Bilateral Benign Paroxysmal Positional Vertigo Research Articles

Incidence of Benign Paroxysmal Positional Vertigo and Course of Treatment Following Mild Head Trauma-Is It Worth Looking For?

This study aimed to identify the incidence of benign paroxysmal positional vertigo following head trauma. This study is a prospective cross-sectional study. Initially, a targeted search for the identification of patients with the international classification of diseases (ICD-10) diagnosis of cerebral commotio at relevant emergency units in the Northern Region of Denmark was done. This was followed by a clinical examination to determine the incidence of benign paroxysmal positional vertigo (BPPV) within this population. Of the 295 patients diagnosed with commotio cerebri during a 4-and-a-half month period, 85 patients were included. All patients underwent clinical examination in a mechanical repositional chair wearing Video Frenzel Goggles. Additional examinations included a complete video head impulse test. A total of six patients were identified with benign paroxysmal positional vertigo (BPPV) following minor head trauma. Bilateral BPPV, multicanal BPPV, and BPPV of a single semicircular canal were identified. All patients experienced relief of benign paroxysmal positional vertigorelated symptoms within 3 treatment sessions. Five patients were identified with a pathological video head impulse test, 54 with an inconclusive examination, and 15 with a normal video head impulse test. The incidence of benign paroxysmal positional vertigo following minor head trauma was 7%. A relatively high number of atypical subtypes of benign paroxysmal positional vertigo was found. When applying strict criteria for the interpretation of video head impulse test examination, the number of patients with inconclusive video head impulse test examination was higher than expected and 6.7% of patients had a pathological video head impulse test examination. No relationship between benign paroxysmal positional vertigo and pathological video head impulse test was observed.

Unilateral mimicking bilateral BPPV- a forgotten entity? Characteristics of a large cohort of patients, comparison with posterior canal BPPV and clinical implications

ObjectiveUnilateral mimicking bilateral benign paroxysmal positional vertigo (umb-BPPV) was attributed to inappropriate head positioning during testing of the posterior canal. Despite its inclusion in the Diagnostic criteria for the classification of vestibular disorders of the Bárány Society, the clinical characteristics and treatment responsiveness of this BPPV subtype have not been intensively studied. MethodsRecords of patients with BPPV seen at a single outpatient dizziness clinic during the years 2000–2020 were reviewed. Eighty seven patients with umb-BPPV and 86 random patients with posterior canal BPPV (p-BPPV) were retrieved. Their demographics and BPPV characteristics were analyzed. ResultsPatients' and BPPV characteristics were similar in umb- and p-BPPV except for the prevalence of males in the umb-BPPV group. No differences were found between treatment responsiveness and recurrences in both groups. The recurrence rate of umb-BPPV was not influenced by age, gender, BPPV side, duration of symptoms or treatment responsiveness during the first attack. ConclusionsIn accordance with our hypothesis about mixed canalo- and cupulolithiasis as the underlying mechanism of umb-BPPV, patients did not differ in characteristics and treatment responsiveness from p-BPPV patients. Recognition of umb-BPPV is important since inappropriate treatment can cause an unnecessary delay in therapy success.

Systematic Review of Bilateral Benign Paroxysmal Positional Vertigo.

To evaluate the success rates of canalith repositioning maneuvers (CRM) in the treatment of patients diagnosed with bilateral benign paroxysmal positional vertigo (BiBPPV). Systematic review. A comprehensive search of only English studies in PubMed, Ovid (1946 to the present), and Embase (1974 to the present) databases was done up until January 1, 2021. Studies that diagnosed patients with BiBPPV specifically and evaluated the CRM success from all published years were included. Studies were excluded if follow-up was less than 6 months or if they failed to distinguish BiBPPV from ipsilateral multi-canal BPPV. A total of nine studies were included with a total study population of 325 patients. Included studies were evaluated for bias with the National Institutes of Health (NIH) Study Quality Assessment Tool. Success rates of CRM, number of treatments required, and disease recurrence rates were extracted. The overall success rate was compiled using a fixed-effect binary inverse variance model and was 95.2% (CI: 92.9%-97.5%). A qualitative review suggested treating the more affected side first on separate visits until resolved, followed by contralateral treatment (recommendation). The mean number of treatments was 2.9 (CI: 2.4-3.4), and the recurrence rate was 19.8% (CI: 11.7%-27.9%). There was a higher proportion of trauma etiology of BiBPPV compared to unilateral, with an odds ratio of 8.9 (CI: 5.1-15.3). Overall, this meta-analysis shows high success rates for CRM in the treatment of BiBPPV. Rates are similar to CRM efficacy for unilateral BPPV. Laryngoscope, 132:640-647, 2022.

