Positional Vertigo Research Articles

Clinical outcomes for various benign paroxysmal positional vertigo (BPPV) diagnoses in adolescents and young adults with recent concussions

ObjectiveDetermine how positive BPPV findings in adolescents and young adults following concussion impacted the total number of treatments required and time until discharge. SettingOutpatient physical therapy clinic. Participants167 individuals who were diagnosed with concussion or brain injury. DesignRetrospective chart review. Main measuresTotal number of treatments and days until discharge were compared for various BPPV diagnoses (anterior canal, posterior canal, horizontal canal, and combination) and for individuals with and without BPPV. ResultsFifty-one out of 167 cases (30.54%) were diagnosed with BPPV. The total number of treatments provided was statistically different across BPPV diagnoses (P = .004). However, days until discharge were not statistically different between BPPV diagnoses (P = .28). There was no significant difference between time to discharge between those with BPPV (median = 21 days, range = 7–126) and those without (median = 28 days, range = 7–84 days; P = .23, r = 0.09). ConclusionTo optimize outcomes, including symptom resolution and return to sport and/or work, early identification of BPPV and subsequent intervention should be prioritized for individuals who have concussion symptoms that suggest vestibular dysfunction.

What is the current status of care by neuro-otology specialists in Switzerland-A national survey.

Vertigo and dizziness are frequent presenting symptoms in the emergency department and in outpatient centers. While the majority of dizzy patients are evaluated by primary care physicians, specialists are often involved in the diagnostic workup. We aimed to gain more insights into the role of specialists in the care of dizzy patients. Board-certified neurologists and ear-nose-throat (ENT) physicians working in Switzerland were invited to participate in an online survey. Descriptive statistical analyses were performed, and prospectively defined hypotheses were assessed using correlation analyses. All 111 participating specialists (neurologists = 62; ENT specialists = 49) were familiar with testing for posterior canal benign paroxysmal positional vertigo (BPPV), and 66% regularly applied provocation maneuvers for suspected lateral canal BPPV. Reposition maneuvers for posterior (99%) and lateral (68%) canals were frequently performed. ENT physicians were familiar with lateral canal BPPV repositioning maneuvers significantly more often than neurologists (84 vs. 56%, p ≤ 0.012). Specialists strongly agreed that performing the head impulse test (86%) and looking for deficient eccentric gaze holding (82%) are important. Compared to neurologists, significantly fewer ENT physicians indicated ordering brain MRI in acutely dizzy patients (OR = 0.33 [0.16-0.067], p = 0.002) and physical therapy in patients with acute (50 vs. 20%, p = 0.005) or episodic/chronic dizziness (78 vs. 50%, p = 0.003). We found substantial differences in the care of dizzy patients by neurologists and ENT physicians. This underlines the need for a standardized, guideline-oriented diagnostic workup and treatment across specialties. Dedicated training for performing lateral canal BPPV repositioning maneuvers should be prioritized for neurologists. Similarly, physical therapy should be considered more often by ENT physicians.

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. 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. 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). 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. Keywords: Magnesium; calcium; benign paroxysmal positional vertigo; otolithic membrane; matched-pair analysis

Low Bone Mineral Density and the Risk of Benign Paroxysmal Positional Vertigo.

This study aimed to comprehensively analyze the relationship between low bone mineral density (BMD) and the risk of benign paroxysmal positional vertigo (BPPV) based on the large prospective population-based UK Biobank (UKB) cohort. Prospective population-based cohort study. The UKB. This prospective cohort study included UKB participants recruited between 2006 and 2010 who had information on BMDand did not have BPPV before being diagnosed with low BMD. Univariable and multivariable logistic regression models were constructed to assess the association between low BMD (overall low BMD, osteopenia, and osteoporosis) and BPPV. We further conducted sex and age subgroup analysis, respectively. Finally, the effects of antiosteoporosis and female sex hormone medications on BPPV in participants with osteoporosis were evaluated. In total, 484,303 participants were included in the final analysis, and 985 developed BPPV after a maximum follow-up period of 15 years. Osteoporosis was associated with a higher risk of BPPV (odds ratio [OR] = 1.37, P = .0094), whereas osteopenia was not. Subgroup analyses suggested that the association between osteoporosis and BPPV was significant only in elderly females (≥60 years, OR = 1.51, P = .0007). However, no association was observed between antiosteoporosis or female sex hormone medications and BPPV in the participants with osteoporosis. Osteoporosis was associated with a higher risk of developing general BPPV, especially in females aged ≥ 60 years old, whereas osteopenia was not associated with BPPV.

