Cases Of Benign Paroxysmal Positional Vertigo Research Articles

Trait anxiety, depression, and insomnia among benign paroxysmal positional vertigo cases: A multidisciplinary cross-sectional study

Background: Benign paroxysmal positional vertigo is the most common peripheral vestibular disease and is often associated with psychiatric conditions, including anxiety, depression, and insomnia. Studies evaluating trait anxiety in benign paroxysmal positional vertigo cases are limited. Our study aimed to assess trait anxiety, depression, and insomnia levels among those cases to investigate and emphasize the clinical value of evaluating psychiatric comorbidities. Methods: Individuals who applied to an otorhinolaryngology outpatient clinic and were diagnosed with benign paroxysmal positional vertigo were consecutively invited to participate. An extensive psychiatric assessment, Beck Anxiety Inventory, Beck Depression Inventory, Insomnia Severity Index, and Penn State Worry Questionnaire, was applied. Results: Of 35 benign paroxysmal positional vertigo patients (21 females, 14 males, mean age: 51), almost half were diagnosed with anxiety disorders, and one-third were diagnosed with depressive disorders. 34.3% (n = 12) of the sample had mild anxiety, whereas 28.6% (n = 10) had moderate and 31.4% (n = 11) had severe anxiety. 25.7% (n = 9) of the cases reported mild depressive symptoms, while 22.9% (n = 8) had moderate, and 11.4% (n = 4) had severe depression scores. 77.1% (n = 27) of the patients had mild to severe insomnia severity. All 35 participants in the study showed higher trait anxiety levels than the cut-off values of the scale. Conclusions: Evaluating benign paroxysmal positional vertigo cases for psychiatric conditions could contribute to the practical and integrated treatment of the disease, reduce its triggering causes, and increase the quality of life of the patients.

Is diagnostics of Benign Paroxysmal Positional Vertigo with a mechanical rotation chair superior to traditional manual diagnostics? A randomized controlled crossover study.

Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause of vertigo. While various techniques and technologies have improved BPPV diagnostics and treatment, optimizing BPPV healthcare pathways requires a comprehensive understanding of the diagnostic modalities across diverse clinical settings. To compare traditional manual BPPV diagnostics (MD) with diagnostics done with the aid of a mechanical rotation chair (MRC) when using videonystagmography goggles with both modalities. This prospective, open-label, randomized diagnostic crossover study involved 215 adults with typical BPPV symptoms at a tertiary University Hospital-based outpatient clinic (Aalborg University Hospital, Denmark). Participants referred by general practitioners or otorhinolaryngologist clinics underwent both traditional manual and MRC diagnostics with the aid of videonystagmography goggles. The order of the diagnostic modalities was randomly assigned, and the two modalities were separated by a minimum of 30 min. The primary outcomes included sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of traditional MD compared to MRC diagnostics. The secondary outcome was the agreement between the two modalities. The MRC demonstrated a significantly higher sensitivity for BPPV detection in general for all participants (p = 0.00). Compared to MRC diagnostics, traditional MD displayed a sensitivity of 69.5% (95% confidence interval (CI): 59.8-78.1), specificity of 90.9% (95% CI: 83.9-95.6), PPV of 88.0% (95% CI: 83.9-95.6), and NPV of 75.8% (95% CI: 67.5-82.8). The overall inter-modality agreement was 80.5% (95% CI: 75.2-85.8, Cohen's kappa 0.61). While both modalities detected unilateral posterior canal BPPV equally good (p = 0.51), traditional MD underperformed for non-posterior BPPV (significantly) and in subgroups referred by ENTs (trend) or with impaired cooperation during traditional MD (significantly). Traditional manual BPPV diagnostics remains a valuable first-line approach for most patients. However, MRC diagnostics offers advantages for complex BPPV cases, patients with impaired cooperation, patients referred from otorhinolaryngologist clinics, and those with negative traditional MD but an evident BPPV history. MRC may be useful as a second opinion diagnostic tool for treatment-resistant BPPV. ClinicalTrials.gov identifier: NCT05846711.