Epley’s Maneuver versus Semont’s Maneuver in the Treatment of Posterior Semicircular Canal Benign Paroxysmal Positional Vertigo: A Cohort Study

Introduction: Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause of vertigo in otorhinolaryngological practice. Canalolithiasis and cupulolithiasis are the main theories which describe the pathophysiology of BPPV. Particle repositioning maneuvers are non invasive, simple, bedside procedure that are better tolerated by patients and give symptomatic relief. Aim: To compare the effectiveness of Epley’s vs Semont’s maneuver in the treatment of Posterior Semicircular Canal (PSC) BPPV. Materials and Methods: A cohort study was conducted in Otorhinolaryngology Department of Chettinad Hospital and Research Institute from October 2020-March 2021. A total of 108 patients who reported to the outpatient department and were diagnosed with PSC BPPV were included in this study. A detailed clinical history was recorded audio vestibular examination was conducted and Dix-Hallpike maneuver were performed to confirm the diagnosis. Following which, patients were subjected to treatment with either Epley’s maneuver or Semont’s maneuver. A total of 54 patients were treated with Epley’s maneuver and 54 patients were treated with Semont’s maneuver. Patients were followed-up one week after performing the maneuver. In case of presence of persistent symptoms, the maneuver was repeated upto a maximum of three times. Successful treatment was assessed based upon the patient’s symptomatic improvement of vertigo and a negative Dix-Hallpike test which was performed at the follow-up. Data was presented in proportion (descriptive statistics) and chi-square test was used. The p-value <0.05 was considered as statistically significant. Results: In a total of 108 cases, the most common age group affected by BPPV was that of 21-40 years. Left side BPPV was noted in 50 (46.3%) patients, right side BPPV in 48 (44.4%) patients and 10 (9.3%) patients were found to have bilateral BPPV. Fifty two patients responded well for Epley’s maneuver and had complete resolution of symptoms on first follow-up and 46 patients responded to Semont’s maneuver and improved symptomatically. Conclusion: Greater number of patients improved symptomatically in the first visit itself with Epley’s maneuver compared to Semont’s maneuver. Hence, Epley’s maneuver is the preferred initial treatment and effective modality for PSC BPPV.

Incidence of unilateral and bilateral benign paroxysmal positional vertigo when the left and right Dix-Hallpike manoeuvres are positive: a model based on the sense of torsional nystagmus

SUMMARYPatients presenting with nystagmus indicative of benign paroxysmal positional vertigo (BPPV) during the left and the right Dix-Hallpike manoeuvres (DHMs) are frequently seen in clinical practice. In such cases, BPPV may be unilateral or bilateral. The aim of this study is to describe the incidence of unilateral and bilateral BPPV when both DHMs are positive, taking into account the sense of the torsional component of nystagmus. This is a prospective multicentre study. BPPV patients were classified into three groups: patients with only one positive DHM (control group, CG), patients showing positive bilateral DHM with nystagmus in the same sense in both DHMs (same sense group, SSG) and patients showing positive bilateral DHM with the torsional component of nystagmus beating in opposite senses in each DHM (opposite sense group, OSG). Only one Epley Manoeuvre (EM) was performed on all patients. Based on the ipsilateral result of the EM, the contralateral result of the same EM and the BPPV resolution rate in the control group, a model was developed to predict the incidence of unilateral and bilateral BPPV in the SSG and the OSG. There were 234 patients in the control group, 20 in the SSG and 23 in the OSG. The model estimated that the percentage of unilateral BPPV would be 89.5% in SSG and 38.7% in OSG. Using these findings, we conclude that when both DHMs are positive, BPPV may be unilateral or bilateral. If the torsional components of both nystagmuses beat in the same sense, it is more likely to be unilateral BPPV. If the torsional components beat in opposite senses, both situations can be considered equally likely.