Epley manoeuvre’s efficacy for benign paroxysmal positional vertigo (BPPV) in primary-care and subspecialty settings: a systematic review and meta-analysis

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.

Preceding Benign Paroxysmal Positional Vertigo as a Trigger for Persistent Postural-Perceptual Dizziness: Which Clinical Predictors?

Persistent postural-perceptual dizziness (PPPD) is a syndrome described as secondary, when it is the consequence of an organic disorder (s-PPPD), or primary, when no somatic triggers can be identified. We evaluated a group of patients diagnosed as s-PPPD, with Benign Positional Paroxysmal Vertigo (BPPV) as the main somatic trigger, with the aim of identifying the predictive clinical elements of evolution towards PPPD. Retrospective case review. Tertiary referral center. We evaluated 126 patients diagnosed with PPPD; 54 patients were classified as p-PPPD (43%) and 72 as s-PPPD (57%). Of these, 51 patients had BPPV as a somatic trigger of PPPD, and in this group, we evaluated the prevalence of some clinical features (age, sex, latency between the onset of BPPV and the final diagnosis, recurrence of BPPV and the presence of migraine headache) for comparison with a group of patients who suffered from BPPV without an evolution towards PPPD (control group). In the group with PPPD secondary to BPPV, we found a significantly higher mean age and a longer latency between the onset of BPPV and the final diagnosis compared to the control group. No difference between the two groups was found regarding sex, recurrence rate and the presence of migraine headache. The parameters most involved as potential precipitants of PPPD after BPPV were the age of the patients and a long latency between the onset of BPPV and the final diagnosis; the mean age of the subjects who developed PPPD following BPPV was significantly higher. These findings lead us to emphasize the importance of the early identification and treatment of BPPV, especially in older 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.

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.

Delayed Diagnoses in Patients With Dizziness in the US Commonwealth of Virginia and the Tidewater Region.

In a region of approximately 1.7 million people (Tidewater, coastal Virginia), identify secondary diagnoses in persons with dizziness. This cross-sectional study utilizing TriNetX included individuals in the region of interest diagnosed with dizziness between 2010 and 2020. Subsequent diagnoses of vestibular disease or medical conditions possibly associated with dizziness in the same subjects were catalogued. During the study period, 31,670 subjects were identified with diagnoses of dizziness as a symptom; 18,390 subjects were subsequently given a dizziness-related nonvestibular diagnosis, and 930 were given a subsequent vestibular disease diagnosis. The proportion of subjects diagnosed with vestibular disease (3%) after the dizziness diagnosis is far below expected norms (25%-34%) in the general population. There were greater proportions of delayed diagnoses of labyrinth dysfunction (odds ratio [OR], 4.8; P < 0.0001), superior semicircular canal dehiscence (OR, 3.1; P = 0.0023), otolith disease (OR, 3.1; P = 0.0023), among others, and a decreased proportion of delayed diagnosis of benign paroxysmal positional vertigo (OR, 0.56; P < 0.0001). The discrepancy between expected and observed prevalence in our region indicates that vestibular disease is likely underdiagnosed.

Sudden unilateral hearing loss and recurrent positional vertigo following delayed cerebellar perfusion deficit and infarction

Sudden unilateral hearing loss and recurrent positional vertigo following delayed cerebellar perfusion deficit and infarction

Posterior stroke manifested as positional vertigo involving vertical canal

Posterior stroke manifested as positional vertigo involving vertical canal

Effects of Different Durations and Frequencies of Vestibular Rehabilitation in Patients With Residual Symptoms After Benign Paroxysmal Positional Vertigo Repositioning.