Clinical Study on the Treatment of Residual Dizziness in Benign Paroxysmal Positional Vertigo with the Structural Balancing Acupuncture Method

Benign paroxysmal positional vertigo (BPPV) often has residual dizziness symptoms after manipulative repositioning, and acupuncture is experienced in treating this disease. In this study, 68 cases of BPPV were recruited and randomly divided into 2 groups: acupuncture combined with manipulative reset group and reset group, and acupuncture treatment was performed with empirically prescribed structural balancing acupuncture method. The Dizziness Handicap Inventory (DHI), Dizziness Visual Analog Scale (VAS), and the effective rate were assessed after two treatments. The results showed that the acupuncture combined with manipulative restoration group was able to reduce the DHI scale score significantly, and a trend change was seen in the visual analog scale (VAS) of dizziness and the effective rate between groups after treatment. The results showed that the combination of structural balancing and manipulative repositioning in the treatment of benign paroxysmal positional vertigo could improve the residual dizziness symptoms compared with manipulative repositioning alone, which can be clinically promoted and further validated in a large-sample RCT in the future.

Residual dizziness after BPPV management: exploring pathophysiology and treatment beyond canalith repositioning maneuvers.

Despite the high success rate of canalith repositioning maneuvers (CRMs) in the treatment of benign paroxysmal positional vertigo (BPPV), a growing number of patients report residual dizziness symptoms that may last for a significant time. Although the majority of BPPV cases can be explained by canalolithiasis, the etiology is complex. Consideration of the individual patient's history and underlying pathophysiology of BPPV may offer the potential for treatment approaches supplementary to CRMs, as well as a promising alternative for patients in whom CRMs are contraindicated. This article provides a summary of the possible underlying causes of BPPV and residual dizziness, along with suggestions for potential management options that may be considered to relieve the burden of residual symptoms.

Tỷ lệ và phân loại chóng mặt tư thế kịch phát lành tínhống bán khuyên ngang tại Bệnh viện Quân y 175

Objective: To determine the prevalence of benign paroxysmal positional vertigo (BPPV) in the horizontal semicircular canal and classify the mechanism at Military Hospital 175.Methods: A cross-sectional study conducted at the Department of Neurology, Military Hospital 175, from March 2022 - September 2023, patients were examined and performed positioning tests on the videonystagmography system. Patients with atypical results were examined with imaging and the HINT test. Patients with BPPV were included in the analysis.Results: 466 cases were diagnosed with BPPV. 133 patients had horizontal semicircular canal BPPV, accounting for 28.54% of BPPV cases. In the group of 133 patients with horizontal semicircular canal BPPV, 116 cases were due to otoliths in the semicircular canal (canalithiasis), accounting for 87.22%; 14 cases were due to otoliths on the cupula (cupulothiasis), accounting for 10.53%; 3 cases were due to light cupula mechanism, accounting for 2.26%.Conclusion: The prevalence of horizontal semicircular canal BPPV was 28.54% in BPPV patients, higher than other previous studies in Europe. 87.22% of horizontal semicircular canal BPPV were hii due to stones in the semicircular canal, 10.53% were due to stones in the semicircular canal and 2.26% were due to light cupula mechanism. Performing a positioning head roll test in addition to the Dix-Hallpike test is necessary to avoid missing horizontal semicircular canal BPPV.

Bilateral Apogeotropic Lateral Canal BPPV: Role of Secondary Signs of Lateralization in Diagnosis.

Bilateral lateral canal benign paroxysmal positional vertigo (BPPV) is extremely uncommon because of difficulties in diagnosing such cases. We present first case of bilateral apogeotropic lateral canal BPPV. We want to stress that secondary signs of lateralization like bow lean test is of great help in diagnosing such cases.

Benign Paroxysmal Positional Vertigo Secondary to Acute Unilateral Peripheral Vestibulopathy: Evaluation of Cardiovascular Risk Factors.