Bilateral Posterior Canal Benign Paroxysmal Positional Vertigo Co-existing with Cranial Nerves Schwannoma and Meniere Disease: Case Report

Benign Paroxysmal Positional Vertigo (BPPV) is characterized by intense positional provoked vertigo with a brief duration and is one of the most common types of peripheral vestibular problems. The most commonly affected semi-circular canal is the posterior canal with a greater prevalence seen in females between the ages of 71-80. BPPV has a 60% right ear predisposition with canalithiasis as the predominant type. Most cases are unilateral, although bilateral BPPV is not atypical when associated with falls with head trauma, ototoxicity or co-existing vestibulopathy. To our knowledge, reports on bilateral BPPV coexisting with bilateral progressive vestibulopathy are scant. We describe a case of bilateral posterior canal BPPV with definite Menieres Disease (MD), Vestibular Schwannoma (VS) secondary to a schwannoma arising from the Jugular Foramen (JF) with mass effect and an incidental schwannoma of the right orbital optic nerve. Underlying BPPV may mask other clinical presentations, making it challenging to diagnose co-existing vesitbulopathy, especially those of a progressive episodic nature. In making management decisions, this serves as a reminder for clinicians to have in-depth conceptual and procedural knowledge to recognise and focus on the insidious progressive pathologies and not be distracted by the easily treatable BPPV.

Benign paroxysmal positional vertigo associated with Meniere's disease.

We studied the clinical features of benign paroxysmal positional vertigo (BPPV) associated with Meniere's disease. The medical records of 120 patients with BPPV was retrospectively analyzed. Complete otolaryngological, audiological, and neurotological evaluation results were available for all patients, including nystagmography. All patients were diagnosed using the Dix-Hallpike test or roll test and treated with the canalith repositioning procedure. The outcomes were compared among the three groups. A series of 120 BPPV cases. Results showed that Group A and Group B based on the following features: unilateral semicircular canal BPPV occurred more often than bilateral BPPV and the posterior semicircular canal was the most common canal involved. Additionally, Meniere's disease patients with multiple semicircular canal BPPV required repeated canalith repositioning procedures and had a higher recurrence rate. A lower treatment success rate and a higher recurrence rate were found in the BPPV patients with Meniere's disease compared with the patients without Meniere's disease. The recurrence rate was highest in the patients with multiple semicircular canal BPPV with Meniere's disease.

Use of Vestibular Evoked Myogenic Potentials in Ear Selection for Surgical Treatment of Bilateral Benign Paroxysmal Positional Vertigo

Use of Vestibular Evoked Myogenic Potentials in Ear Selection for Surgical Treatment of Bilateral Benign Paroxysmal Positional Vertigo

The Incidence of Benign Paroxysmal Positional Vertigo (BPPV) in Patients Admitted to an Acquired Brain Injury Unit

Objective: Brain injury is described as one potential cause of benign paroxysmal positional vertigo (BPPV); however, there is little information regarding the actual incidence in people who have suffered a brain injury. The objectives of this study were to determine the incidence of BPPV in a group of inpatients with a brain injury and to document the pattern of recovery.Methods: A retrospective chart review was used to collate data associated with dizziness and BPPV for all inpatients admitted to an acquired brain injury (ABI) unit over 1 year.Results: Data from 89 individuals were collated. Forty-three individuals reported dizziness and 13 of these were clinically diagnosed with BPPV. All cases of BPPV occurred in individuals with traumatic brain injury (TBI) with 17.6% of this diagnostic group affected. Over half the cases were diagnosed with bilateral BPPV. Seventy per cent of individuals with BPPV required multiple treatments to resolve all symptoms.Conclusions: Forty-one per cent of the inpatients who reported dizziness, and were able to be assessed, received a clinical diagnosis of BPPV. The study highlights the high incidence of BPPV following TBI, the importance of specifically enquiring about vertigo symptoms and undertaking appropriate assessment, and the increased complexity of treating BPPV in this group.

