Particle Repositioning Maneuver Research Articles

Epidemiology of benign paroxysomal positional vertigo (BPPV) and risk factors for secondary BPPV: a population-based study

BackgroundBPPV (benign paroxysmal positional vertigo) is a disorder that causes sudden, spinning sensation for few seconds with specific head movements. Of all disorders of inner ear that causes dizziness, BPPP is the most common one. To understand this disorder, we conducted a retrospective study at a tertiary care ENT hospital in Eastern India.Aims and objectives1. To know the incidence of BPPV among all vertigo patients.2. To know the age-sex distribution of BPPV.3. To identify secondary causes of BPPV and their prevalence.4. To know the incidence of different canal BPPVs.5. To ascertain the treatment outcome of different particle repositioning maneuvers in BPPV.MethodsTotal 575 patients presented to the vertigo clinic from 15 September 2018 to 21 March 2022. Out of them 151 patients (26.6%) were diagnosed with BPPV by proper history taking, clinical examination including provocative tests. They were treated with appropriate particle repositioning maneuvers (PRM). Patients were followed for mean 6 months and results were analyzed.Results and analysisOf all vertigo patients, BPPV constitutes 26.6% of cases, making it most common cause of peripheral vertigo. It commonly affects 40–60 years of age group with equal sex predilection. Eighty-three percent of cases were idiopathic, secondary causes include vestibular migraine, Meniere’s disease, labyrinthitis, and orthostatic hypotension. Posterior canal was most commonly affected (74%), followed by lateral and anterior canal. Particle repositioning maneuver (PRM) cures 96% of all BPPV patients (75% needs only one PRM, 15% requires the second one) with overall success rate of 96% after 6 months of follow-up.ConclusionBPPV is the most common cause of peripheral vertigo. One has to understand the anatomy, physiology and pathophysiology of vestibular system to provide better patient care in these patients. Particle repositioning maneuver (PRM) is the treatment for BPPV.

Gait and Falls in Benign Paroxysmal Positional Vertigo: A Systematic Review and Meta-analysis.

Benign paroxysmal positional vertigo (BPPV) is one of the most common vestibular disorders, and is treated effectively with particle repositioning maneuvers (PRM). The aim of this study was to assess the influence of BPPV and treatment effects of PRM on gait, falls, and fear of falling. Three databases and the reference lists of included articles were systematically searched for studies comparing gait and/or falls between (1) people with BPPV (pwBPPV) and controls and (2) pre- and posttreatment with PRM. The Joanna Briggs Institute critical appraisal tools were used to assess risk of bias. Twenty of the 25 included studies were suitable for meta-analysis. Quality assessment resulted in 2 studies with high risk of bias, 13 with moderate risk, and 10 with low risk. PwBPPV walked slower and demonstrated more sway during tandem walking compared with controls. PwBPPV also walked slower during head rotations. After PRM, gait velocity during level walking increased significantly, and gait became safer according to gait assessment scales. Impairments during tandem walking and walking with head rotations did not improve. The number of fallers was significantly higher for pwBPPV than for controls. After treatment, the number of falls, number of pwBPPV who fell, and fear of falling decreased. BPPV increases the odds of falls and negatively impacts spatiotemporal parameters of gait. PRM improves falls, fear of falling, and gait during level walking. Additional rehabilitation might be necessary to improve gait while walking with head movements or tandem walking.Video Abstract available for more insights from the authors (see the Supplemental Digital Content Video, available at: http://links.lww.com/JNPT/A421 ).

Posterior canal occlusion for benign paroxysmal positional vertigo

Benign paroxysmal positional vertigo is the most common etiology of peripheral vertigo and is caused by the hydrodynamic influence from free-floating canaliths. Any of the 3 semicircular canals can be involved, but posterior canal BPPV is the predominant subtype. The condition is diagnosed clinically, and the preponderance of cases resolve spontaneously or are amenable to particle-repositioning maneuvers. A small subset of patients experience intractable symptoms for which surgical intervention can be considered. Transmastoid posterior canal occlusion surgery has been demonstrated to be a safe and curative procedure insofar as it can eradicate vertiginous symptoms while preserving auditory function.