Lindsay-Hemenway syndrome was first described as an acute unilateral peripheral vestibulopathy followed by positional vertigo. A vascular etiology was proposed. An association between cardiovascular risk factors and benign paroxysmal positional vertigo secondary to acute unilateral peripheral vestibulopathy has been described with contradictory evidence. The study aimed to evaluate the prevalence of cardiovascular risk factors in patients with benign paroxysmal positional vertigo secondary to acute unilateral peripheral vestibulopathy and analyze differences in prior history of benign paroxysmal positional vertigo, affected semicircular canals, and response to repositioning maneuvers between patients with idiopathic benign paroxysmal positional vertigo and secondary to acute unilateral peripheral vestibulopathy. We performed a retrospective, descriptive study of all cases of benign paroxysmal positional vertigo between January/2017 and June/2020, with or without a history of acute unilateral peripheral vestibulopathy within the previous year. Cases secondary to trauma or otoneurological causes and acute unilateral peripheral vestibulopathy without confirmatory tests and cases with auditory symptoms were excluded. In total, 242 cases were obtained; 158 idiopathic benign paroxysmal positional vertigo and 84 secondary to acute unilateral peripheral vestibulopathy. No statistically significant differences were found in relation to age: 61.2 ± 14.6 versus 62.4 ± 16.2 years (P=.55), sex: female 78.5% versus 73.8% (P=.41), presence of cardiovascular risk factors: 52.5% versus 54.8% (P=.67), prior history of benign paroxysmal positional vertigo: 22.2% versus 27.7% (P=.43), affected semicircular canals (P=.16) or number of repositioning maneuvers (P=.57). Associations between age, cardiovascular risk factors, and benign paroxysmal positional vertigo secondary to acute unilateral peripheral vestibulopathy have been described with conflicting evidence. This is the first study to evaluate cardiovascular risk factors specifically for Lindsay-Hemenway syndrome, and we did not observe any differences between idiopathic benign paroxysmal positional vertigo cases and those secondary to acute unilateral peripheral vestibulopathy.

Transition Rates from Benign Paroxysmal Positional Vertigo to Persistent Postural-Perceptual Dizziness

AbstractPersistent postural-perceptual dizziness (PPPD) is a chronic dizziness disorder that is newly listed in the World Health Organization (WHO)'s International Classification of Diseases (ICD-11) revised in 2018. In this study, I selected definite cases of the first occurrence of benign paroxysmal positional vertigo (BPPV) among vertigo patients who visited our clinic in the past 1 year, and retrospectively reviewed the age at the first visit, gender, affected side, previous medical conditions, type of BPPV, and their tendency toward transition to PPPD. Eligible patients were new first-ever cases of BPPV who visited our clinic during the 1-year period from June 1, 2020, to May 31, 2021, and who met the diagnostic criteria for BPPV established by the Japan Society for Equilibrium Research. There were 311 cases, including 120 men and 191 women, with a male:female ratio of 1:1.6; hence, the majority of patients were women. The mean age ± standard deviation was 60.7 ± 17.8 years. Men ranged in age from 14 to 88 years, with a mean age of 64.2 ± 16.3 years. Women ranged in age from 11 to 90 years, with a mean age of 58.5 ± 18.5 years. Thus, the average age of the men was higher. As for the type of BPPV, there were 172 cases of posterior semicircular canal-type BPPV (canalolithiasis), 79 cases of lateral semicircular canal-type BPPV (canalolithiasis), and 60 cases of lateral semicircular canal-type BPPV (cupulolithiasis), with the posterior semicircular canal-type BPPV (canalolithiasis) being the most common. In regard to the affected side, the right side was affected in 164 cases and the left side in 147 cases; thus, involvement of the right side was more common. The time to remission was less than 0.5 months in 86 cases, less than 1 month in 69 cases, less than 2 months in 50 cases, less than 3 months in 22 cases, and more than 3 months in 57 cases. Remission was achieved in less than 3 months in 72.9% of cases. The course remained unknown in 27 cases, as the patients discontinued their clinic visits. There was only one case of a 75-year-old man and one case of a 70-year-old woman who transitioned to PPPD. Both cases had left-sided posterior semicircular canal-type BPPV (canalolithiasis). The man had underlying hypertension, while the woman had underlying hypertension and diabetes mellitus. The rate of transition from BPPV to PPPD was 0.6% when cases with an unknown course were included, and the rate was as low as 0.7% when cases with an unknown course were excluded. Thus, the frequency of transition from BPPV to PPPD is low.

