Benign Paroxysmal Positional Vertigo Patients Research Articles

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.

Analysis of inducement of benign paroxysmal positional vertigo

Objective:To analyze the related factors that may affect the onset of benign paroxysmal positional vertigo（BPPV）. Methods:Fifty BPPV patients treated in Department of Otolaryngology Head and Neck Surgery, Shanxi Provincial People's Hospital from May to September 2023 were selected as the case group, and 50 healthy adults were selected as the control group. Relevant information was collected by means of questionnaire survey and medical history inquiry. The two groups were compared in terms of sleep time, night sleep duration, wake times, underlying diseases（hypertension, diabetes, coronary heart disease, etc.） and negative emotional impact. Results:The proportion of male and female in the case group was 16% and 84%, and that in the control group was 20% and 80%. The mean age of the case group was（54.66±13.39） years old, and the mean age of the control group was（54.42±12.55） years old, ranging from 27 to 80 years old. The sleeping time of the case group was significantly later than that of the healthy group, and the difference was statistically significant（P<0.05）. The night sleep duration of the case group was shorter than that of the healthy group, the difference was statistically significant（P<0.05）. There was no significant difference in awakening times between the case group and the healthy group（P>0.05）. There were more patients in the case group with underlying diseases（54%） and affected by negative emotions（70%） than in the healthy group, and the difference was statistically significant（P<0.05）. Conclusion:Late sleep time, short sleep duration at night, accompanied by underlying diseases and negative emotions can affect the onset of BPPV.

Pediatric Benign Paroxysmal Positional Vertigo: Degree of Nystagmus and Concurrent Dizziness Differs from Adult BPPV.

Background: Benign paroxysmal positional vertigo (BPPV) is characterized by brief, intense episodes of vertigo triggered by abrupt changes in head position. It is generally accepted as being most common in adults, while it is regarded as rare in children. It is necessary to compare the disease between pediatric and adult patients for a better understanding of the disease's characteristics and its natural history. This study aimed to identify the clinical characteristics of BPPV in children and compare them with those of adult BPPV patients. Methods: All children ≤ 18 years old who were diagnosed with BPPV were selected by searching the electronic database of our hospital. Clinical features were identified by medical record review. For adult patients, we collected data from patients > 19 years of age. Results: A total of 30 pediatric (13.65 ± 4.15 years old) and 264 adult patients (60.86 ± 13.74 years old) were included in the study. Among pediatric patients, the lateral canals were involved in 80% and the posterior canals in 16.67%. In adult patients, the lateral and posterior canals were involved similarly (p = 0.007). The degree of nystagmus in pediatric patients was 6.82 ± 12.09, while in adults it was 15.58 ± 20.90 (p < 0.001). The concurrent dizziness disorder was higher in the pediatric group and recurrence was higher in the adult group. In the regression analysis, it was found that adult patients had a stronger nystagmus with a value of 6.206 deg/sec, and the risk of concurrent dizziness disorder was found to be 5.413 times higher in the pediatric group (p < 0.05). Conclusions: BPPV occurs in pediatric patients with lower prevalence, but it cannot be overlooked. In the pediatric group, a relatively high proportion of patients demonstrated lateral canal involvement, weaker nystagmus, and additional dizziness disorder.

Increased functional connectivity between default mode network and visual network potentially correlates with duration of residual dizziness in patients with benign paroxysmal positional vertigo.

To assess changes in static and dynamic functional network connectivity (sFNC and dFNC) and explore their correlations with clinical features in benign paroxysmal positional vertigo (BPPV) patients with residual dizziness (RD) after successful canalith repositioning maneuvers (CRM) using resting-state fMRI. We studied resting-state fMRI data from 39 BPPV patients with RD compared to 38 BPPV patients without RD after successful CRM. Independent component analysis and methods of sliding window and k-means clustering were adopted to investigate the changes in dFNC and sFNC between the two groups. Additionally, temporal features and meta-states were compared between the two groups. Furthermore, the associations between fMRI results and clinical characteristics were analyzed using Pearson's partial correlation analysis. Compared with BPPV patients without RD, patients with RD had longer duration of BPPV and higher scores of dizziness handicap inventory (DHI) before successful CRM. BPPV patients with RD displayed no obvious abnormal sFNC compared to patients without RD. In the dFNC analysis, patients with RD showed increased FNC between default mode network (DMN) and visual network (VN) in state 4, the FNC between DMN and VN was positively correlated with the duration of RD. Furthermore, we found increased mean dwell time (MDT) and fractional windows (FW) in state 1 but decreased MDT and FW in state 3 in BPPV patients with RD. The FW of state 1 was positively correlated with DHI score before CRM, the MDT and FW of state 3 were negatively correlated with the duration of BPPV before CRM in patients with RD. Additionally, compared with patients without RD, patients with RD showed decreased number of states and state span. The occurrence of RD might be associated with increased FNC between DMN and VN, and the increased FNC between DMN and VN might potentially correlate with the duration of RD symptoms. In addition, we found BPPV patients with RD showed altered global meta-states and temporal features. These findings are helpful for us to better understand the underlying neural mechanisms of RD and potentially contribute to intervention development for BPPV patients with RD.

