Posterior Canal Benign Paroxysmal Positional Vertigo Research Articles

Clinical spectrum of positional downbeat nystagmus: a diagnostic approach.

Positional downbeat nystagmus (pDBN) is a common finding in dizzy patients, with etiologies ranging from benign paroxysmal positional vertigo (BPPV) to central vestibular lesions. Although peripheral pDBN often presents with distinct clinical features that differentiate it from BPPV, diagnosing its etiology can be challenging. A thorough clinical evaluation, including the physical characteristics of the nystagmus, response to positional maneuvers, and neurological findings, is often sufficient to diagnose conditions that provoke pDBN such as anterior canal BPPV, atypical posterior canal BPPV, and central causes. However, when the diagnosis remains uncertain, a brain MRI focusing on the posterior fossa is required. In human lesion models, the vestibulocerebellum (nodulus and uvula) is commonly implicated in pDBN. Central causes of positional vertigo include vascular events, tumors, immune mediated, toxicity, and demyelinating diseases. Ultimately, a significant number of cases will remain without a clear etiology despite extensive workup. Clinicians should be vigilant for signs suggesting central vestibular dysfunction at follow-up in cases of apparently refractory BPPV. The aim of this work is to provide a comprehensive overview of pDBN and offer a logical approach to its assessment, along with recommendations for future research directions.

Postural crisis in patients undergoing canalith repositioning procedures for posterior canal benign paroxysmal positional vertigo: A systematic review and meta-analysis.

The Epley or Semont maneuver is performed for posterior canal benign paroxysmal positional vertigo (PC-BPPV). The postural crisis indicates the phenomenon that the patient experiences severe dizziness, is unable to maintain the sitting posture, and suddenly falls backward or sideways on the examination table when returning to the sitting position, which is the final step of the canalith repositioning procedure (CRP). The postural crisis increases the risk of falls during CRP. This meta-analysis aimed to determine the incidence of postural crisis among patients who underwent CRP for PC-BPPV. Literature searches were conducted on PubMed, Embase, Cochrane Library, Web of Science, and Google Scholar. The random-effects model was utilized based on the results of the heterogeneity using the Tau2 test and I2 statistic. We included 5 nonrandomized studies that reported the total number of cases of CRP for PC-BPPV and postural crisis. In each study, postural crisis occurred in 4.0% to 14.9% of the subjects. Of a total of 1177 cases, the incidence of postural crisis in all CRP cases was 10% (95% confidence interval = 6%-15%). BPPV is the most common among peripheral vestibular diseases, usually occurring in the posterior semicircular canal. Therefore, 10% of cases with CRP for PC-BPPV is significant. When performing CRP for PC-BPPV, considering that the postural crisis related to increasing the risk of falls may occur, preparations for the phenomenon should be made in advance.

Benign paroxysmal positional vertigo

Abstract Benign paroxysmal positional vertigo (BPPV) is the leading etiology of peripheral vertigo. It manifests with transient, recurring bouts of vertigo brought on by movements of the head. BPPV happens when particles known as otoliths, which can either float freely (canalithiasis) or become attached to the cupula (cupulolithiasis), stimulate semicircular canals abnormally. The clinical symptoms of the BPPV are triggered when the head changes position so that the involved semicircular canal aligns vertically with gravity. During the Dix–Hallpike maneuver (used to diagnose posterior canal BPPV) and the supine roll test (used to diagnose horizontal canal BPPV), patients typically experience a brief delay followed by acute vertigo and nystagmus. Reversing the head position often causes the nystagmus to change direction. The location of otolith debris and the semicircular canal that is affected determine the severity, frequency, and length of symptoms in BPPV. There may be a spontaneous recovery of the BPPV with the help of conservative treatments. However, an important treatment option such as the canalith repositioning maneuver is helpful for giving an immediate resolution of the symptoms by clearing otolithic debris from the semicircular canal into the vestibule. This review article will discuss the prevalence, etiopathology, clinical features, differential diagnosis, and management of different types of BPPV including medical and surgical treatment and rehabilitation for BPPV.

Is diagnostics of Benign Paroxysmal Positional Vertigo with a mechanical rotation chair superior to traditional manual diagnostics? A randomized controlled crossover study.

Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause of vertigo. While various techniques and technologies have improved BPPV diagnostics and treatment, optimizing BPPV healthcare pathways requires a comprehensive understanding of the diagnostic modalities across diverse clinical settings. To compare traditional manual BPPV diagnostics (MD) with diagnostics done with the aid of a mechanical rotation chair (MRC) when using videonystagmography goggles with both modalities. This prospective, open-label, randomized diagnostic crossover study involved 215 adults with typical BPPV symptoms at a tertiary University Hospital-based outpatient clinic (Aalborg University Hospital, Denmark). Participants referred by general practitioners or otorhinolaryngologist clinics underwent both traditional manual and MRC diagnostics with the aid of videonystagmography goggles. The order of the diagnostic modalities was randomly assigned, and the two modalities were separated by a minimum of 30 min. The primary outcomes included sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of traditional MD compared to MRC diagnostics. The secondary outcome was the agreement between the two modalities. The MRC demonstrated a significantly higher sensitivity for BPPV detection in general for all participants (p = 0.00). Compared to MRC diagnostics, traditional MD displayed a sensitivity of 69.5% (95% confidence interval (CI): 59.8-78.1), specificity of 90.9% (95% CI: 83.9-95.6), PPV of 88.0% (95% CI: 83.9-95.6), and NPV of 75.8% (95% CI: 67.5-82.8). The overall inter-modality agreement was 80.5% (95% CI: 75.2-85.8, Cohen's kappa 0.61). While both modalities detected unilateral posterior canal BPPV equally good (p = 0.51), traditional MD underperformed for non-posterior BPPV (significantly) and in subgroups referred by ENTs (trend) or with impaired cooperation during traditional MD (significantly). Traditional manual BPPV diagnostics remains a valuable first-line approach for most patients. However, MRC diagnostics offers advantages for complex BPPV cases, patients with impaired cooperation, patients referred from otorhinolaryngologist clinics, and those with negative traditional MD but an evident BPPV history. MRC may be useful as a second opinion diagnostic tool for treatment-resistant BPPV. ClinicalTrials.gov identifier: NCT05846711.

Effectiveness of Brandt-Daroff exercises in benign paroxysmal positional vertigo: a systematic review

IntroductionBenign Paroxysmal Positional Vertigo (BPPV) is defined as a disorder of the inner ear characterised by repeated episodes of positional vertigo. BPPV is one of the most prevalent vestibular disorders in the general population, accounting for one-third of all vestibular disorders. The prevalence of BPPV is higher in females than males and this prevalence increases with increasing age. The common non-surgical treatments of BPPV are repositioning manoeuvres and habituation exercises. This review aimed to explore the effectiveness of Brandt-Daroff exercises in patients with BPPV.MethodsTwo search engines, PubMed and Cochrane, were used. Articles focusing on Brandt-Daroff exercises as management of BPPV were included in this review. All articles were published in English and results up to February 2023 were included.ResultsEpley’s repositioning manoeuvre is a better treatment option for posterior canal BPPV. Epley’s manoeuvre is more effective if applied alone as compared to its application along with Brandt-Daroff exercises or with medication. Epley’s manoeuvre was more effective than any other repositioning manoeuvre, such as the Semontmanoeuvre. The application of Brandt-Daroff was ineffective when applied alone. However, it was effective when applied in combination with the Cawthorne-Cooksey exercises in reducing the symptoms of BPPV.ConclusionsBrandt-Daroff exercises have inconsistent results in the treatment of BPPV; hence, high-quality randomised controlled trials should be carried out to investigate their efficacy.

Comparing the efficacy of repositioning manoeuvres over medications in the treatment of posterior and lateral canal benign paroxysmal positional vertigo: a prospective, randomized and comparative study

Background: Benign paroxysmal positional vertigo (BPPV) is a benign peripheral disorder of vestibular system and is the most common cause of peripheral vertigo. The aim of our study was to compare and assess the efficacy of Epley’s and Barbeque roll over manoeuvres with labyrinthine sedatives in the management of Benign Paroxysmal Positional Vertigo (BPPV) over a period of one month and to know the prevalence of BPPV in different age and gender groups among the two semicircular canals(posterior and lateral). Methods-This prospective randomized comparative clinical trial included 60 patients with clinically diagnosed BPPV in a tertiary care centre and were investigated for a period on one year. The clinical diagnosis of specific canal type of BPPV was assessed based on the diagnostic tests, Dix Hallpike test and McClure test. In manoeuvre group, posterior canal BPPV, Epley’s manoeuvre was performed and for lateral canal BPPV, Barbeque roll over manoeuvre was performed as treatment. In pharmacological group, labyrinthine sedatives i.e. either cinnarizine 25mg twice a day or betahistine 16 mg twice a day were administered for one month as treatment. Results: Results were assessed at the end of 48 hours (immediate time period) and at four weeks’ time period after the treatment, under three different outcome categories namely disappeared, improving and unchanged. Treatment of Benign Paroxysmal Positional Vertigo with repositioning manoeuvre had higher success percentage of 83.3% than the medical treatment. Conclusion: The treatment of BPPV with repostioning manoeuvres had a better outcome than the medical treatment.