Clinical significance of down-beating nystagmus and postural control loss when returning to a sitting position during the canalith repositioning maneuver

Patients with benign paroxysmal positional vertigo (BPPV) occasionally experience severe dizziness, could not maintain the sitting posture, and then fall onto or off the examination table when they return to the sitting position, which is the last step of the barbecue maneuver and Epley maneuver (EM); down-beating nystagmus is also observed. This study aims to investigate the clinical characteristics and significance of these findings. We retrospectively reviewed video data showing nystagmus and medical records of adult patients diagnosed with canalolithiasis of the horizontal canal and the posterior canal (PC) BPPV who underwent barbecue maneuver and EM, respectively, in outpatient clinics from April 2014 to March 2019. This study included 112 patients (28 horizontal canal BPPV and 94 PC BPPV cases). Among the 122 BPPV cases, only 14 (14.9%) were analyzed, due to their occurrence during EM. Down-beating nystagmus appeared at 3.6 seconds on average after returning to the sitting position, and the patients fell onto or off the examination table at 4.4 seconds on average after the onset of the nystagmus. The average duration of the down-beating nystagmus was 20.3 seconds. In all 14 cases, no nystagmus was induced by the Dix-Hallpike test performed again after EM, confirming that the treatment was successful. During the EM, down-beating nystagmus and falling onto or off the examination table occurred in approximately 15% of cases. As the risk of falls increases, the patient should be secured immediately after EM. Moreover, it can be inferred that the findings occur when otoconia in the PC enter the utricle, suggesting a successful treatment.

Outcomes of Treatment of Multicanal Benign Paroxysmal Positional Vertigo by Means of TRV Chair

Introduction: Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of peripheral vertigo and can manifest in different forms. Multicanal BPPV is rare and difficult to treat. TRV Chair is a method that offers diagnosis and treatment at the same time. The aim was to analyze the outcomes of treatment of multicanal BPPV by means of TRV Chair and compare those results with manual maneuvers. Methods: Forty-nine subjects aged 26–73 and diagnosed with multicanal BPPV were included. Appropriate maneuvers were performed on affected canals either by TRV Chair or manually. The number of maneuvers required by TRV Chair and manual maneuver were analyzed and compared. Results: The mean number of maneuvers performed until the treatment was completed in manual treatment group was 2.57 ± 1.03, and in TRV group, it was 2.25 ± 1.16. No significant difference was observed between the number of maneuvers performed in either group until the end of the treatment (p > 0.05). Discussion/Conclusions: Neither TRV Chair nor manual maneuvers were superior to the other in the treatment of multicanal BPPV cases.

Demographic and etiological analysis of peripheral vertigo, as a common public health problem

<p class="abstract"><strong>Background:</strong> Vertigo was defined by Gowers in 1893 as any movement or sense of movement either in the individual himself or in external environment that involves a defect, real or seeming in the equilibrium of body. The aim of present study was evaluation of demographics and etiology of patient presenting with vertigo.</p><p class="abstract"><strong>Methods:</strong> The study was prospective study. Present study consisted of an assessment of 55 cases of vertigo whose examination was conducted in the ENT department. All patients were evaluated for the various causes of vertigo and include all the age group and both sexes.</p><p class="abstract"><strong>Results:</strong> Out of 55 patients, 80% belonged to 21-50 years age group. In present study, 29 cases out of 55 cases were diagnosed as a case of BPPV. Among them 22 diagnosed as posterior canal BPPV (benign paroxysmal positional vertigo) and 7 as horizontal canal BPPV.</p><p class="abstract"><strong>Conclusions:</strong> The maximum number of patients belongs in the 4 decades. Of the associated sign and symptoms dizziness is most common than dizziness with other sign and symptoms. Among peripheral causes posterior canal BPPV is most common. This approach leads not only to diagnosis but also helps to plan the intervention for the patient. In the present study, 12 cases (21.8%) were diagnosed clinically normal. It shows those tests used in this study are efficient to diagnose true or false vertigo.</p>

