Horizontal Benign Paroxysmal Positional Vertigo Research Articles

Climatic variations and pollution on benign paroxysmal positional vertigo in Kars, Türkiye

Benign paroxysmal positional vertigo (BPPV) is the most common diagnosis for peripheral vertigo. Although pathophysiological mechanisms remain unclear, BPPV is mostly idiopathic and factors related to BPPV are still being investigated. Knowing these factors can contribute to the prevention and management of BPPV. In this study, we investigated the correlations between climatic variations, pollution, and BPPV retrospectively. 262 patients diagnosed with BPPV between 2019 and 2021 in Kars, Türkiye, were included in our study. Meteorological parameters were obtained from Turkish State Meteorological Service. Horizontal BPPV increased significantly with the humidity (p < 0.05). In addition, carbon monoxide levels significantly increased the potantial of BPPV (p < 0.05). Surprisingly, BPPV increased in the summertime and showed a significant relationship with humidity. We believe this change is related with the city-specific features as it is the coldest place in the country, emigrant province and crowded in the summer times.

Assessment of semicircular canal function in benign paroxysmal positional vertigo using the video head impulse test and caloric test.

To assess semicircular canal function in benign paroxysmal positional vertigo (BPPV) using the video head impulse test (vHIT) and caloric test. We retrospectively reviewed 39 patients with idiopathic BPPV who underwent both vHIT and the caloric test. Twenty-one patients had posterior BPPV (p-BPPV) and eighteen had horizontal BPPV (h-BPPV). Vestibulo-ocular reflex (VOR) gain and corrective saccades (CS) were analyzed in vHIT and canal paresis (CP) was calculated in the caloric test. The mean VOR gain of the posterior canal in p-BPPV was 0.75 ± 0.28 on the affected side, which was significantly smaller than that on the contralateral side (0.93 ± 0.24, p=.00738). On the other hand, there were no significant differences in the VOR gain of the horizontal canal in h-BPPV between the affected and the contralateral sides (p=.769). The rates of the presence of CS were not significantly different between the affected canal and the contralateral canal either in p-BPPV (p=.111) or h-BPPV (p=.0599). The mean CP value in h-BPPV patients (43.5 ± 31.3%) was significantly higher than that in p-BPPV patients (22.2 ± 22.9%; p=.0184). The VOR gain of vHIT in the affected canal was significantly smaller than that in the contralateral canal in p-BPPV, but not in h-BPPV. The caloric responses of the affected canal are reduced to a significantly larger extent in h-BPPV compared to p-BPPV. These results suggest that BPPV affects the semicircular canal function differently depending on which semicircular canal is involved.

Recurrence Rate and Risk Factors of Recurrence in Benign Paroxysmal Positional Vertigo: a Single-Center Long-Term Prospective Study With a Large Cohort.

This study aimed to assess the long-term recurrence rate and correlations between recurrence and potential risk factors in patients with benign paroxysmal positional vertigo (BPPV). A total of 548 consecutive patients who demonstrated typical posterior or horizontal BPPV between January 2010 and December 2012 were included in this prospective study. All patients were contacted by phone every 6 months for 5 years and were asked to revisit the clinic when they experienced positional vertigo to be reexamined for recurrence. Recurrence of BPPV was defined as having positional vertigo and nystagmus confirmed following a symptom-free period of at least 7 days after complete resolution. We assessed the 5-year recurrence rate of BPPV, and the time point of recurrence in all patients as well as the risk factors of BPPV recurrence, including the clinical characteristics, therapeutic results of BPPV, and various comorbidities. Among the 548 patients, 121 (22.1 %) had at least one recurrence. Of these, 78 patients (54.5%) had only one recurrence within 5 years, while 43 (45.5%) patients experienced two or more recurrences. A recurrence occurred within 1 year in 82 patients (67.8%). The Cox proportional hazard ratio analysis found that head trauma (p = 0.015), Meniere's disease (p = 0.016), the number of canalith repositioning procedures performed (p = 0.037), and the number of previous vertigo attacks (p = 0.038) were significant risk factors of BPPV recurrence as opposed to hypertension or hyperlipidemia. The recurrence rate of BPPV was 22.1% at 5 years after the initial treatment. About 70% of recurred patients had a recurrence within 1 year. Head trauma, ipsilateral Meniere's disease, the number of canalith repositioning procedures performed, and the number of previous vertigo attacks were significant risk factors of BPPV recurrence.