Benign paroxsymal positional vertigo - recommendations for treatment in primary care.

Background: Benign paroxysmal positional vertigo (BPPV) is a common cause of vertigo that can be easily diagnosed and treated in primary care.Purpose: We describe our experience with a large cohort of patients and include recommendations for diagnosis and treatment in the primary care setting.Patients and methods: Three hundred and fifty-nine patients were diagnosed with BPPV between June 2011 and March 2017 at the dizziness clinic of Fujian Provincial Hospital, Fuzhou, China. We mainly used Epley’s maneuver and barbecue roll for the treatment of PSC-BPPV and HSC-BPPV respectively.Results: Our results show that posterior semicircular canal (PSC) involvement is the most common (n=264, 73.5%), followed by horizontal semicircular canal (HSC, n=81, 22.5%) and multicanal (n=12, 3.3%) involvement. Anterior semicircular canal (ASC) BPPV is the rarest (n=2). Particle repositioning maneuvers (PRM) are the treatment of choice and have a high success rate (1 month after treatment), from 75% (9 out of 12) for multicanal to 95.8% (253 out of 264) for PSC, and to 100% for HSC and ASC involvement respectively.Conclusion: We recommend the use of the Epley’s maneuver and barbecue roll for the treatment of PSC-BPPV and HSC-BPPV, respectively. Patients should be reviewed regularly and repeated maneuvers can be performed. Unresolving symptoms require tertiary evaluation.

BALANCE AND GAIT PERFORMANCE AFTER PARTICLE REPOSITIONING MANEUVER IN BENIGN PAROXYSMAL POSITIONAL VERTIGO PATIENTS

Purpose: The purpose of this study was to examine subjective complaints, recurrence of benign paroxysmal positional vertigo (BPPV), balance and gait with a particle repositioning maneuver (PRM), and to investigate the effects of Brandt Daroff (BD) exercises and comorbid factors as migraine on recovery in BPPV patients. Methods: Fifty-seven patients were treated with a PRM for posterior canal BPPV. The perception of vertigo was estimated with Visual Analogue Scale (VAS), gait with Dynamic Gait Index (DGI), balance with the modified Clinical Test of Sensory Integration and Balance (mCTSIB). If the Dix-Hallpike test was still positive one week after the PRM, the maneuver was repeated. When remission was confirmed, patients were called back after one month to repeat all tests. If the patient suffered only from residual dizziness after one week, BD exercises were recommended for one month. Results: The VAS scores for all patients improved significantly one month after a PRM (p 0.05). It was found that patients with migraine had complaints of more severe imbalance. Conclusion: Subjective complaints, balance and gait abilities improved in all patients after PRM. BPPV patients with migraine have a greater risk of recurrence and lower improvement in balance and gait ability after PRM. BD exercises did not prevent recurrence and residual dizziness.

Benign paroxysmal positional vertigo in patients after mild traumatic brain injury.

Post-traumatic vertigo, dizziness and balance disorders following head trauma range from 15% to 78% in the general population. Benign paroxysmal positional vertigo (BPPV) is the most common vestibular disorder in such patients. The aim of the study was to assess the occurrence of BPPV in patients with mild traumatic brain injury (MTBI) and determine the outcome of treatment. A group of 179 patients, with a mean age of 45.2 years, complaining of vertigo/ /dizziness and balance instability after MTBI, was enrolled into the study. All these patients were diagnosed and treated in the Department of Otolaryngology (Medical University of Lodz, Poland) between the years 2012 and 2014. Anamnesis and otoneurological examination were conducted in each patient. The diagnosis was based on the medical history, the Dix-Hallpike test or the rollover test. The treatment comprised the Epley, barbecue and particle repositioning (RM) maneuvers. Nineteen patients (10.6%) complained about attacks of vertigo elicited by positional changes. The diagnosis of BPPV was confirmed in 9 (47.4%) patients: 8 cases with a positive Dix-Hallpike test and 1 with the roll test. In 10 cases, a high probability of BPPV was diagnosed based on the medical history. Eight patients were treated by a single Epley maneuver and 1 patient by the barbecue roll. In 4 (44.4%) patients, the maneuvers were repeated. On the follow-up examination, the patients were not found to have vertigo. Benign paroxysmal positional vertigo should be diagnosed and treated successfully in patients after head trauma.