Efficacy and Safety of Bilateral Posterior Canal Occlusion in Patients With Refractory Benign Paroxysmal Positional Vertigo

To highlight the effectiveness, safety, and adverse effects of treating intractable posterior canal benign paroxysmal positional vertigo (BPPV) with bilateral posterior canal occlusions. Included in this study are 6 patients diagnosed with bilateral BPPV refractory to medical treatment and particle repositioning maneuvers (PRMs) who underwent bilateral posterior semicircular canal occlusions. Patients were selected from tertiary hospital referral centers in London, Ontario, Canada, and St. Louis, Missouri, USA. This study used the following interventions: preoperative and postoperative audiogram testing to monitor long-term changes in hearing, computed tomography of the head to rule out central lesions and confirm normal inner ear anatomy before surgery, magnetic resonance imaging of the head as needed to rule out posterior fossa lesions causing persistent vertigo, Dix-Hallpike maneuver to diagnose BPPV, PRM and physiotherapy vestibular rehabilitation to attempt treating BPPV before surgical intervention, and sequential transmastoid posterior semicircular canal occlusion for treatment of intractable BPPV. Postoperative resolution of vertigo induced by head movement and hearing preservation by audiometric testing and postural stability. All patients with severe debilitating bilateral BPPV refractory to medical treatment and PRM had complete resolution of their positional vertigo after bilateral sequential posterior semicircular canal occlusion. Hearing was preserved at the preoperative level in all but 1 patient who developed bilateral postoperative, mild, high-tone sensorineural loss. Residual postoperative adverse effects included transient imbalance in all patients and episodic, nonpositional vertigo in 1 patient. When stressed by extreme head motion, some patients had mild residual instability. There were no other significant long-term complications. Bilateral sequential posterior semicircular canal occlusion is a definitive, effective, and safe treatment modality for intractable bilateral BPPV, providing patients with resolution of their vertiginous symptoms. All 6 patients stated that the alleviation of their BPPV symptoms far out-weighed the residual motion sensitivity resulting from the occluded canals.

Benign paroxysmal positional vertigo simultaneously affecting several canals: a 46-patient series

Although it is uncommon for benign paroxysmal positional vertigo (BPPV) to affect more than one canal simultaneously, it is not exceptional. We attempt to determine whether these patients present differences relative to "single-canal" cases. A prospective study was done in patients with BPPV, divided into three groups: single-canal BPPV, multi-canal BPPV in one ear and multi-canal BPPV in both ears. Diagnosis was by Dix and Hallpike, supine roll and cephalic hyperextension tests. Treatment was according to the affected canals, by Semont, Epley, Lempert and Yacovino manoeuvres. Aetiology, sex, age, response to treatment, recurrence and final status in each of the three groups was evaluated. Five hundred and eighty-three patients were diagnosed with BPPV: 537 single-canal (92 %) and 46 multi-canal (8 %); of the latter, 36 bilateral and 10 unilateral cases. Basic differences between groups were: greater percentage of idiopathic cases in single-canal (p < 0.0001, Chi-square), greater percentage of post-traumatic cases in bilateral multi-canals (p = 0.006, Chi-square) and prior history of BPPV was more common in unilateral multi-canal (p = 0.006, Chi-square). No differences between groups in response to treatment, recurrence and final status were detected. There are aetiological differences between patients with single-canal BPPV, unilateral multi-canal BPPV and bilateral multi-canal BPPV. Response to therapeutic manoeuvres, however, shows that over 90 % of the patients in all the groups are cured.