The importance of Epley maneuver in posterior canal benign paroxysmal positional vertigo.

We investigated symptom scores and quality of life in unilateral posterior canal benign paroxysmal positional vertigo (BPPV) patients. In this retrospective and multicentric study, 78 patients with unilateral posterior canal BPPV (47 right-sided and 31 left-sided) were included. All patients have performed the Standard Epley maneuver. Features of the nystagmus [nystagmus duration (second), latent period (second)] and features of the disease [side (right or left-sided), disease duration (years), and recurrence of disease (present or absent)] were noted. Before and 1 week after the Epley maneuver, all patients were evaluated using the Vertigo Symptom Scale (VSS), Vertigo Dizziness Imbalance Symptom Scale (VDI-SS), and Vertigo Dizziness Imbalance health-related quality of life scale (VDI-HQoL). Our results showed that VSSs of the right-sided group were significantly higher than those in the left-sided group before and 1 week after the maneuver (p<0.05). One week after the maneuver, VDI-HQoLs of the left-sided group were significantly higher than those in the right-sided group (p<0.05). In all right-sided and left-sided groups, at 1 week after the maneuver, VSSs were significantly lower, and VDI-SSs and VDI-HQoLs were significantly higher than those before the maneuver (p<0.05). As VSS values increased, VDI-SS and VDI-HQoL values decreased (p<0.05). In the left-sided group, VSS values decreased, and VDI-HQoL values increased. As disease duration increased, VSS values increased before the maneuver (p<0.05). In females, VSS values increased, and VDI-SS and VDI-HQoL values decreased before the maneuver (p<0.05). In posterior canal BPPV, the Epley maneuver effectively decreased VSS values and increased VDI-SS and VDI-HQoL values. In the left-sided BPPV group, there were lower VSS values and higher VDI-HQoL values that showed better quality of life of the patients. Older age and female gender are other factors related to lower quality of life with higher symptom scores.

Vitamin D Supplementation and Recurrence of Benign Paroxysmal Positional Vertigo.

Positional vertigo manifests as a spinning sensation triggered by changes in head position relative to gravity. Benign paroxysmal positional vertigo (BPPV) is an inner ear disorder characterized by recurrent episodes of positional vertigo. The connection between vitamin D insufficiency/deficiency and the onset and recurrence of BPPV is established. This study aims to assess vitamin D as a recurring factor in BPPV and the efficacy of vitamin D supplementation in preventing its recurrence. A comprehensive literature review on the relationship between vitamin D and BPPV recurrence was conducted, searching PubMed, Embase, Web of Science, and article reference lists for studies published from 2020 to 2023. A total of 79 articles were initially identified through the search, with 12 of them being utilized in the study. Recurrence rates for BPPV varied from 13.7% to 23% for studies with follow-up less than 1 year and 13.3% to 65% for studies with follow-up equal to or exceeding 2 years. Risk factors for BPPV recurrence include advanced age, female sex, hypertension, diabetes mellitus, hyperlipidemia, osteoporosis, and vitamin D deficiency. While earlier studies did not establish a link between low vitamin D levels and initial BPPV occurrence, they did associate recurrent episodes with low vitamin D levels. Recent research indicates that vitamin D supplementation in BPPV patients with deficiency or insufficiency decreases both the numbers of relapsing patients and relapses per patient. To validate these findings across diverse populations, further randomized controlled studies with larger cohorts and extended follow-up durations are essential.

Altered parietal operculum cortex 2 functional connectivity in benign paroxysmal positional vertigo patients with residual dizziness: A resting-state fMRI study.