Demographic and clinical characteristics of BPPV patients: a retrospective large cohort study of 1599 patients

Benign Paroxysmal Positional Vertigo (BPPV) is one of the most common peripheral vestibular problems, characterized by intense positionally provoked vertigo with a brief duration. However, studies of BPPV with demographic analyses are scant. To our knowledge, this is the largest retrospective analysis of BPPV patients seen in a 5-year period (2015-2019). The aim of this study is to document the demographic data of BPPV patients and describe the distribution of age, gender, the most common form and affected ears, associated comorbidities, type of treatment used, treatment efficacy, recurrence rates, prevalence of falls and postural instability. Predisposition for right posterior canal BPPV is almost unequivocally consistent in the literature. Hypertension is significantly associated with the occurrence of BPPV. The lower incidence of horizontal canal in this study may be explained by higher rates of spontaneous resolution and the exclusion of iatrogenic horizontal BPPV due to migration, while the lack of anterior canal BPPV was due to exclusion of atypical variants. There is also a high prevalence of falls and postural instability in BPPV patients, which requires further study. The demographic analyses are consistent with the literature, however treatment efficacy based on type of maneuver used, the influence of BPPV and its treatment on postural stability have not been sufficiently addressed. In this study, there is a high prevalence of self-reported falls (47.7%) and more than half of the patients (54%) with abnormal postural stability. Future prospective studies are necessary to validate such findings.

A survey of current management of Benign Paroxysmal Positional Vertigo (BPPV) by physiotherapists’ interested in vestibular rehabilitation in the UK

ObjectivesBenign Paroxysmal Positional Vertigo (BPPV) is the most common cause of dizziness. Extensive research has identified the best assessment and treatment manoeuvres for each subtype of BPPV. Education in vestibular rehabilitation (VR) is inconsistent. It is unclear if the evidence has been adopted by UK physiotherapists in clinical practice and no research has investigated this specifically. DesignAn online survey with closed- and open-text answers. ParticipantsA purposive sample of physiotherapists interested in VR. A response rate of 67% (100/150) was obtained, from which 20 responses were excluded. ResultsParticipants had good evidence-based awareness in assessment (79/80, 99%) and treatment (72/80, 90%) of posterior BPPV. Horizontal BPPV assessment awareness was lower than treatment (37/80, 46% vs 60/80, 75%). Differential diagnosis was poor in subjective (20/80, 25%) and objective stages of assessment (34/80, 43%). Thirty six percent (29/80) were able to list ≥3 test precautions with all three nystagmus characteristics described by 29% (23/80). Eighty one percent (65/80) encourage activity restrictions post-treatment. Only 28% (22/80) were aware of practice guidelines or Cochrane reviews in BPPV.External courses were rated the top method for learning how to manage BPPV. Lack of peer support (26/77, 34%) was the main challenge faced whilst learning. Recommendations for improving BPPV education included more external courses (23/87, 26%) and competency guidelines (13/87, 15%). ConclusionsGood awareness of research evidence was observed in some aspects of BPPV management but many areas require development. Translation and implementation of evidence remains poor and suggests changes in education and knowledge dissemination are warranted.

Effect of a hybrid maneuver in treating posterior canal benign paroxysmal positional vertigo.

Benign paroxysmal positional vertigo (BPPV) is the most common disorder of the vestibular system of the inner ear, which is a vital part of maintaining balance. Although the efficacy of the Epley maneuver-also known as the canalith repositioning maneuver (CRM)-is well established, data comparing CRM versus a hybrid treatment are lacking. The purpose of this study was to determine the effect of a hybrid treatment, the Gans repositioning maneuver (GRM) either with or without postmaneuver restrictions, compared with CRM on treatment of posterior canal BPPV (PC-BPPV). Study design was a randomized controlled trial. A total of 45 patients (30 males and 15 females) with unilateral PC-BPPV were randomly allocated to one of three equal groups on the basis of the date of the first visit with matched assignment for gender: a GRMR group (GRM with postmaneuver restrictions), a GRM group, and a CRM group. Patients received weekly administration of the maneuver until resolution of symptoms. The Dix-Hallpike test was performed before treatment at every appointment, and finally after 1 mo from the last maneuver. Nystagmus duration and vertigo intensity were recorded. The supine roll test was performed in case the Dix-Hallpike test was negative to test otoconial migration. Data were analyzed with repeated-measures analysis of variance, paired t-tests with a Bonferroni correction, and the Spearman rank correlation coefficient. All patients showed improvement within the groups, and PC-BPPV symptoms were resolved by an average of 2, 1.7, and 1.6 maneuvers for GRMR, GRM, and CRM, respectively, with no statistical differences among the three groups (p > 0.05). Only two patients had recurrence, and one patient had horizontal BPPV at 1 mo follow-up. We demonstrated that the GRM as a new treatment is effective in treating PC-BPPV with no benefits to postmaneuver restrictions.

A simple algorithm for treating horizontal benign paroxysmal positional vertigo.