This study aimed to explore the effects of different duration and daily frequency of vestibular rehabilitation (VR) in patients with residual symptoms after benign paroxysmal positional vertigo (BPPV) successful repositioning. Patients with successful BPPV repositioning (n = 118) were divided into 3 groups according to VR duration and frequency: group A (n = 30; 15 minutes, 3 times/day), group B (n = 30; 30 minutes, 3 times/day), group C (n = 28; 15 minutes, 6 times/day), and control group D (n = 30; no VR). All patients completed the dizziness handicap inventory (DHI) and vestibular rehabilitation benefit questionnaire (VRBQ) at baseline and after 2 and 4 weeks. The emotional scores and the proportion of severe dizziness disability in the DHI scores were significant differences between VR groups A to C and control group D after 2 and 4 weeks (all P < .05). There were significant differences in total DHI and VRBQ scores among the VR groups A to C after 2 and 4 weeks (all P < .05). Interestingly, emotion scores were not significantly different in group A (P = .385), group B (P = .569), and group C (P = .340) between 2 and 4 weeks. Meanwhile at 2 weeks, the difference in motion-provoked dizziness score between group A and B was statistically significant (P = .02). A total VR duration over 4 weeks can reduce dizziness and improve VR benefits in routine therapy in patients with residual dizziness after successful BPPV repositioning. Emotional improvement can be observed after 2 weeks. VR may help to relieve motion-provoked dizziness earlier if patients are willing to consider increasing the duration to more than 15 minutes.

Assessment of Benign Paroxysmal Positional Vertigo (BPPV) Incidence Following Closed Sinus Lift and Ridge Splitting Surgeries: A Cohort Study.

With a notable increase in demand for implant placement in atrophic cases, this study aimed to evaluate the occurrence of benign paroxysmal positional vertigo (BPPV) following closed sinus lift and ridge splitting surgeries. Healthy patients requiring posterior maxillary closed sinus lift or ridge split surgeries at Mashhad Dental School from September 2021 to September 2022 were enrolled in this cohort study. A single surgeon performed all surgeries under standard protocols. The intervention groups consisted of closed sinus lift and ridge splitting procedures. The primary outcome variable was BPPV, and the Dix-Hallpike maneuver was used before and after the operation to diagnose BPPV. The data were statistically analyzed using SPSS 23, and the significance level was set at 0.05. A total of 112 patients (51 women and 61 men) with a mean age of 48.4 ± 9.5years participated in the study. The average BMI was 21.5 ± 2.4, and the mean duration of surgery was 31.9 ± 6.6min. Of the patients, 10.7, 36.6, 27.7, 12.5, and 1.8% presented with hypertension, headache, dizziness, nausea, and BPPV, respectively. Two patients (3.1%) in the closed sinus lift group were diagnosed with BPPV, whereas no patients in the ridge split group were diagnosed. However, there was no significant difference (P = 0.509). No statistically significant difference in the occurrence of certain symptoms between two groups was found. There was a significant association between certain health conditions and the onset of BPPV. The study suggests closed sinus lift surgery may have a higher risk of BPPV than ridge split surgery, but further studies with larger sample are needed to confirm this association.

Correction to: Clinical Practice Update Part I: Diagnosis and Treatment for Benign Paroxysmal Positional Vertigo

Correction to: Clinical Practice Update Part I: Diagnosis and Treatment for Benign Paroxysmal Positional Vertigo

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.

Comparing Epley Maneuver, Betahistine, and Dimenhydrinate in the Treatment of Benign Paroxysmal Positional Vertigo: A Prospective Study.