To investigate changes in functional connectivity (FC) focusing on parietal operculum cortex 2 (OP2) in benign paroxysmal positional vertigo (BPPV) patients with residual dizziness (RD) after successful canalith repositioning procedure (CRP). High-resolution three-dimensional T1 and resting-state functional magnetic resonance imaging (fMRI) were performed on 55 healthy controls (HCs), 55 BPPV patients with RD, and 55 patients without RD after successful CRP. Seed-based (bilateral OP2) FC was calculated to investigate the changes in FC among the three groups. Additionally, we further explored the associations between abnormal FC and clinical symptoms. One-way analysis of covariance showed significant FC differences among the three groups. Post-hoc analysis showed that patients with RD exhibited decreased FC between left OP2 and regions of left angular gyrus (AG), thalamus, precuneus, middle frontal gyrus (MFG), and right cerebellum posterior lobe (CPL) in comparison with HCs. In addition, compared with patients without RD, patients with RD showed decreased FC between left OP2 and regions of left MFG, AG, middle temporal gyrus, and right CPL. Moreover, in patients with RD, the FC between left thalamus and OP2 was negatively correlated with duration of RD, and the FC between left AG and OP2 was negatively correlated with duration of BPPV. BPPV patients with RD showed reduced FC between brain regions involved in vestibular processing and spatial cognition; These results suggested that BPPV patients with RD might have diminished central processing of vestibular information and impaired spatial cognition.

Comparison of depression, anxiety, sleep quality and quality of life among benign paroxysmal positional vertigo with or without tinnitus

Aim: Patients with benign paroxysmal positional vertigo (BPPV) may be accompanied by tinnitus, less frequently and mildly than vertigo secondary to other vestibular disorders. In this study, we aimed to separate patients with BPPV into two different groups, those with and without tinnitus, and to examine and compare depression, anxiety, disability, sleep quality, and quality of life in these patient groups.&#x0D; &#x0D; Methods: This cross-sectional study included 20 BPPV patients without an acute attack who were referred from the emergency department to the neurology outpatient clinic between April 2022 and July 2022. Beck anxiety scale was used for anxiety, Beck depression inventory was used for depression, Pitsburg sleep quality scale was used for sleep quality, the dizziness handicap inventory (DHI) was used for disability caused by dizziness, and 36-Item Short Form Health Survey (SF-36) was used for quality of life.&#x0D; &#x0D; Results: 20 BPPV patients were included in the study. While 12 of 20 patients (7 Female, 5 Male) were not accompanied by tinnitus, 8 (5F, 3M) were accompanied by tinnitus. No significant difference was detected between BPVV groups with and without tinnitus. A positive correlation was found between sleep quality and quality of life and its subparameters in BPPV patients. A direct relationship was observed between DHI and its subparameters, physical, functional, and emotional parameters, and quality of life.&#x0D; &#x0D; Conclusion: No significant relationship was found between the presence or absence of tinnitus and depression, anxiety, sleep quality, disability, and quality of life in BPVV patients.

Evaluation of Serum 25-Hydroxyvitamin D Levels in Benign Paroxysmal Positional Vertigo Patients

Background: Benign paroxysmal positional vertigo (BPPV) is characterized by the occurrence of a rotational type of vertigo and nystagmus due to the otoconia dislodgment from the utricle into semicircular canals. Repeated vertigo attacks reduce the quality of life by affecting the normal daily activities in the population of all age groups. The most accepted theory for BPPV is the displaced otoconia particle, which aggravates vertigo and nystagmus. The otoconia is made of calcium carbonate, which is regulated by calcium homeostasis. Vitamin D receptors are essential for calcium regulation and homeostasis. Objectives: The objectives of this study are to estimate the serum 25-hydroxyvitamin D levels in BPPV patients and compare them with the healthy participants/control. Materials and Methods: This study was conducted in a tertiary care hospital in south India. In Group A (case group), patients diagnosed with BPPV were included and their serum 25-hydroxyvitamin D levels were measured and compared with the healthy individuals’ serum 25-hydroxyvitamin D levels in Group B (control group). Results: This study showed no significant difference in age and gender between the two groups (P = 0.99 and 0.323, respectively). The serum 25-hydroxyvitamin D levels were lower in Group A than in Group B (P = 0.005). The prevalence of Vitamin D deficiency in Group A was higher than that in Group B. Conclusion: There is an association between 25-hydroxyvitamin D levels and BPPV patients. Further studies on Vitamin D supplementation in BPPV patients with long-term follow-up will be beneficial to know whether Vitamin D deficiency is an associated risk factor for BPPV.