Incidence and Treatment Outcomes of Post Traumatic BPPV in Traumatic Brain Injury Patients.

The aim of this study is to assess the incidence of post traumatic BPPV and evaluate its treatment outcomes in mild and moderate traumatic head injury patients. The study population consisted of 128 patients (89 male:39 female) who were admitted with head and neck injury (Motor Vehicle Accident, Blow to the head, Fall from Height, Whiplash injury) as inpatients in Department of Neurosurgery in Tertiary care hospital in Kerala during a 2month period from 1st April 2014 to 31st May 2014. The age range was 10-70years and mean 39.8 with standard deviation 15.5. All cases were evaluated and serially followed up to a period of 6months in Department of Otorhinolaryngology. In our study, the number of patients with mild injuries (Glasgow coma scale 13-15) were 108 and moderate injury (Glasgow coma scale 9-12) were 20. We found out that post traumatic BPPV was found to be 17% of the traumatic brain injury patients. All patients were treated with particle re-positioning maneuvers and were followed up for a period of 6months. Recurrence were reported in 9 (40.9%) patients. In these patients re positioning maneuvers were repeated.

Home particle repositioning maneuver to prevent the recurrence of posterior canal BPPV

ObjectiveTo check the value of home particle repositioning maneuver in the prevention of the recurrence of posterior canal benign paroxysmal positional vertigo (pc-BPPV). MethodsIn this study, patients diagnosed as unilateral posterior canal BPPV were selected following an accurate evaluation using video goggle VNG system. All patients were managed by particle repositioning maneuver (PRM). Patients were instructed to do home PRM once weekly for five years. Then, they were divided into two groups (according to choice of patient to do PRM). The first group (control group) consisted of 144 patients who did not do home PRM; whereas the second group (study group) included 165 patients who performed home PRM. All patients (control & study groups) were followed up every four months for five years. ResultsThe study found out that the recurrence rate of pc-BPPV in control group was 33 patients in the first year (27.2%), 11 patients in second year (9%), 5 patients in third year (4%), 3 patients in fourth year (2.5%) and 3 patients in fifth year (2.5%). The recurrence of pc-BPPV in the treated side (study group) of patients was reported as 5 patients in the first year (3.5%), 3 patients in the second year (2%), 2 patients in the third year (1.4%), 2 patients in the fourth year (1.4%), and 1 patient in the fifth year (0.7%). There was statistically significant difference between the control and the study groups regarding the recurrence rates in the first year follow up which was the highest in first four months. ConclusionHome particle repositioning maneuver has the capacity to prevent the recurrence of pc-BPPV. It proved to be more successful and functional in minimizing the recurrence of the disease in the study than in the control group. Hence, home particle repositioning maneuver is highly recommended for one year at least in pc-BPPV.

Analysis of risk factors influencing the outcome of the Epley maneuver.