Post-traumatic camel-related benign paroxysmal positional vertigo

Benign paroxysmal positional vertigo (BPPV) is a common form of dizziness. The causes of BPPV are not yet known but a relationship between the onset of vertigo and head trauma has been found. Among the causes of head injury related to BPPV, dropping off a camel has not been reported in literature yet. We describe two cases of persons that fell off a camel during a safari in Middle East countries. After the fall they reported vertigo symptoms that were not interpreted as BPPV. When they returned to Italy, due to symptoms persistence, they were referred to our ENT practice: we found evidence of BPPV. In a case it was a bilateral BPPV (bBPPV). Falling off a camel may be a relevant cause of BPPV. We suggest a correct evaluation of the labyrinth for BPPV with the appropriate diagnostic maneuvers and, if necessary, a treatment with repositioning maneuvers.

Clinical features of multiple canal involvement in benign paroxysmal positional vertigo

To describe a series of patients with multiple canal involvement in benign paroxysmal positional vertigo (BPPV), with respect to diagnosis and management. Ninety-five individuals with symptoms of BPPV and positional nystagmus were included in this study. The diagnosis was based on a history of brief episodes of vertigo and the presence of multiple positional nystagmus as confirmed by video-oculographic examination. Patients were treated by means of different particle repositioning manoeuvres according to the affected canal. Ninety-five patients showed multiple positional nystagmus during the examination corresponding to simultaneous multi-canal BPPV. Fourteen patients (14.7%) had bilateral canal BPPV. Six patients had bilateral posterior canal. Six patients had bilateral horizontal canal, and two patients had bilateral anterior canal. Fifty-three patients (55.8%) had torsional, up-beating nystagmus with down-beating nystagmus, which suggested possible affected both of posterior and anterior canals. Twenty patients (21.1%) had torsional up-beating nystagmus and horizontal direction nystagmus, which suggested possible affected both of posterior and horizontal canals. Five patients had down-beating nystagmus with horizontal nystagmus, which suggested affected both of anterior and horizontal canals. Three patients had torsional up-beating with down-beating and horizontal nystagmus, which suggested possible affected multiple canals. Treatment given to the patients varied according to the canal affected, started with the canal that elicited a strong positional nystagmus and vertigo, and 93.7% (89/95) of patients were symptom free or improved. It has been found that multi-canal BPPV is not a rate observation in clinic, and most of them affected posterior and anterior canals. Treatment of multi-canal BPPV can be effective using repositioning maneuver.

Combined Horizontal and Anterior Canal Benign Paroxysmal Positional Vertigo: A Case Report

Background and Aim: Benign paroxysmal positional vertigo (BPPV) is the most common type of peripheral vertigo. According to the canalolithiasis theory, it is caused by gravity-dependent movements of otoconial debris that collects in the endolymph of the posterior semicircular canal. The horizontal semicircular canal is occasionally affected, but involvement of the anterior canal is extremely rare. We report a case of bilateral BPPV involving the right horizontal and the left anterior semicircular canals.

Benign Paroxysmal Positional Vertigo: Concomitant Involvement of Different Semicircular Canals

We evaluated the simultaneous ipsilateral or contralateral involvement of the posterior and lateral, anterior and lateral, or posterior and anterior semicircular canals in patients with benign paroxysmal positional vertigo (BPPV). The files of 2345 patients with BPPV were analyzed. Single-canal BPPV occurred in 2310 cases (98.5%)--unilaterally in 2058 (89.1%) and bilaterally in 252 (10.9%). Multiple-canal BPPV occurred in 35 cases (1.5%). Of these 35 cases, there was simultaneous involvement of the posterior and lateral canals on the same side (23) or on opposite sides (9) in 32 cases (91.4%). Simultaneous involvement of the anterior canal on one side and the posterior canal on the opposite side occurred in 2 cases (5.7%), and that of the anterior canal on one side and the lateral canal on the opposite side occurred in 1 case (2.9%). All cases represented canalithiasis. Multiple-canal BPPV was rare, and usually involved canals on the same side; simultaneous involvement of the posterior and lateral canals was much more common than involvement of the anterior and posterior canals or the anterior and lateral canals. Trauma increased the risk for multiple-canal BPPV, but not the risk for bilateral single-canal BPPV. Cupulolithiasis was not a factor in multiple-canal BPPV.