EFFECTIVENESS OF EPLEY MANEUVER AND GANS REPOSITIONING MANEUVER ON DIZZINESS, BALANCE AND KINESIOPHOBIA IN PATIENTS WITH POSTERIOR CANAL BENIGN PAROXYSMAL POSITIONAL VERTIGO

Background: Benign paroxysmal positional vertigo (BPPV) is the most prevalent type of peripheral vestibular vertigo, typically affecting the posterior semi-circular canal. Objective: The objective of study was to compare the effectiveness of Epley maneuver and Gans repositioning maneuver on dizziness, balance and kinesiophobia in patients with posterior canal BPPV. Methods: 30 BPPV patients were selected and assigned into two groups based on the selection criteria. Group-A (N=15), received Epley maneuver and 15 were assigned to Group-B, undergone Gans repositioning maneuver, for 20 minutes per session, 3 session (alternate days) per week for 3 weeks. Cawthorne and Cooksey Exercises were given to both the group as common intervention. Dizziness, balance and kinesiophobia were assessed both before and after the 3-week intervention program using Dizziness Handicap Inventory (DHI) scale, Timed-Up and Go (TUG) test and Tampa Scale of Kinesiophobia (TSK), respectively. The collected data were subsequently tabulated and analyzed using appropriate statistical tools. Results: The unpaired ‘t’ test analysis of dizziness and balance revealed statistically significant scores in DHI(t=2.2259) and TUG(t=2.2547), respectively, at a 95% confidence interval. Consequently, Group A demonstrated significant reduction in dizziness and balance improvement in patients with posterior canal BPPV. The scores of Kinesiophobia for both the groups were (A, Mean=31.6; B, Mean= 32.2), which showed no significant difference(t=1.074), that means the group showed the improvement from baseline. Conclusion: The study concluded that a 3-week intervention combining the Epley maneuver with Cawthorne-Cooksey exercises was effective in treating dizziness, balance and kinesiophobia in patients with posterior canal BPPV. Implication: The Epley and Gans maneuvers effectively reduce dizziness and improve balance in patients with posterior canal BPPV. They also may alleviate kinesiophobia, enhancing patient confidence in movement. These interventions highlight the importance of targeted therapy in managing vestibular disorders, promoting functional recovery and quality of life.

Study Protocol for Assessing Serum Superoxide Dismutase Response to a Novel Head Rotation Maneuver in Posterior Canal Benign Paroxysmal Positional Vertigo Treatment

Abstract Background: Benign paroxysmal positional vertigo (BPPV) is a condition with sudden onset which causes short episodes of severe vertigo on altering the position of the head. Superoxide dismutases (SODs) are antioxidant proteins that regulate oxidative stress response in the body. Through this study, we evaluate the role of SOD in causing BPPV and effect of a new alternating maneuver, head rotation maneuver, for the treatment of BPPV of the posterior canal in reducing oxidative stress levels. Methodology: For investigating the role of serum SOD in the occurrence of BPPV Posterior canal, 60 BPPV and 60 healthy controls will be recruited. Their serum samples will be collected and SOD levels will be evaluated through colorimetry. For evaluating the effectiveness of head rotation maneuver in reducing the oxidative stress, patients with posterior canal BPPV (PC-BPPV) will be enrolled and divided into two groups through random allocation. Both the groups will be treated with head rotation and Epley maneuvers, respectively, by two separate therapists. Post-therapy SOD level will also be assessed. Results: Two-way repeated measures analysis of variance will be used to compare the groups’ improvement; treatment measures will be referred to as intergroup variables. Binary logistic regression analysis will be used to determine how SOD levels affect BPPV and recurrent BPPV. Pre- and postmaneuver SOD level will also be compared. Conclusion: SOD can be established as a reliable and strong biomarker for the occurrence of BPPV. Moreover, head rotation maneuver which is easy to perform can be used for managing PC-BPPV if the results show promising outcomes.

Minimal Stimulus Strategy in Benign Paroxysmal Positional Vertigo: Its Application in a Resource Limited Setting.

