BPPV had been based on either the avoidance of the provoking positions or habituation. The assumption that the dislodgment of otoconia toward the semicircular canals or the ampulla is the underlying pathophysiological mechanism has led to the development of canalith repositioning procedures (CRPs) [3–6]. Indeed, the successful results attributed to CRPs seem to have verified the respective theories. The careful observation, through the Frenzel glasses or videonystagmography, of the nystagmus provoked by simple changes in the position of the patient's head can usually provide the ability to localize the dislodged otoconia in the ampulla or the lumen of one or more of the six semicircular canals (SCCs) [7]. In some cases diagnosis can also go as far as detecting, for example, that the dislodged otoconia is located in the posterior arm of the horizontal SCC (canalolithiasis) if the nystagmus is geotropic in side positions, or in the anterior arm of the horizontal SCC, either free floating (canalolithiasis) or attached to the cupula (cupulolithiasis), if the nystagmus is apogeotropic [8–10]. The details in the diagnosis that a specialized observer can reach through a noninvasive and simple-to-perform examination are indeed quite amazing, while the observation of nystagmus during CRPs allows speculations on the movement of debris and the appropriate treatment strategy. Finally, the simultaneous or successive insult of multiple canals might be a complex issue in the diagnosis and treatment of BPPV. Challenges in Diagnosis and Treatment Due to the existence of several and to a large extent unknown contributing factors, BPPV remains a challenging field that is constantly evolving in terms of pathophysiology, clinical manifestation, recovery, treatment, and recurrence. For example, clinicians sometimes encounter atypical and intractable BPPV patients who show frequent relapses or poor response to physical therapy. Anatomic variations, stenoses in the SCC lumen, or multiple clots of particles in the same SCC which cause unpredictable endolymphatic currents can account for some of the “difficult” cases. Another observation with intriguing underlying pathophysiology is the fact that the treatment of BPPV secondary to head trauma is less effective than that of idiopathic BPPV. Several other causes of intractability in BPPV have been reported including osteoporosis [11], trauma [12], position during bed rest [13], diabetes [14], and Meniere's disease [15]. Furthermore, there seems to exist an interesting but poorly understood relationship between migraine and BPPV [16, 17]. Finally the anterior SCC was considered in the past as being free from dislodged otoconia due to its anatomical position, but recent observations have proved that such a BPPV variation, although rare, is indeed possible [18, 19]. The considerable variation in the vertical and torsional contributions to the nystagmus induced by the Dix Hallpike maneuver, especially when considering the anterior and posterior canals, constitutes another pathophysiologic and diagnostic question which cannot be explained solely by the canalolithiasis and cupulolithiasis theories [20]. The role of the interactions between the semicircular canals and the otolith organs in the clinical signs and symptoms, as well as the recovery from BPPV, is still under investigation [21, 22]. Potential involvement of the vestibular nuclei, ganglia, peripheral nerve fibres, and central nervous system vestibular centres is also being studied [23]. Recent high-resolution magnetic resonance imaging (MRI) seems to be able to identify an obliteration of the membranous labyrinth as filling defects of the inner ear fluid spaces, semicircular canal stenosis, and/or a plug of otoconial debris, and morphological abnormalities in the inner ear of patients with intractable BPPV such as fractures, stenoses, filling defects, and a fold of semicircular canals have been reported [24, 25]. BPPV is a frequent disease which is usually resolved spontaneously or by office-based canalith repositioning maneuvers. In some cases, however, it may also be manifested as a persisting and/or recurrent disabling problem. During the last decade, the treatment of these “difficult”, although rare, cases has rendered BPPV a constantly evolving and intriguing subject of investigation. Partly due to its numerous potential variations and partly due to its yet unknown pathophysiological mechanisms and predisposing and prognostic factors, BPPV remains a challenging and promising investigation field. Stavros Korres Linda Luxon Paolo Vannucchi Bill Gibson

Vertigo is not common in the pediatric age group, but probably more often than was formerly thought. Benign paroxysmal positional vertigo (BPPV) is the most common cause of peripheral vertigo. It consists of the short duration of vertigo attacks found in a definite head position. The exact cause of BPPV is related to the idiopathic detachment of otoconia from the utricular membrane. The prevalence of BPPV in children is lower than in the adult age group. In children with BPPV, the symptoms consist of transitory rotational vertigo and torsional/ vertical/ horizontal or mixed nystagmus, depending on the position of the intra-labyrinthine otoliths, with latency and intensity in a typical crescendo-decrescendo pattern and it is exhaustible, reversible and fatiguing similar to adults. The diagnosis of BPPV can be accurately done by taking a detailed medical history, audiogram, and by use of positional testing. In children, BPPV can be successfully diagnosed and treated. In most cases, pediatric patients could not express details of their symptoms, and clinicians cannot always obtain adequate medical histories and determine their objective signs. So, it is not easy to study the BPPV in children. There are only a few articles describing BPPV in the pediatric age group, and therefore this subject is not well known to most otolaryngologists and clinicians. This review article discusses the epidemiology, etiopathology, clinical manifestations, diagnosis, and treatment of BPPB in the pediatric age group.