Benign paroxysmal positional vertigo (BPPV) is the most frequent type of vertigo. The treatment of canalithiasis of the posterior semicircular canal consists in performing a particle-repositioning maneuver, such as the Epley maneuver (EM). However, the EM is not effective in all cases. The objective of this study is to identify risk factors, which predict the EM failure, among the clinical variables recorded in anamnesis and patient examination. This is an observational prospective multicentric study. All patients presenting with BPPV were recruited and applied the EM and appointed for a follow-up visit 7days later. The following variables were recorded: sex, age, arterial hypertension, diabetes, hyperlipidemia, smoking habit, alcohol consumption, migraine, osteoporosis, diseases of the inner ear, previous ipsilateral BPPV, previous traumatic brain injury, previous sudden head deceleration, time of evolution, sulpiride or betahistine treatment, experienced symptoms, outcome of the Halmagyi maneuver, laterality, cephalic hyperextension of the neck, intensity of nystagmus, intensity of vertigo, duration of nystagmus, occurrence of orthotropic nystagmus, symptoms immediately after the EM, postural restrictions, and symptoms 7days after the EM. Significant differences in the rate of loss of nystagmus were found for six variables: hyperlipidemia, previous ipsilateral BPPV, intensity of nystagmus, duration of nystagmus, post-maneuver sweating, and subjective status. The most useful significant variables in the clinical practice to predict the success of the EM are previous BPPV and intensity of nystagmus. In the other significant variables, no physiopathological hypothesis can be formulated or differences between groups are too small.

Are Cervical Collars a Necessary Postprocedure Restriction in Patients With Benign Paroxysmal Positional Vertigo Treated With Particle Repositioning Maneuvers?

Benign paroxysmal positional vertigo (BPPV) is managed with particle repositioning maneuvers (PRM), following which patients are advised of activity restrictions to prevent recurrence. This can include wearing a cervical collar. Does the use of BPPV postprocedure restriction with a cervical collar impact on the number of PRMs required to resolve a patient's symptoms? Combination of retrospective and prospective review of 624 patients treated in a tertiary UK hospital. All were diagnosed with posterior canal BPPV and received a modified Epley maneuver (PRM). The "with cervical collar" (WC) retrospective group 2002 to 2009 (n = 263) were advised to wear a cervical collar for 48 hours postprocedure, and the "no cervical collar" (NC) prospective group 2010 to 2014 (n = 361) were not. The main outcome measure was the resolution of patient symptoms following a PRM for BPPV. Quantitative and statistical analysis using χ test was undertaken. In the WC group, 84% (n = 221) had resolution of symptoms after the first PRM, versus 82.8% (n = 299) in the NC group. After the second PRM 11% (n = 29) resolved, versus 13.6% (n = 49) in the NC group. After the third PRM 4.9% (n = 13) resolved, versus 3.6% (n = 13) in the NC group. Both clinically and statistically there was no significant difference in outcome between groups. Our review of 624 patients is the largest study in this subject and the results demonstrate that wearing a cervical collar following PRM for BPPV concedes no significant benefit. Excluding this from postprocedure guidance allows patients to manage without the inconvenience of wearing a cervical collar, and allows departments to update clinical guidance.

Chapter 7 - Bedside examination

In most dizzy patients a limited selection of bedside tests, together with the history, is adequate to establish a differential diagnosis and select the next diagnostic and therapeutic procedures. A set of basic bedside tests that should be applied in every patient with vertigo or imbalance allows identifying: (1) patients who need immediate referral for further assessment and treatment; (2) patients with nonthreatening disorders for which treatment can be started without more detailed testing; (3) patients with benign paroxysmal vertigo, in whom a detailed work-up is not required and who can immediately be treated with an appropriate particle-repositioning maneuver; and (4) patients who need a comprehensive neuro-otologic and neurologic work-up. Additional neuro-otologic bedside tests help to further refine the differential diagnosis.