Benign Paroxysmal Positional Vertigo in Pregnancy

Background: Benign paroxysmal positional vertigo (BPPV) is a common clinical condition characterized by sudden, brief paroxysmal attacks of rotation vertigo occurred by changing the head position. BPPV is the most common peripheral vestibular pathology and is found frequently in females. There are very limited data on the association between BPPV and pregnancy. Objective: The objective of this study was to study the BPPV during pregnancy along with details of clinical manifestations and management. Patients and Methods: This is a cross-sectional study where pregnant women with BPPV were enrolled. The study was conducted between April 2020 and May 2022. Detailed neurological examinations were done at the vertigo clinic. Results: There were seven cases of BPPV associated with pregnancy in this study. The most common symptom was rotatory vertigo. All were diagnosed with the Dix–Hallpike test. All underwent Epley maneuver and symptoms resolved. Out of seven cases, two showed low 25-hydroxyvitamin D levels. Conclusion: Vertigo is a morbid symptom during pregnancy that affects both pregnant women and fetal status. To improve the quality of life during gestation, clinicians should consider this BPPV as an important clinical entity in their differential diagnosis of vertigo.

Apogeotropic Horizontal Canal Benign Paroxysmal Positional Vertigo: Zuma e Maia Maneuver versus Appiani Variant of Gufoni.

Benign paroxysmal positional vertigo (BPPV) is one of the most common disorders that causes dizziness. The incidence of horizontal semicircular canal (HSC) BPPV ranges from 5% to 40.5% of the total number of BPPV cases diagnosed. Several studies have focused on establishing methods to treat BPPV caused by the apogeotropic variant of the HSC, namely, the Appiani maneuver (App). In 2016, a new maneuver was proposed: the Zuma e Maia maneuver (ZeM), based on inertia and gravity. The aim of this study is to analyze the efficacy of App versus ZeM in the resolution of episodes of BPPV produced by an affectation of the horizontal semicircular canal with apogeotropic nystagmus (Apo-HSC). A retrospective, quasi-experimental study was conducted. Patients attended in office (November 2014–February 2019) at a third-level hospital and underwent a vestibular otoneurology assessment. Those who were diagnosed with Apo-HSC, treated with App or ZeM, were included. To consider the efficacy of the maneuvers, the presence of symptoms and/or nystagmus at the first follow up was studied. Patients classified as “A” were those with no symptoms, no nystagmus; “A/N+”: no symptoms, nystagmus present during supine roll test; “S”: symptoms present. Previous history of BPPV and/or otic pathology and calcium levels were also compiled. From the 54 patients included, 74% were women. The average age was 69. Mean follow-up: 52.51 days. In those patients without previous history of BPPV (n = 35), the probability of being group “A” was 63% and 56% (p = 0.687) when treated with App and ZeM, respectively, while being “A/N+” was 79% and 87% for App and ZeM (p = 0.508). Of the 19 patients who had previous history of BPPV, 13% and 64% were group “A” when treated with App and ZeM (p = 0.043), and 25% and 82% were “A/N+” after App and ZeM, respectively (p = 0.021). In conclusion, for HSC cupulolithiasis, ZeM is more effective than App in those cases in which there is a history of previous episodes of BPPV (“A”: 64% (p = 0.043); “A/N+”: 82% (p = 0.021)).