Horizontal benign paroxysmal positional vertigo (H-BPPV) is more difficult to successfully treat than posterior benign paroxysmal positional vertigo (P-BPPV) because of the diverse mechanisms required. We developed a simple, rapid, and effective treatment algorithm for treating all subtypes of H-BPPV in an ear, nose, and throat (ENT) outpatient department. Four hundred ninety patients with BPPV receiving outpatient treatment at Mackay Memorial Hospital were investigated. Among the 490 patients, 86 (17.6%; 86/490) were diagnosed as having H-BPPV variants using the McClure-Pagnini test. Fifty-four patients were female, and 32 were male; they ranged in age from 18 to 92 years (mean age, 56.2 yr). Among the 86 H-BPPV patients, 74.4% (64/86) were hypothesized to have canalithiasis, 20.9% (18/86) were hypothesized to have cupulolithiasis-utricle type (Cup-U), and 4.7% (4/86) were hypothesized to have the cupulolithiasis-cupula type (Cup-C). The primary treatment maneuver was the forced prolonged position (FPP). For 3 patients exhibiting refractory symptoms, we introduced the Gufoni maneuver. The total average success rate of treatment was 96%. We concluded that for H-BPPV patients with initial geotropic nystagmus, the FPP alone yielded an excellent treatment-control rate, and the barbecue-rotation maneuver was unnecessary. However, observing the nystagmus transformation of apogeotropic patients was necessary before administering treatment. For cupulolithiasis patients with the apogeotropic variant who did not respond to FPP treatment alone, we determined that the Gufoni maneuver was necessary as well.

Changes in presynaptic inhibition during movement restriction of unilateral lower limb in a hemiparetic patient and healthy individuals

WCN 2013 No: 1168 Topic: 36 — Other topic Changes in presynaptic inhibition during movement restriction of unilateral lower limb in a hemiparetic patient and healthy individuals M. Morishita, H. Yamaguchi, K. Egawa, A. Hirohata, M. Kobayashi. Kibi International University, Takahashi, Japan; Watanabe Hospital, Shiseikai Medical Corporation, Niimi, Japan; Graduate School, Waseda University, Tokorozawa, Japan Background:We previously reported that movement restriction of the non-paretic lower limb improved gait patterns in hemiparetic patients. Objective: We assessed presynaptic inhibition (PI) to determine if movement restriction of the non-paretic lower limb is regulated by upper motor neuron mechanisms in hemiparetic patients compared with healthy individuals. Patients and methods: This study included one hemiparetic patient and 16 young healthy individuals. Participants walked with a knee brace on the non-paretic/non-dominant side. The subjects walked normally for about 10 min and then with the brace for another 10 min (gait training period). PI was measured before and after every 5 min in both conditions. PI was assessed in the soleus muscle on the paretic/ dominant side, and conditioning stimulation of the common peroneal nerve was used prior to soleus H-reflex measurement. Results: The single limb support time for the paretic/dominant side was longer after gait training in both the hemiparetic and healthy individuals. Two-way ANOVA revealed a significant interaction for time and restriction effects in healthy individuals. After gait training, PI was greater than during normal walking conditions in healthy individuals. In the hemiparetic patient, only slight PI was observed before gait training, but PI appeared to the same degree as in healthy individuals after gait training. Conclusion: Our results suggest that gait training with a knee brace may be effective not only for improvement of gait patterns, but also for regulation of upper motor neuron systems caused by increasing weight bearing ratio in paretic lower limbs. doi:10.1016/j.jns.2013.07.2152 Abstract — WCN 2013 No: 1165 Topic: 36 — Other topic Comparison of reposition rate between headshaking maneuver and vibration maneuver in ageotrophic horizontal BPPV H.S. Han, D.S. Shin. Neurology, St Carollo Hospital, Suncheon-si, Republic of Korea Background: Benign paroxysmal positional vertigo (BPPV) is one of the most commondisorders causingdizziness. Posterior Canal(PC)-BPPVhas been said to account for 60–90% of all BPPV cases, and Horizontal Canal(HC)-BPPV for 5–30% of the cases. However, HC-BPPV now appears to be more prevalent than was previously thought. The apogeotropic type is usually persistent, resistant to reposition maneuver, and its pathophysiology is cupulolithiasis in majority. We compare reposition rate between headshaking with modified Semont maneuver and vibration with modified Semont maneuver. Method: The subjectwere 64 patientswith ageotrophic type of HC-BPPV whowere diagnosed by the supine roll test using videonystagmography. We perform modified Semont maneuver after headshaking on 33 patients. We performed modified Semont maneuver after vibration on 31 patients. The patients with remaining vertigo after maneuver were retreated with the same method. After 1 week, We interviewed all patients using call whether vertigo has subsided. 4 patients had vertigo but they didn't come to the hospital because of private reason (3 in headshaking group and 1 in vibration group). We count the number of performance and compare with headshaking group and vibration group. Result: Fifty twice maneuvers were performed in headshaking group and fiftieth maneuvers were performed in vibration group (P N 0.05). The more vertigo is severe, the less maneuver was performed in both groups. Conclusion: There is no significant difference in recurrence rate between headshaking group and vibration group. doi:10.1016/j.jns.2013.07.2153 Abstract — WCN 2013 No: 1163 Topic: 36 — Other topic Symbiosis of neuro-interventionists: From parallel practice to interdisciplinary patient care WCN 2013 No: 1163 Topic: 36 — Other topic Symbiosis of neuro-interventionists: From parallel practice to interdisciplinary patient care T.W. Leung, M. Tang, A. Chan, G.K. Wong, S.C. Yu. Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region Backgrounds: In centers with endovascular service established by radiologists, neurosurgeon, cardiologists and/or vascular surgeons, budding interventional neurologists may struggle to portray their role. Objective: In a university teaching hospital, we delivered neurointerventional treatment by a team-oriented approach consisting of radiologists, neurosurgeons and interventional neurologists. We aimed to evaluate this multidisciplinary patient care model through a quantitative framework construct survey. Methods: Responded on a voluntary basis, doctors, nurses, and radiographers defined the existing mode of collaboration over a continuum with parallel practice and non-hierarchical integration at both ends, and gave opinions on 4 major aspects: philosophy (believes in benefits of interprofessional collaboration and knowledge of each other's treatment approach), trust, process (knowledge exchange, physician centrality and conflicts associated with interprofessional collaboration) and outcomes (job satisfaction, personal growth, intention to leave in the following year, and research output). Abstracts / Journal of the Neurological Sciences 333 (2013) e579–e628 e618