Management of Bilateral Benign Paroxysmal Positional Vertigo

To describe a series of patients with bilateral benign paroxysmal positional vertigo (BiBPPV), with respect to demographics, management, and outcome. All patients who were identified and treated for BiBPPV in a previous 36-month period with a minimal follow-up period of 6 months were included. Patients were treated with Epley's maneuver (EM) on the side that was more symptomatic and that had a greater velocity and amplitude of tortional nystagmus. Patients were re-treated according to symptoms and findings on follow-up visits. Ten patients were identified with BiBPPV. Most patients complained of nonlocalized positional vertigo and unsteadiness. Four were males and 6 were females, and the mean age was 54 years. There was a positive history of recent head trauma in 4 of the patients. All patients recovered after performing a mean of 2.6 EMs during a 3-month period. One patient experienced unilateral recurrence and was re-treated successfully. BiBPPV has typical characteristics and can be managed successfully with EM, performed on the more symptomatic side, followed by repeated treatments as needed. C.

Benign Paroxysmal Positional Vertigo can Interfere with the Cardiac Response to Head-Down Tilt

To assess the pulse rate and the respiratory rate responses to head-down tilt of the whole body in the plane of the posterior canals in healthy subjects and in patients with benign paroxysmal positional vertigo (BPPV). Although BPPV attacks are usually accompanied by autonomic symptoms, there are no studies assessing autonomic responses during triggering maneuvers for BPPV, neither in healthy subjects nor in patients. We evaluated nine healthy subjects and four BPPV patients (3 unilateral and 1 bilateral). Using a two-axis rotator, from an upright position they were rotated 135 degrees backwards to head-down tilt, either in the plane of the right or the left posterior canal. In healthy subjects, head-down tilt always induced a significant decrease of the pulse rate, which was similar after rotation to the right and to the left posterior canals. This response was observed in patients with unilateral BPPV only when they were rotated toward the nonaffected side, and it was not evident when they were rotated toward the affected side (p < 0.025). In the patient with bilateral BPPV, no change of the pulse rate was observed after rotation toward the right or to the left posterior canal. Although, in all the patients, the respiratory rate increased during the tilt, a similar increase was observed in two healthy subjects. After rotation in the plane of the affected semicircular canal, BPPV can interfere with the cardiac response to head-down tilt of the whole body.

Combined Horizontal and Posterior Canal Benign Paroxysmal Positional Vertigo in Three Patients with Head Trauma

We report 3 patients who complained of positional vertigo shortly after head trauma. Positional maneuvers performed in the plane of the posterior canal (PC; Dix-Hallpike maneuver) and the horizontal canal (HC; patients were rolled to either side in a supine position with the head raised 30 degrees) revealed a complex positional nystagmus that could only be interpreted as the result of combined PC and HC benign paroxysmal positional vertigo (BPPV). Two patients had a right PC BPPV and an ageotropic HC BPPV, and 1 patient had a bilateral PC BPPV and a left geotropic HC BPPV. All 3 patients were rapidly free of vertigo after the PC BPPV was cured by the Epley maneuver and the geotropic HC BPPV was cured by the Vannucchi method. The ageotropic HC BPPV resolved spontaneously. Neuroimaging (brain computed tomography and/or magnetic resonance imaging scans) findings were normal in all 3 patients. From a physiopathological viewpoint, it is easy to conceive that head trauma could throw otoconial debris into different canals of each labyrinth and be responsible for these combined forms of BPPV. Consequently, in trauma patients with vertigo, it is mandatory to perform the Dix-Hallpike maneuver, as well as supine lateral head turns, in order to diagnose PC BPPV, HC BPPV, or the association of both. Early diagnosis and treatment of BPPV may help to reduce the postconcussion syndrome.