Maneuvers For Benign Paroxysmal Positional Vertigo Research Articles

Comparison of semont's maneuver and epley's maneuver with and without betahistine therapy in relieving vertigo in posterior semicircular canal benign paroxysmal positional vertigo

Context: Benign paroxysmal positional vertigo (BPPV) is a disorder characterized by attacks of vertigo and nystagmus and aggravated with changes in head posture. BPPV can be treated effectively by relocating otoconia from the semicircular canal duct into the vestibule using different repositioning maneuvers. Our study is to determine the role of maneuvers in BPPV and to study the efficacy of the maneuvers in BPPV. Aims: The aim of this study is (1) to determine the role of Semont's and Epley's maneuver in BPPV and (2) to study the efficacy of these maneuvers with or without betahistine therapy. Settings and Design: A prospective study was done on sixty BPPV patients from Department of ENT, A. J. Institute of Medical Sciences, Mangalore. Subjects and Methods: Inclusion criteria were positive Dix-Hallpike maneuver and normal pure tone audiometry. Exclusion criteria were cervical spondylosis, multiple canal disease, and inner ear disease. Patients were selected based on above criteria, were examined for posterior semicircular canal BPPV, and further divided into four groups by random selection. Different treatment modalities are used. Statistical Analysis Used: Wilcoxon signed ranks test was used for statistical analysis. Results: The evaluation of outcome was done at the end of 4th week and after 3 months of the initial therapy with Dix-Hallpike and the quality of life was evaluated using visual analog scale for Vertigo and Dizziness Handicap Inventory. The results were compared using the above scales before and after the treatment. Conclusions: Vertigo is a common symptom which has significant morbidity physically and economically. These maneuvers are safe, short, inexpensive, and effective in treating posterior semicircular BPPV and can be practiced regularly.

Non-drug therapy of vertigo

To study the efficacy of various methods of non-drug therapy of diseases manifested by vertigo and dizziness in neurological practice. Referral and final diagnoses were compared after neurovestibular examination of 599 patients (177 men and 422 women), aged 25 to 79 years (mean age 55 years), with various causes of vertigo. Patients underwent vestibular rehabilitation, trainings on the stabiloplatform with biological feedback (biofeedback), repositioning maneuvers in patients with benign paroxysmal positional vertigo (BPPV). Severity of dizziness on a Visual analogue scale of dizziness (VAS-d) and balance on stabilography before and after a course of vestibular rehabilitation was analyzed. Before neurovestibular examination, the diagnoses of vertebrobasilar insufficiency (44%), hypertensive or atherosclerotic encephalopathy (35%), cervical spondyloarthrosis (8%), autonomic dystonia (11%)) are often considered mistakenly as the causes of vertigo and dizziness. After neurovestibular examination, the diagnoses were as follows: BPPV (39%), phobic postural vertigo (29%), Ménière's disease (14%), vestibular neuritis (11%), multisensory dizziness in elderly (5%). The effectiveness of repositioning maneuvers in BPPV was 90,2% after the first session and 100% after the second session. After a course of vestibular exercises and trainings on the stabiloplatform with biofeedback, there was the marked improvement in indicators of stabilography and VAS-d in patients with vestibular neuritis, Meniere's disease, phobic postural vertigo (p<0.05). Vestibular rehabilitation was most effective if started within the first month after vestibular neuritis. There was the high efficacy of complex rehabilitation, including vestibular exercises and trainings on stabilographic platform with biofeedback, in patients with Meniere's disease. In the rehabilitation of patients with phobic postural vertigo, better results were achieved when vestibular exercises were combined with trainings on stabilographic platform with biofeedback and psychotherapy. The results demonstrated the low accuracy of diagnosis of diseases manifested by vertigo and dizziness and high efficacy of non-drug therapy in most cases, especially BPPV, vestibular neuritis, Meniere's disease, postural phobic vertigo.

A safe-repositioning maneuver for the management of benign paroxysmal positional vertigo: Gans vs. Epley maneuver; a randomized comparative clinical trial.