Effect of small-dose Lorazepam on residual dizziness in elderly benign paroxysmal positional vertigo after successful particle repositioning maneuver

Objective To evaluate the effect of small-dose Lorazepam on residual dizziness in elderly patients with benign paroxysmal positional vertigo (BPPV) after successful particle repositioning maneuver (PRM). Methods A total of 268 patients aged 60 years and over, who were diagnosed as BPPV and underwent successful treatment of PRM, were randomly assigned to medication group and control group. The patients in the medication group were prescribed low-dose lorazepam for 1 week (0.25 mg/time, 3 times/d), whereas the patients in the control group were not prescribed any medication. Hamilton Anxiety Scale (HAMA) was employed to evaluate the anxiety status of patients before and after PRM, and the effect of small-dose lorazepam on residual dizziness was accessed by using the Dizziness Handicap Inventory (DHI) scale and the Activities-specific Balance Confidence (ABC) scale in elderly BPPV patients after PRM. Results No difference in HAMA scores was found between the two groups (t=-0.316, P=0.753) before PRM. The medication group (t=19.931, P=0.000) and the control group (t=26.930, P=0.000) showed a significant improvement in HAMA scores after PRM versus before PRM. However, HAMA scores after PRM was lower in the medication group than in the control group (t=14.967, P=0.000). The medication group had significant improvements after PRM versus before PRM in the following: DHI scores (t=43.661, P=0.000), functional (t=32.326, P=0.000981), emotional (t=31.981, P=0.000), physical (t=14.330, P=0.000) subscale scores, as well as in the ABC scores (t=-23.248, P=0.000). The improvements were also found in the control group in DHI scores (t=46.282, P=0.000), functional (t=32.117, P=0.000), emotional (t=34.563, P=0.000), physical (t=13.182, P=0.000) subscale scores, as well as in the ABC scores(t=-24.536, P=0.000)after PRM versus before PRM. However, after PRM the total DHI score, functional, emotional and physical subscale scores were lower in medication group than in control group (t=5.994, 3.206, 4.757 and 2.851, respectively, P=0.000, 0.002, 0.000 and 0.005). The ABC scores were higher in medication group than in control group (t=2.678, P=0.008) after PRM. Conclusions The elderly patients with BPPV are often accompanied by symptoms of anxiety. The small-dose Lorazepam can alleviate residual dizziness in elderly BPPV patients after successful PRM. Key words: Vertigo; Semicircular canals; Lorazepam

Elderly falls associated with benign paroxysmal positional vertigo

SummaryBenign Paroxysmal Positional Vertigo (BPPV) can cause falls, especially in the elderly.Aimto study whether or not elderly patients with BPPV have a reduction on their falls after the particle repositioning maneuver (PRM).Materials and Methodsretrospective study including elderly with BPPV who had fall(s) during the last year. All patients were submitted to the PRM according to the affected semicircular canal (SCC). After the abolition of positioning vertigo and nystagmus, the patients were submitted to a 12 month follow-up and were investigated about the number of fall(s). Wilcoxon's test was performed to compare the number of fall(s) before and after 12 months of the PRM.ResultsOne hundred and twenty one patients were included in the study. One hundred and one patients presented involvement of the posterior SCC, 16 of the lateral and four of the anterior. We noticed a reduction on the number of falls, with statistically significant difference when all the patients were analyzed together (p<0.001), the posterior canal BPPV patients (p<0,001) and the lateral canal VPPB patients (p=0.002). We also found a tendency of statistically significant difference for the anterior canal BPPV patients (p=0.063).ConclusionBPPV elderly patients had indeed a reduction on the number of falls after the PRM.

An iPhone-assisted particle repositioning maneuver for benign paroxysmal positional vertigo (BPPV): a prospective randomized study.

The Epley particle repositioning maneuver (PRM) is an effective treatment for benign paroxysmal positional vertigo (BPPV), the most common cause of peripheral vertigo in primary care settings. The goal of this study was to determine whether the use of an iPhone application (DizzyFIX; Clearwater Clinical Ltd, Ottawa, Ontario, Canada) by medical students had a significant impact on the performance of the PRM. We recruited senior medical students who had previously been trained in the management of BPPV and asked them to perform the PRM on a healthy volunteer. One half of the students used a real iPhone application, whereas the others used a sham application. The PRM performance scores of the 2 groups were compared. iPhone application users scored significantly higher on their PRM performance compared with controls (P < .0001) and performed the PRM significantly more slowly (P < .0001). Senior medical students performed a more correct PRM when assisted by the iPhone application. This application represents a significant improvement from standard medical school training using written instructions. Family physicians could also use this iPhone application for the quick and effective treatment of BPPV.