Blood Serum Levels of Magnesium in Patients with Benign Paroxysmal Positional Vertigo

Background and Aim: Magnesium is essential for the morphogenesis of otoconia. The imbalance in the chemical composition of otoconia can make people susceptible to Benign Paroxysmal Positional Vertigo (BPPV). The primary outcome was to compare serum magnesium levels in BPPV patients with controls. The Ca/Mg ratios in participants are also recorded and analyzed in the present study.&#x0D; Methods: In this case-control study, we measured the serum Mg, Ca, and vitamin D in BPPV patients and age-, sex-matched subjects without BPPV. The results were adjusted for Ca, vitamin D, hypertension, and body mass index.&#x0D; Results: A total of 123 BPPV patients participated in this study. The mean Mg value was higher in patients than controls (2.01 vs. 1.95 mg/dL, p=0.030). Condition logistic regression analyses showed a higher rate of BPPV among subjects with low Ca/Mg ratio (quartile 1), relative to subjects with medium ratio (quartiles 2 and 3) (adjusted OR: 3.92, p=0.003).&#x0D; Conclusion: The present study demonstrated an imbalance of Ca and Mg in the BPPV patients as significantly higher Mg levels and lower serum Ca/Mg ratio. Although it appears decreased Ca/Mg ratio to be a risk factor for BPPV, this result should be confirmed in confirmatory studies.&#x0D; &#x0D; Keywords: Magnesium; calcium; benign paroxysmal positional vertigo; otolithic membrane; matched-pair analysis

Evaluation of Mental Rotation Ability in Patients with Unilateral Benign Paroxysmal Positional Vertigo.

Our study aims to determine whether there are differences in mental rotation abilities between unilateral benign paroxysmal positional vertigo patients and healthy controls using object-based mental rotation tasks. Our study included 17 unilateral posterior canal benign paroxysmal positional vertigo patients and 20 healthy adults. Spontaneous nystagmus test, saccade test, and dynamic positional tests with videonystagmography and object-based mental rotation test with 2-dimensional images of cubes rotated at certain angles in 3-dimensional space were performed on the participants. The mental rotation test response time and the number of correct answers were compared between patients and controls. We also evaluated whether there was a relationship between saccade test parameters and mental rotation test parameters in our study. No significant relationship was found between benign paroxysmal positional vertigo patients and controls on any of the dependent measures (P -gt; .05). When we evaluated the relationship between saccadic latency and accuracy and mental rotation test response time and number of correct answers in benign paroxysmal positional vertigo patients, no significant relationship was found (P -gt; .05). Our findings show that unilateral, posterior canal benign paroxysmal positional vertigo does not affect object-based mental rotation performance. In our study, no correlation was found between saccadic function and mental rotation ability in unilateral benign paroxysmal positional vertigo patients.

Risk Factors and a Nomogram Model for Residual Symptoms of Cured Benign Paroxysmal Positional Vertigo.

We aimed to analyze the independent risk factors that affect the treatment outcomes of residual symptoms of cured benign paroxysmal positional vertigoand to construct a nomogram model. A total of 186 benign paroxysmal positional vertigo patients who were treated in our hospital from June 2019 to August 2021 were selected. According to whether there were residual symptoms, they were divided into a group with residual symptoms (n=82) and a group without residual symptoms (n = 104). The logistic regression model was used to analyze the independent risk factors affecting the treatment outcomes, and the results were incorporated into R software to establish a nomogram model for verification. The incidence rate of residual symptoms in the 186 patients was 44.09% (82/186). Logistic regression analysis showed that age, course of disease, number of maneuvers, anxiety state, diabetes mellitus, and hypertension were independent risk factors affecting the treatment outcomes of residual symptoms after cured benign paroxysmal positional vertigo. The area under the receiver operating characteristic curve of the nomogram model was 0.938. The calibration curve was fitted well (χ2 = 8.165, P = .417). The nomogram model constructed based on age, course of disease, number of maneuvers, anxiety state, diabetes mellitus, and hypertension had a high predictive value for the treatment outcomes of residual symptoms in benign paroxysmal positional vertigo patients.