Benign paroxysmal positional vertigo (BPPV) is the most common cause of peripheral vertigo. Some repositioning maneuvers have been described for its management. The aim of this study was comparing the therapeutic effect of Epley and Gans maneuvers in BPPV. This randomized clinical trial was performed from September to December 2015. 73 patients with true vertigo diagnosed as BPPV enrolled the study. They randomly assigned in quadripartite blocks to modified Epley maneuver group (E) or Gans maneuver group (G). 1 day and 1 week after intervention, the objective and subjective responses to treatment were assessed. Statistical analysis was performed using the Chi-square test and regression model in the SPSS software version 21. Thirty patients enrolled each group with a mean age of 46.9±13.4 (E group) and 46.7±7.5year (G group). 23.3% of E group and 26.7% of G group were men (p=0.766). In E and G groups in the first day, subjective outcomes revealed 86.7 and 60% rate of success (p=0.02); and 86.7 and 56.7% of patients exhibited objective improvement, respectively (p=0.01). After 1week, the subjective and objective outcomes revealed improvement among 70% of E group and 46.7% of G group (p=0.067). The only complication with significant difference was cervical pain with a higher rate in E group (23.3 vs. 0.0%, p=0.005). These results revealed the similar long-term efficacy of Epley and Gans maneuver for the treatment of BPPV. Cervical pain was most frequent complication of Epley maneuver.

Manobra de Epley na vertigem posicional paroxística benigna associada à doença de Ménière

Os efeitos da manobra de Epley na vertigem posicional paroxística benigna (VPPB) associada à doença de Ménière são controvertidos. OBJETIVO: Avaliar a vertigem e o nistagmo de posicionamento após uma ou mais manobras de Epley na vertigem posicional paroxística benigna (VPPB) associada à doença de Ménière e na recorrência da VPPB. MATERISL E MÉTODO: Estudo retrospectivo de 62 pacientes com VPPB associada à doença de Ménière submetidos à manobra de Epley e acompanhados durante 12 meses após a extinção do nistagmo de posicionamento. RESULTADOS: Para abolir o nistagmo de posicionamento, foi necessária uma manobra de Epley em 80,7% dos pacientes, duas em 16,1% e três em 3,2%. A vertigem foi eliminada em 71,0% dos pacientes, melhorou em 27,4% e permaneceu inalterada em 1,6%. Quatro semanas após a extinção do nistagmo de posicionamento, todos os pacientes ficaram assintomáticos. Recorrência da VPPB foi observada em 19,4% dos casos, com eliminação da vertigem e nistagmo de posicionamento à manobra específica para o canal afetado. CONCLUSÕES: Na VPPB associada à doença de Ménière, vertigem e nistagmo de posicionamento foram eliminados com uma, duas ou três manobras de Epley. A recorrência da VPPB foi resolvida com uma manobra para o canal envolvido.

Efficacy of particle repositioning maneuver in BPPV: a prospective study

Purpose A single blinded prospective randomized controlled trial was conducted in 40 patients with benign paroxysmal positional vertigo (BPPV) to determine the efficacy of particle repositioning maneuver (PRM). Materials and methods Out of 40 patients, 20 underwent PRM with the rest receiving a placebo treatment. Postprocedural instructions were given to all the patients who underwent PRM. Follow-up was for 1 year at regular intervals. Analysis was based on the symptomatic status and the Hallpike maneuver at each visit. Results After the initial week, 95% showed complete resolution of symptoms with none reporting a recurrence after PRM. On the contrary, only 15% of the controls had complete resolution with 14 out of 20 reporting a recurrence of BPPV. Results remained more or less the same at the end of 4 weeks. Six months after PRM, 19 of 20 patients had no vertigo with a meager 5% showing recurrence versus 75% of controls reporting a recurrence with only 3 of 20 reporting a favorable symptom status. At the end of 1 year, 18 of 20 patients had complete relief from symptoms with only 10% showing Hallpike maneuver positive in the study group compared with 3 of 20 reporting a relief from symptoms with 90% turning out to be Hallpike maneuver positive in the control group. Conclusions This study establishes the efficacy of PRM in short- and long-term management of BPPV; the procedure is easy and simple.