Variables for One Year Recurrence of Benign Paroxysmal Positional Vertigo

Received December 23, 2013 Revised February 4, 2014 Accepted February 4, 2014 Address for correspondence Gu Il Rhim, MD, MBA, PhD Yonseimirae Otorhinolaryngology Clinic, 1 Hugok-ro, Paju 413-826, Korea Tel +82-31-942-1275 Fax +82-31-942-1278 E-mail guzi9170@naver.com Background and ObjectivesZZAlthough benign paroxysmal positional vertigo (BPPV) was treated with particle repositioning maneuver (PRM) with a high success rate, the condition often recurred. The purpose of this study was to evaluate the variables for one year recurrence of BPPV recurrence. Subjects and MethodZZRetrospective review was performed for 295 patients diagnosed as BPPV visiting clinic between February 2010 and June 2012. All patients underwent a complete otolaryngologic, audiologic, and neurologic evaluation. The appropriate PRM was performed, depending on the type of BPPV. Patients who received treatment were classified into two groups according to recurrence: a no recurrence group (n=240) and a recurrence group (n=55). Optimal independent variables were determined by using logistic regression analysis with forward stepwise selection. Binary logistic regression analyses were adjusted for age, sex, day of symptoms, associated ear disease, involved ear, type of otolith, affected canal and visit of treatment sessions. ResultsZZAverage follow up time was 12 months. The recurrence rate was 18.6%. Two variables had a statistically significant impact on one year recurrence. The number of visits for treatment sessions was higher in the recurrence group than in the no recurrence group (mean±standard deviation=3.67±2.49 versus 2.44±1.55, p<0.001). The other variable was age being above 40 years (p=0.037). Age above 40 years was an independent variable for the one-year recurrence. Patient sex, day of symptoms, associated ear disease, involved ear, type of otolith and affected canal had no statistically significant impact. ConclusionZZOur data suggested that the number of visit for treatment sessions and age above 40 years were variables associated with the one-year recurrence of BPPV. Korean J Otorhinolaryngol-Head Neck Surg 2014;57(5):314-9

Effectiveness of the particle repositioning maneuver for benign positional vertigo following traumatic brain injury

ObjectiveThe purpose of this pilot project was to explore the clinical presentation of benign positional vertigo (BPV) in patients with mild or moderate traumatic brain injury (TBI) and to determine...

Particle Repositioning Maneuver Versus Brandt-Daroff Exercise for Treatment of Unilateral Idiopathic BPPV of the Posterior Semicircular Canal

To compare the outcome and probability of recurrence in a series of patients with unilateral idiopathic benign paroxysmal positional vertigo of the posterior canal (PC-BPPV) that were randomly treated by Brandt-Daroff exercise (B-D exercise) or by particle repositioning maneuver (PRM). Randomized prospective clinical trial. Tertiary referral center. Patients were included in this study if they complained of vertigo and had been diagnosed as having unilateral idiopathic PC-BPPV for at least 1 week before Dix-Hallpike maneuver (DHM), remained for 30 days in the randomly assigned treatment, and had at least 48 months' follow-up. Forty-one patients were treated with a single PRM and 40 patients by B-D exercise. Resolution of benign paroxysmal positional nystagmus on the DHM. The probability of recurrence was also studied. At Day 7, DHM was negative in 80.5% of the PRM-treated patients and in 25% of those treated by B-D exercise (p < 0.001). At Month 1, the differences between both treatment groups remained statistically significant (92.7% in PRM versus 42.5% in the B-D exercise had a negative DHM; p < 0.001). The variable that influenced that DHM became negative was the PRM (RR = 4.8; 95% confidence interval, 2.5-9.2; p < 0.001). The number of recurrences in PRM and B-D exercise were 0.56 ± 0.8 and 0.48 ± 0.8, respectively (p = 0.48). The recurrence rate at 48 months was 35.5% (15/41) in B-D exercise and 36.6% (9/31) in the PRM group (p = 0.62). Although the time interval until the first recurrence was similar (p = 0.44), patients included in the PRM group showed a significantly longer time interval between the first and second recurrence (p = 0.04). PRM is more effective treatment and as safe as B-D exercise in the short term for unilateral and idiopathic PC-BPPV, and although it does not reduce the probability of recurrence in the 4-year follow-up period compared with B-D exercise, it may delay the second recurrence's onset in those patients who had already experienced a single recurrence. Our study supports the use of PRM as the treatment of choice in unilateral and idiopathic PC-BPPV, although exercise may be also considered as an alternative treatment in selected cases.