Failure of Gan CRM Overcome by Successful Semont Manoeuvre in BPPV Post Head Trauma: A Case Study

Objective: Benign paroxysmal positional vertigo (BPPV) is one of common peripheral vestibular problem reported that head injury is one of common cause among young age. In current situation it only treated by medication or injection by medical officer and specialist. Medication is not an optimal treatment and it only symptomatic therapy and often need chronic prescriptions if not treated properly. There are an optimum specific manoeuvre offers curative therapy in majority of BPPV cases such as Epley’s manoeuvre, Gan Canal repositioning Manoeuvrer (CRM) and Semont manoeuvre. Semont manoeuvre is one of selected manoeuvre that recently done in posterior BBPV case if Epley’s and Gan CRM failed, but less practice among our clinician due to less exposure.
 Case Studies: A 22 -year-old gentleman, complain of imbalance, difficulty in walking and vertigo for the past few days. He history of moderate traumatic brain injury (left parietooccipital Epidural Haemorrhage) and surgical intervention done last 5 days ago. He also complained of reduced hearing and on off left tinnitus over left side. No prominent psychological involvement reported.
 Detail physical and balance assessment done using BAL EX Foam test Modified Dix Hallpike Test (DHT) done. During the left DHT there is rotatory up beating nystagmus then it proceeds with GRM three-time, 1 session on previous day and 2 session on the current day but it was failed. Then proceed with Semont manoeuvre by specialist in vestibular rehabilitation. After 10 minutes of manoeuvre, modified DHT done and show negative result found there is no nystagmus.

Epley versus Semont Maneuver in the Treatment of Benign Paroxysmal Positional Vertigo

AbstractIntroduction Benign paroxysmal positional vertigo (BPPV) is characterized by brief but violent attacks of paroxysmal vertigo provoked by certain positions of the head. This study aimed to compare the outcomes of Epley and Semont maneuvers for the relief of vertigo in posterior semicircular canal BPPV.Materials and Methods This was a prospective comparative study conducted in a tertiary referral hospital over 1 year. Among 70 cases of BPPV, 35 were treated with Epley and 35 with Semont maneuver. Follow-up was done at 1 week, 1 month, and 3 months to assess symptomatic improvement using visual analogue scale.Results Out of 70 patients of BPPV, 62 patients responded very well to the maneuvers and got relief from vertigo. Thirty-two patients (91.4%) in the Epley group and 30 (85.7%) patients in the Semont group had a significant improvement post-therapy and the balance was the same in both groups. At 1 month, there was no significant statistical difference in mean visual analogue score (VAS) score between both groups.Conclusion Majority of cases showed symptomatic improvement with both maneuvers. However, patients treated with Epley maneuver showed earlier relief from vertigo than those treated with the Semont maneuver.

Positional Manoeuvres for BPPV: Theoretical Approach to Remote Training for Non-specialists.

Positional Manoeuvres for BPPV: Theoretical Approach to Remote Training for Non-specialists.

The Risk of Benign Paroxysmal Positional Vertigo After Head Trauma.

Head trauma may cause dislodgement of otoconia and development of benign paroxysmal positional vertigo (BPPV). The risk of developing BPPV is expected to be highest shortly after the trauma, then decrease and approach the risk seen in the general population. The aim of this study was to estimate the risk-time curve of BPPV development after head trauma. Prospective observational study. Patients with minimal, mild, or moderate head trauma treated at the Department of Neurosurgery or the Department of Orthopedic Emergency at Oslo University Hospital, were interviewed and examined for BPPV using the Dix-Hallpike and supine roll maneuvers. BPPV was diagnosed according to the International diagnostic criteria of the Bárány Society. Telephone interviews were conducted at 2, 6, and 12 weeks after the first examination. Out of 117 patients, 21% developed traumatic BPPV within 3 months after the trauma. The corresponding numbers were 12% with minimal trauma, 24% with mild, and 40% with moderate trauma. The difference in prevalence between the groups was significant (P= .018). During the first 4 weeks after the trauma, it was observed 20, 3, 0, and 1 BPPV onsets, respectively. No BPPV cases were seen for the remainder of the 3-month follow-up. The risk of developing BPPV after minimal-to-moderate head trauma is considerable and related to trauma severity. Most cases occur within few days after the trauma, but any BPPV occurring within the first 2 weeks after head trauma are likely due to the traumatic event. 3 Laryngoscope, 132:443-448, 2022.