Semicircular canals are long in patients with benign paroxysmal positional vertigo.

To search for any morphological variation contributing to aetiopathogenesis and the diagnosis of benign paroxysmal positional vertigo, we measured the sizes of the semicircular canals in patients with and without benign paroxysmal positional vertigo using multidetector computed tomography. Cranial bone computed tomography images of 30 benign paroxysmal positional vertigo patients and 30 control patients were acquired with a 128-slice computed tomography scanner and a transverse plane with a thickness of 0.67 mm. The inner diameter, height and width of the canals were measured. The width of the anterior semicircular canals, and the width and height of the posterior semicircular canals of the affected ears in benign paroxysmal positional vertigo patients (n = 30) were significantly greater than in the control patients (n = 90; p = 0.001, p = 0.023, p = 0.003, respectively). In benign paroxysmal positional vertigo patients, the posterior and anterior semicircular canals are longer than those in people without benign paroxysmal positional vertigo. These morphological changes may contribute to elucidating the aetiopathogenesis and be used as a radiological sign for diagnosis of benign paroxysmal positional vertigo disease.

Influence of BPPV and Meniere's Disease on Cognitive Abilities: A Questionnaire-Based Study

The vestibular system connects the inner ear to the midbrain and subcortical structures and can affect cognition. Patients with vertigo often experience cognitive symptoms such as attention deficits, memory problems, and spatial perception difficulties. This study aimed to explore the cognitive impairments associated with Benign paroxysmal positional vertigo (BPPV) and Meniere's Disease (MD). A non-experimental group comparison design was used with 107 participants divided into three groups: Group I (clinically normal), Group II (BPPV), and Group III (MD). Participants completed a questionnaire with 10 cognition-related questions, and their responses were scored. The data were found to be non-normally distributed. The analysis revealed a significant difference in scores between Group I and both Group II and Group III. Chi-square tests showed that the responses to cognition-related questions varied among the groups, with Group II exhibiting more cognitive problems. Associated conditions like hypertension, diabetes, and hearing loss did not significantly influence the responses within each group. This study suggests a significant relationship between cognitive problems and patients with BPPV and MD. However, there was no association found between the cognitive problems experienced in BPPV and MD patients. These findings align with previous research indicating that vestibular disorders can lead to deficits in spatial memory, attention, and other cognitive functions. By understanding the link between cognition and vestibular disorders, we can improve diagnosis and rehabilitation services to enhance the quality of life for these patients.

Evaluation of electrocardiogram findings and inflammatory parameters in patients with benign paroxysmal positional vertigo.

Benign Paroxysmal Positional Vertigo (BPPV) is a common vestibular disorder characterized by brief episodes of intense vertigo, often accompanied by nausea and nystagmus. The frontal QRS-T (fQRS-T) angle, a novel indicator of ventricular depolarization and repolarization heterogeneity, has garnered attention due to its potential to reveal insights into cardiac function. This study aimed to investigate the potential relationship between the fQRS-T angle and inflammation markers in individuals with BPPV. The study encompassed 49 BPPV patients and 51 healthy individuals as a control group. Laboratory assessments were conducted to measure inflammation parameters. Electrocardiogram (ECG) data was analyzed, focusing on conduction parameters including fQRS-T angle, QRS duration, QT interval, and corrected QT interval. The study revealed that the fQRS-T angle was significantly higher in BPPV patients compared to the control group (p<.001). Moreover, inflammation markers such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), and C-reactive protein-to-albumin ratio (CAR) were notably elevated in BPPV patients (p<.001, for all). The findings of the correlation analysis demonstrated a strong association between NLR and the fQRS-T angle (r=.718, p<.001). Additionally, the results of the linear regression analysis indicated that NLR positively predicted the fQRS-T angle (p<.001). The study's outcomes have underscored a significant increase in the fQRS-T angle among BPPV patients, suggesting altered ventricular repolarization dynamics. The strong correlation between NLR and the fQRS-T angle raises intriguing possibilities of inflammation's potential role in influencing cardiac electrophysiology. The study contributes to the growing body of evidence suggesting that BPPV might have implications beyond its immediate vestibular manifestations.

Dispelling Mist That Obscures Positional Vertigo in Vestibular Migraine.