Comparison of reposition rate between headshaking maneuver and vibration maneuver in ageotrophic horizontal BPPV

Background: Benign paroxysmal positional vertigo (BPPV) is one of the most common disorders causing dizziness. Posterior Canal(PC)-BPPV has been said to account for 60–/INS;90% of all BPPV cases, and Horizontal Canal(HC)-BPPV for 5–/INS;30% of the cases. However, HC-BPPV now appears to be more prevalent than was previously thought. The apogeotropic type is usually persistent, resistant to reposition maneuver, and its pathophysiology is cupulolithiasis in majority. We compare reposi/INS;tion rate between headshaking with modified Semont maneuver and vibrat/INS;ion with modified Semont maneuver.

Complications of canalith repositioning procedure for benign paroxysmal positional vertigo

To investigate the incidence of complications of canalith repositioning procedure (CRP) for benign paroxysmal positional vertigo (BPPV) in order to recognize and intervene the complication. Totally 430 cases of BPPV were treated by CRP between Jan., 2005 and Nov., 2007. The patients with complication were retreated with CRP according to the new canals otolith falling into. There were 313 patients with posterior canal BPPV, among which 5 had complications during CRP for posterior canal BPPV and 3 for horizontal canal BPPV. And 1 patient transformed from cupulolithiasis to canalithiasis during Semont CRP, which made CRP possible. Three patients had horizontal BPPV during CRP for posterior canal BPPV. Horizontal BPPV emerged during CRP for anterior canal BPPV in 1 patient. CRP for the posterior BPPV had more patients with complication than that of CRP for the anterior BPPV, but the percentage was on the contrary, and they were 1.9% (8/313) and 28.6% (2/7) respectively. The rate of complication during CRP was 3.3% (14/430) and all of them recovered well with CRP. There are possibility for canal otolith transferred from one canal to another. Careful observation of nystagmus and reevaluation of the patients with BPPV in case of unsuccessful treatments are crucial to determine the complications.

良性発作性頭位めまい症 臨床疫学と病態生理

Benign paroxysmal positional vertigo (BPPV) is the most common type of vertigo due to peripheral vestibular lesion. BPPV is classified according to different canal's origin: posterior canal BPPV, anterior canal BPPV and horizontal canal BPPV. In most cases with posterior canal BPPV, canalolithiasis that is free-floating otolith is to cause the syndrome. The movement of canalolithiasis by changes in position of the head induces endolymphatic flow in the posterior canal, resulting in the accompanying nystagmus. The rotation axis of the nystagmus is perpendicular to the affected posterior canal. The canalith repositioning procedure is recommended for the treatment of BPPV. The purpose of this procedure is to relocate free-floating otolith from the posterior canal into the vestibule of the vestibular labyrinth. Horizontal BPPV is induced by lateral movement of the head. The direction-changing horizontal geotropic nystagmus is caused by canalolithiasis of the horizontal canal and the direction-changing horizontal ageotropic nystagmus is caused by cupulolithiasis. Anterior canal BPPV is rare. Because an imbalance in the function of the utriculi in patients with BPPV, otolith detached form the utricular macula is suggested to be a sauce of canalolithiasis and cupulolithiasis.