Influence of vascular risk factors on seasonality of benign paroxysmal positional vertigo

Objective: To investigate the seasonal changes of benign paroxysmal positional vertigo (BPPV) onset, and explore the relationship between vascular risk factors and the seasonal patterns of BPPV. Methods: Data of 3 886 patients subjected to vestibular function examination and diagnosed with BPPV who underwent manipulation or instrumental repositioning from January 1, 2016 to December 31, 2019 in the Department of Neurology, Beijing Tiantan Hospital were retrospectively analyzed. Demographic information and medical history of the patients were recorded. Weather temperature data of Beijing were obtained and monthly averages were calculated. The relationship between the BPPV onset and temperature and seasonality was investigated. Meanwhile, the influence of vascular risk factors on the seasonal patterns of BPPV was determined. Results: BPPV is more common in women (n=2 667). The male to female ratio of patients was approximately 1∶2, with a mean age of (55±13) years. The cases of BPPV in spring (March-May), summer (June-August), autumn (September-November) and winter (December-February) were 1 000 (25.7%), 911 (23.4%), 808 (20.8%) and 1 167 (30.0%), respectively. The peak incidence of BPPV occurred in December (n=491) and the lowest occurred in September (n=251). The number of BPPV cases diagnosed monthly was inversely correlated with mean temperature (R2=0.317; P<0.001). Patients with ≥2 vascular risk factors were at higher risk of developing BPPV in spring or winter than those without risk factors (OR=1.32, 95%CI: 1.13-1.53,P<0.001). Proportion of onset in spring or winter increased with each additional risk factor (P trend<0.001). Conclusions: BPPV often occurs in the months with low temperature (spring and winter) and the number of cases is inversely correlated with temperature. Compared with those with no vascular risk factors, patients with more vascular risk factors are more likely to develop BPPV in spring and winter.

The bucket test reinterpreted: a study on benign paroxysmal positional vertigo and M\xe9ni\xe8re\u2019s disease patients

BackgroundThe bucket test is a simple and practical instrument to evaluate vestibular diseases; additionally, it could be a useful tool in the evaluation of the vertigo patient. Unfortunately, the bucket test still lacks standardization. The objective of this study was to evaluate and to interpret the subjective visual vertical (SVV) using the bucket test in benign paroxysmal positional vertigo (BPPV) and Ménière’s disease patients. We performed a cross-sectional study in a secondary care center. All patients with diagnosis of unilateral posterior canal BPPV or Ménière’s disease underwent complete neuro-otological physical examination and the bucket test. Normal bucket test was 0° to 3° according to previous study.ResultsWe included seventy-eight subjects. Benign paroxysmal positional vertigo cases (n = 51) showed a mean 2.62° of SVV prior to the Epley maneuver and 1.7° of SVV after the maneuver (p = < 0.001), 57% of patients with BPPV were categorized as abnormal. Inactive Ménière’s disease patients (n = 22) had mean SVV of 2.74° and Ménière’s disease with active crisis (n = 5) had 5.06° of SVV (p = 0.002).ConclusionThe bucket test is a simple and useful test for the evaluation of SVV, and it has a role in the evaluation of patients with active vestibular diseases such as Ménière’s disease and BPPV.

Epley manoeuvre for posterior semicircular canal benign paroxysmal positional vertigo in people with multiple sclerosis: protocol of a randomised controlled trial

IntroductionVestibular disorders in multiple sclerosis (MS) could have central or peripheral origin. Although the central aetiology is the most expected in MS, peripheral damage is also significant in this disease....