(1) Background: Patients with vestibular migraine (VM) often present with positional vertigo. A portion of these patients have features of benign paroxysmal positional vertigo (BPPV). It is a challenge to rapidly identify the BPPV component of VM associated with positional vertigo. (2) Methods: Retrospective data collected from 60 VM and 47 VM + BPPV patients were used to build a diagnostic model, and then prospective data from 47 patients were used for the external validation. All patients had VM manifesting as positional vertigo, with or without accompanying BPPV. The clinical manifestations and the results of vestibular function tests were comprehensively analyzed using logistic regression. (3) Results: The univariate and multivariate analyses showed that the age, symptom duration, tinnitus, ear fullness, nausea, head shaking nystagmus, the direction of the Dix-Hallpike and roll tests, and horizontal gain could help differentiate between the two groups. A nomogram and an online calculator were generated. The C-index was 0.870. The diagnostic model showed good discriminative power and calibration performance during internal and external validation. (4) Conclusions: This study provided a new perspective for diagnosing VM with positional vertigo by identifying the BPPV component and, for the first time, offers a prediction model integrating multiple predictors.

Altered functional activity of the precuneus and superior temporal gyrus in patients with residual dizziness caused by benign paroxysmal positional vertigo.

Benign paroxysmal positional vertigo (BPPV) is a common clinical vertigo disease, and the most effective treatment for this disease is canal repositioning procedures (CRP). Most patients return to normal after a single treatment. However, some patients still experience residual dizziness (RD) after treatment, and this disease's pathogenesis is currently unclear. The purpose of this study is to explore whether there are abnormal brain functional activities in patients with RD by using resting-state functional magnetic resonance imaging (rs-fMRI) and to provide imaging evidence for the study of the pathogenesis of RD. The BPPV patients in the Second Affiliated Hospital of Xuzhou Medical University had been included from December 2021 to November 2022. All patients had been received the collection of demographic and clinical characteristics (age, gender, involved semicircular canal, affected side, CRP times, BPPV course, duration of RD symptoms, and whether they had hypertension, diabetes, coronary heart disease.), scale assessment, including Dizziness Handicap Inventory (DHI), Hamilton Anxiety Inventory (HAMA), Hamilton Depression Inventory (HAMD), rs-fMRI data collection, CRP treatment, and then a one-month follow-up. According to the follow-up results, 18 patients with RD were included. At the same time, we selected 19 healthy individuals from our hospital's physical examination center who matched their age, gender as health controls (HC). First, the amplitude of low-frequency fluctuations (ALFF) analysis method was used to compare the local functional activities of the two groups of subjects. Then, the brain regions with different ALFF results were extracted as seed points. Functional connectivity (FC) analysis method based on seed points was used to explore the whole brain FC of patients with RD. Finally, a correlation analysis between clinical features and rs-fMRI data was performed. Compared to the HC, patients with RD showed lower ALFF value in the right precuneus and higher ALFF value in the right superior temporal gyrus (STG). When using the right STG as a seed point, it was found that the FC between the right STG, the right supramarginal gyrus (SMG), and the left precuneus was decreased in RD patients. However, no significant abnormalities in the FC were observed when using the right precuneus as a seed point. In patients with RD, the local functional activity of the right precuneus is weakened, and the local functional activity of the right STG is enhanced. Furthermore, the FC between the right STG, the right SMG, and the left precuneus is weakened. These changes may explain the symptoms of dizziness, floating sensation, walking instability, neck tightness, and other symptoms in patients with RD to a certain extent.

Early treatment for benign paroxysmal positional vertigo secondary to sudden sensorineural hearing loss.