Background: Benign paroxysmal positional vertigo (BPPV) is an inner-ear disorder that is the most common cause of peripheral vertigo. Many patients have mild to moderate illness and can be treated in outpatient settings. In those with severe symptoms, BBPV can have a dramatic effect on independence, quality of life, and daily functioning. Objective: This study aimed to determine the prevalence of inpatient treatment in patients who present to the emergency department (ED) with severe BPPV symptoms. Methods: This was a retrospective analysis of adult patients diagnosed with BPPV. Consecutive patients were seen over a nine-month period at seven affiliated EDs. Data collected included clinical features, demographics, diagnostic testing, treatment, and disposition. Patients who required hospital admission were compared to those discharged from the ED. Results: 400 adult ED patients were included in the study; 68 (17.0%) were admitted, and 332 (83.0%) were discharged home. Admitted patients were less likely to have positional testing performed in the ED and were more likely to undergo computed tomography (CT) imaging of the head (69.1% vs. 32.5%, P<0.001). Vestibular suppressant drugs were given to 95.0% of all BPPV patients in the ED while canalith repositioning maneuvers were used in only 4.0%. Patients were admitted because of difficulty with balance and gait (77.9%), persistent vomiting (20.6%), and/or waiting for magnetic resonance imaging (19.1%). Twenty-eight (7.0%) patients returned within 14 days for continued symptoms. Conclusions: BPPV is a common entity in older adults and may have a protracted course and a high risk of recurrence. Overall, 17.0% of adults presenting to the ED were admitted, generally because of difficulty with gait and persistent vomiting. When positional testing was not performed at the bedside, patients were often subjected to unnecessary and expensive investigations. Canalith repositioning maneuvers, such as the Epley maneuver, were used in only 4.0% of ED patients with BPPV. Although repositioning maneuvers can dramatically improve vertigo, some patients still experience residual dizziness at least one month after repositioning. Vestibular suppressant drugs are commonly prescribed in the ED and can be associated with significant adverse reactions.

Background: Benign paroxysmal positional vertigo (BPPV) is a benign peripheral disorder of vestibular system and is the most common cause of peripheral vertigo. The aim of our study was to compare and assess the efficacy of Epley’s and Barbeque roll over manoeuvres with labyrinthine sedatives in the management of Benign Paroxysmal Positional Vertigo (BPPV) over a period of one month and to know the prevalence of BPPV in different age and gender groups among the two semicircular canals(posterior and lateral). Methods-This prospective randomized comparative clinical trial included 60 patients with clinically diagnosed BPPV in a tertiary care centre and were investigated for a period on one year. The clinical diagnosis of specific canal type of BPPV was assessed based on the diagnostic tests, Dix Hallpike test and McClure test. In manoeuvre group, posterior canal BPPV, Epley’s manoeuvre was performed and for lateral canal BPPV, Barbeque roll over manoeuvre was performed as treatment. In pharmacological group, labyrinthine sedatives i.e. either cinnarizine 25mg twice a day or betahistine 16 mg twice a day were administered for one month as treatment. Results: Results were assessed at the end of 48 hours (immediate time period) and at four weeks’ time period after the treatment, under three different outcome categories namely disappeared, improving and unchanged. Treatment of Benign Paroxysmal Positional Vertigo with repositioning manoeuvre had higher success percentage of 83.3% than the medical treatment. Conclusion: The treatment of BPPV with repostioning manoeuvres had a better outcome than the medical treatment.

Benign paroxysmal positional vertigo (BPPV) is the most common cause of peripheral vertigo. Numerous investigations have reported an increased BPPV incidence in females and in the aged population. The hormonal characteristics of BPPV patients have not been previously investigated. This study aimed to determine the risk of BPPV in relation to menopause in a population-based study.Materials and Methods: This retrospective population-based study was designed to use a nationwide longitudinal health insurance database to follow and analyze the incidence of and protective factors against BPPV in a Taiwanese population.Data Analyses: Univariate and multivariate analyses were performed to calculate the adjusted hazard ratio (aHR) for the incidence of BPPV using Cox-proportional regression models.Results: In the multivariate analyses, we found that older people (older than 65 years old) were more prone to develop BPPV (aHR: 5.37, 95% CI: 0 4.83–5.97, p < 0.001). The risk of BPPV was analyzed in two specific age subgroups of elderly females. Results revealed that in both age groups (45–65 years old and >65 years old), patients who took estrogen for menopausal syndromes had a significantly lower incidence of BPPV (aHR; 0.01, 95% CI: 0.06–0.23, p < 0.001).Conclusion: Our study provides a novel etiology and possible treatment method for the prevention of BPPV. Further studies may focus on the pathophysiological mechanism of estrogen in BPPV patients and the development of new drugs for the prevention and treatment of BPPV.

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Vertigo is one of the most distressing symptoms. It is difficult to identify, practically impossible to measure and not easy to treat. Electronystagmography (ENG) objectively records eye movements and thus tests the functional integrity of vestibulo-ocular reflex and its connections from inner ear to the brain. Hence, this present study was taken to evaluate the role of ENG in the diagnosis of vertigo, to know the peripheral, central and other causes of vertigo and to know the side of lesion. The aim of this study was to evaluate the role of ENG in the diagnosis of vertigo, to know the peripheral, central and other causes of vertigo and to know the side of lesion.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This study included 60 patients who presented with primary complaints of vertigo or dizziness. Patients were subjected to ENG under optimal conditions and the results were obtained in the form of a graphical recordings after analysis of the ENG data.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Of the 60 patients subjected to ENG, a peripheral cause was seen in 33 patients. 21 patients were diagnosed with benign positional paroxysmal vertigo (BPPV), whereas 06 patients showed a central lesion of the vestibular system.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; ENG acts as a useful screening tool to differentiate between peripheral cause of vertigo and central cause of vertigo. It has special significance in localizing the side of the lesion. Hence, ENG has proven to be a useful first line investigation in the diagnosis of vertigo.&lt;/p&gt;

Evaluation of Benign Paroxysmal Positional Vertigo in Primary Health-Care and First Level Specialist Care