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.

Early Effect of Barbecue Rotation and Modified Semont Combination in Apogeotropic Horizontal Canal Benign Paroxysmal Positional Vertigo

Received April 16, 2012 Revised June 30, 2012 Accepted July 3, 2012 Address for correspondence Kyu Hwan Jung, MD Department of OtorhinolaryngologyHead and Neck Surgery, Inje University College of Medicine, Haeundae Paik Hospital, 875 Haeundae-ro, Haeundae-gu, Busan 612-030, Korea Tel +82-51-797-0665 Fax +82-51-797-2304 E-mail kwmedi@gmail.com Background and ObjectivesZZBenign paroxysmal positional vertigo (BPPV) of horizontal canal shows reversible direction changing positional nystagmus and diverse clinical courses because of the frequent clinical presentation of cupulolithiasis. The aim of this study is to find out the early effect of particle repositioning maneuver (PRM) including the barbecue and the modified Semont in single treatment session for the apogeotropic horizontal canal BPPV. Subjects and MethodZZThirty-three episodic vertigo patients with direction-changing apogeotropic horizontal nystagmus were enrolled in this study. The patients were initially treated with barbecue rotation and the second PRM was applied 15 minutes after the first PRM. Barbecue rotation was applied when the positional nystagmus was changed its direction to that of geotropic. The modified Semont maneuver or barbecue rotation was randomly applied when nystagmus was not changed. Patients were followed-up 2 or 3 days after the initial visit and the nystagmus was rechecked to determine the single session treatment result. ResultsZZThe combination of PRMs in a single treatment session was effective in 23 out of 33 (69.7%) patients. An initial barbecue rotation was effective in 17 patients (51.5%); geotropic nystagmus was obtained in 12, and no nystagmus in 5. Eleven out of 16 (68.8%) patients with persistent apogeotropic nystagmus after initial treatment were successfully treated with the second PRM. There was no statistical difference between the second PRMs of the modified Semont maneuver and barbecue rotation (p=1.000). ConclusionZZThe combination of PRMs including barbecue rotation and the modified Semont maneuver in a single treatment session showed a comparable success rate as the previously reported studies. Korean J Otorhinolaryngol-Head Neck Surg 2012;55:429-34

Importance of re-examinations in the diagnosis of benign paroxysmal positional vertigo

To evaluate the importance of re-examinations in the diagnosis of benign paroxysmal positional vertigo (BPPV) and its clinical characteristics. The medical records of 288 BPPV patients treated during January 2009 to December 2010 were reviewed and analyzed. The definite diagnosis was established by re-examinations. Among them, 39 (13.5%) were diagnosed by re-examinations or return visits. And 25 patients received a correct diagnosis on the first visit and 14 were diagnosed on return visits. Their ages, gender distribution and the times of particle-repositioning maneuver were the same as the overall profiles. The rate of horizontal semicircular canal BPPV was higher in the 39 re-examined patients than the overall rate (46.15% vs 22.22%). And the latencies decreased during the second examination in 18 patients. Re-examinations and return visits are useful for diagnostic clarifications in the suspected BPPV patients.