Sudden sensorineural hearing loss (SSNHL) accompanied by benign paroxysmal positional vertigo (BPPV) is relatively common in the clinic. There are unified standards for the treatment of primary BPPV with good reduction effect, while there are few studies on the treatment of BPPV secondary to SSNHL within 1 week of onset. The study was to investigate the treatment of BPPV secondary to SSNHL and compare its manual reduction with that of primary BPPV. We selected 90 patients with BPPV accompanied by SSNHL within a week of onset and 210 primary BPPV patients at Hebei Provincial Eye Hospital from June 2020 to December 2022. The former group was divided into the medicine group and manual reduction plus medicine group. The medicines used were extract of Ginkgo biloba leaves injection, betahistine hydrochloride injection and oral prednisone. We contrasted the efficacy respectively for posterior semicircular canal BPPV (psc-BPPV), horizontal semicircular canal BPPV (hsc-BPPV) and multiple semicircular canal BPPV (msc-BPPV). In addition, we compared the manual reduction effect for primary BPPV and manual reduction group, and the evaluation of efficacy are the intensity of nystagmus and the clinical symptoms. In the secondary BPPV group, there was no difference in efficacy between the medicine group and manual reduction group at the 7th-day after reduction for psc-BPPV, hsc-BPPV, and msc-BPPV (P > .05). The immediate effect of reduction was significantly different between the primary BPPV group and the group with SSNHL and BPPV for both psc-BPPV and hsc-BPPV (P < .05), and the effect of the primary BPPV group was better, but it was no difference for msc-BPPV (P > .05). For the treatment of BPPV accompanied by SSNHL within 1 week of onset, the additional reduction therapy showed no benefit, so we need to apply medication for SSNHL.

Low vitamin D and uric acid status in patients with benign paroxysmal positional vertigo.

Growing evidence reported that vitamin D and uric acid metabolism played roles in the occurrence of benign paroxysmal positional vertigo, an otoconia-related vestibular disorder. We aimed to investigate the serum 25-hydroxy vitamin D (25(OH)D) and uric acid in patients with benign paroxysmal positional vertigo and to determine the risk factor for benign paroxysmal positional vertigo. This case-control study comprised 182 patients with benign paroxysmal positional vertigo and 182 age- and gender-matched controls. All subjects' age, body mass index, systolic blood pressure, diastolic blood pressure, 25-hydroxyvitamin D (25(OH)D), uric acid and serum calcium measurements were analyzed. We found a female preponderance of benign paroxysmal positional vertigo patients, with a median of 60 (52-66) years old. The results showed low vitamin D status both in benign paroxysmal positional vertigo and controls, with no significant difference of 25(OH)D levels between benign paroxysmal positional vertigo patients and controls (P > 0.05). Compared with the control group, patients with benign paroxysmal positional vertigo had a higher prevalence of vitamin D deficiency and a lower prevalence of vitamin D sufficiency (P < 0.05). Uric acid was significantly lower in the benign paroxysmal positional vertigo groups (P < 0.05). Logistic regression analysis revealed that age and uric acid were considered higher risk predictors for benign paroxysmal positional vertigo. Our study observed low vitamin D status in patients with benign paroxysmal positional vertigo, with no significant differences of the 25(OH)D level in patients with benign paroxysmal positional vertigo and controls. Elderly, vitamin D deficiency and low uric acid levels may be risk factors for benign paroxysmal positional vertigo occurrence.

Clinical and Prognostic Implications of Cervical and Ocular Vestibular Evoked Myogenic Potentials (cVEMP and oVEMP) in Benign Paroxysmal Positional Vertigo (BPPV): A Prospective Study.

Several studies have investigated the efficacy of VEMP (vestibular evoked myogenic potential) in patients with vestibular disorders and BPPV (benign paroxysmal positional vertigo). However, previous data were inconclusive. The aim of this study was to investigate the difference in latency, amplitude P1-N1, asymmetry ratio (AR), and cervical/ocular-VEMP values between BPPV patients and healthy controls. 125 healthy subjects and 42 BPPV patients were prospectively enrolled in the study. In both groups, c/oVEMP tests with 500 Hz tone-burst stimuli were performed. Latencies P1, N1 peaks, and corrected amplitudes (CA) were measured, and AR was calculated. in the BPPV group, 14.29% of patients lacked oVEMPs that recovered after therapy. N1 latencies were significantly elongated, and 50% of patients had pathological AR; this value normalized at follow-up sessions. In addition, there was a reduction in CA in the pathologic ear compared to healthy ears (p = 0.04) and compared to healthy controls (p = 0.01). For cVEMP, a significant reduction in latency-P1 was observed in BPPV patients compared to controls; no significant differences were observed for P1, N1, and CA values between the two ears. The cVEMPs were absent in 14.29% of BPPV patients (AR > 35) that recovered after therapy. We identified several abnormal c/oVemp values in BPPV patients compared with healthy controls, with most changes in values occurring in oVEMPs, suggesting that utricular dysfunction may be more common than saccular. In addition, patients with oVEMP alteration showed later clinical recovery, suggesting a possible prognostic role of the test.