Although the Epley maneuver is considered the primary treatment in BPPV, anti-vertigo medications are effective in residual symptoms. This study was designed to compare betahistine and dimenhydrinate plus the Epley maneuver and the Epley maneuveralone. This prospective cohort study was performed in Mashhad, Iran, from 2013 to 2015. 90 adult patients diagnosed with BPPV in hospitals and ENT clinics were selected through convenience sampling. Patients receivedbetahistine 8 mg TDS or dimenhydrinate 50 mg once daily plus Epley or the Epley alone for four weeks. SF-36 and the DHI were used before and after the treatment. 49 were females (54.4%). The mean (SD) age was 47.9 (8.7) years. There was no significant difference between the groups in age (P = 0.753) and gender (P = 0.050).There were significant differences in all areas of SF-36 except for social activities in the dimenhydrinate group. There was a marginally significant difference between the betahistine and dimenhydrinate groups in role limitation due to physical health problems (P = 0.046). There were significant differences between the females and males in emotional well-being before and after treatment in the dimenhydrinate group (P = 0.014) and in terms of role limitation due to physical health problems in the Epley maneuver group (P = 0.022). Older patients in the betahistine group had better social activities after treatment (P = 0.048). In severe forms of BPPV, betahistine or dimenhydrinate might effectively reduce the symptoms.

Vestibular migraine and its management in Indian clinical setting: a narrative review

Vestibular migraine (VM) is a disorder connecting two clinical conditions, migraine and vertigo. A high prevalence of VM (~30%) is reported among Indians suffering from dizziness. Yet, there is no gold standard for diagnosis and treatment. Trials specifically for patients with VM are scarce. This review provides an overview on VM and its management in the Indian clinical setting. An evidence-based discussion and review of literature on VM was performed by expert panelists, and opinions were gathered. Experts opined that in vertigo clinics, around 50% of patients are diagnosed with VM, with a higher predominance in females aged 30-50 years, while in children, the age of manifestation is 12-14 years. The most common presenting symptoms of VM among adults are spontaneous vertigo, followed by positional vertigo with headache, nausea, vomiting, photophobia and phonophobia, while intolerance to loud sounds and sudden falls are common symptoms in children with VM. Common comorbidities associated with VM are benign paroxysmal positional vertigo (BPPV) and Meniere’s disease (MD). Experts opined that there are currently no approved standardized treatment protocols for VM. The steps in the management of VM include diet and lifestyle modification, along with medicines for symptomatic relief (abortive) and prophylaxis and vestibular rehabilitation. Globally, prochlorperazine, a vestibular suppressant, is widely used for the management of vertigo and its associated symptoms. According to experts, prochlorperazine 5 mg twice or thrice daily for 5-7 days can play a significant role as an abortive treatment in the management of various patient profiles of VM.

Diagnosis and treatment of dizziness and vertigo in clinical practice

The article describes vertigo diagnostic algorithm. Acute, paroxysmal, and chronic vestibular syndromes determination, attacks duration assessment, provoking factors and comorbid diseases are described. The otoneurologic examination main tests and their interpretation in assessing of spontaneous nystagmus, the results of stato-coordination tests, the head rotation test and positional tests are presented. Diagnostic criteria and basic approach to the most common disorders manifested by vertigo treatment are discussed, including benign paroxysmal positional vertigo, vestibular neuronitis, Meniere's disease, vestibular migraine, persistent postural-perceptual vertigo, bilateral vestibulopathy and others.

Otolithic and canal functions assessment during the acute phase of benign paroxysmal positional vertigo.

Assess otolith and canal involvement in patients with Benign Paroxysmal Positional Vertigo (BPPV) during the acute phase. Ninety patients with BPPV in the acute phase underwent a vestibular assessment that included an assessment with videonistagmography, video Head Impulse Test (vHIT) to evaluate horizontal and vertical semicircular canals, and ocular vestibular evoked myogenic potentials (oVEMPs) for the otolithic function. Ninety patients had an involvement of the posterior canal, fifty-five out of ninety patients presented a BPPV of the right ear. No asymmetry of the otolithic functions was found for the utricular macula. Furthermore, no reduction of the Vestibular Ocular Reflex gain was found for the examined canal functions. The lack of asymmetry suggests that during the acute phase of BPPV, the otolithic function is balanced between the affected and unaffected ears. Moreover, the preserved VOR gain for the examined canal functions suggests that the VOR responses for the examined channels were intact.