Benign paroxysmal positional vertigo (BPPV) is the most common cause for vertigo. It is diagnosed by the characteristic nystagmus induced by provocative positional tests. During these positional tests the patient experiences spinning vertigo and neurovegetative symptoms such as nausea and vomiting. This can cause severe discomfort to the patient during treatment and in some cases reduced compliance. Minimal stimulation strategy reduced the episodes of induced vertigo, nausea and vomiting thereby making the treatment maneuvers more tolerable. This study aims to evaluate the utility of minimum stimulus strategy for managing BPPV in a resource limited center. The present study also evaluated the utility of 3rd step vertigo as an alternative marker for recovery nystagmus in predicting the efficacy of Epley's maneuver in treating posterior canal BPPV. All patients diagnosed with canalolithiasis of posterior semicircular canal (pc-BPPV), horizontal semicircular canal (hc-BPPV), anterior semicircular canal (ac-BPPV) and multiple semicircular canal (mc-BPPV) were included in the study. The side on which the maximum symptoms were experienced was asked to the patients and noted. The first positional test done in all patients was the Dix-Hallpike maneuver and minimum stimulation strategy was used for treating BPPV. Appropriate canalolith repositioning maneuvers (CRM) were used to treat BPPV. Positional maneuvers were repeated after the CRM in the same sitting and the treatment was considered successful if nystagmus had disappeared on repeat positional tests. The presence of 3rd step vertigo during Epley's maneuver was documented. A total of 71 patients were enrolled in the study. Patients correctly identified the side of BPPV in 76.31% of cases. 3rd step vertigo was able to predict a successful Epley's maneuver in pc-BPPV with a sensitivity and specificity of 41.67% and 60% respectively. Incidence of 3rd step vertigo was seen in 41.37% of patients with pc-BPPV and in 90.9% of patients with mc-BPPV. Minimal stimulation strategy is useful in reducing the discomfort experienced by the patients with BPPV during treatment and thereby improve the compliance to treatment maneuvers. Patients were able to identify the correct side of BPPV in 76.31% of cases. Third step vertigo could predict successful Epley's reposition maneuver with a sensitivity of 41.67% and specificity of 60% in our cohort. However, more studies with larger sample size are required to ascertain its role as an alternative marker for 'recovery nystagmus'.

Management Protocol for the Unilateral Posterior Canal - Benign Paroxysmal Positional Vertigo - A Prospective Observational Study.

The objectives of our study were to assess the effectiveness of the single Epley manoeuvre per session for three consecutive days and to determine the protocol for treating posterior canal-Benign Paroxysmal Positional Vertigo (pc-BPPV). At our tertiary care centre, 410 patients with a confirmed diagnosis of unilateral pc-BPPV were included in a prospective observational study. For all the participants, the Epley manoeuvre was performed once daily for three consecutive days. Patients with persistent vertigo underwent Semont's liberatory manoeuvre and were reassessed after one week. The above protocol was repeated for patients who continued to have symptoms. The majority (40.0%) of patients were seen in the 6th decade, followed by the 5th decade (34.4%). Among the study participants, the mean age was 51.57 ± 9.916 years. The male-to-female ratio is 1:1.05. The right ear was affected by 51.75%, and the left by 48.3%. With this protocol, 392 (95.6%) patients were relieved of symptoms by day 3. A six-month recovery rate of 99.75% was achieved. In our study, 99.8% of patients with unilateral pc-BPPV were cured, and 6.34% had a recurrence of symptoms within six months of follow-up. Hence, combining the Epley and the Semont manoeuvres and repeating the manoeuvres on consecutive days has better improvement.

The Effect of Different Sensory Perturbations on Postural Control and Fall Risk in Benign Paroxysmal Positional Vertigo Patients.

Benign paroxysmal positional vertigo (BPPV) patients may experience balance problems in various environmental conditions other than positional dizziness. Therefore, there is a need to investigate the postural control abilities and the ability to use sensory inputs in BPPV patients in different conditions. The aim of this study was to examine the postural control performance of middle-aged adult BPPV patients in easy and difficult balance tasks, the effect of vestibular stimulation on the maintenance of balance, and the risk of falling, by posturographic evaluation in various conditions. A total of 26 patients diagnosed with posterior canal BPPV and 26 controls were included in the study. Sensory Organization Test (SOT), Vestibular Stimulation Test (VST), and fall risk assessment (FRA) were applied to the participants, respectively. Significant difference was observed in SOT medio-lateral (ML) plane in Conditions 2 and 5 (p < .05). A significant difference was observed in the vestibular score in the SOT ML plane. No significant difference was observed in VST test scores (p > .05). In the FRA test, a significant difference was observed in the energy and gain parameters in the anterio-posterior plane (p < .05). The current study examined postural control abilities of patients with BPPV in extensive external conditions and in both planes, using various sensory perturbations and stimulation. It was thought that while BPPV patients were in the active phase of the disease, their postural control skills in the ML plane decreased and they might be at risk of falling.

Comparative Study of Clinical Features of Patients with Different Types of Benign Paroxysmal Positional Vertigo.

Objectives: Even though BPPV is one of the most common causes of vertigo, it is often underdiagnosed and omitted in the diagnosis of patients reporting vertigo. The aim of the study was to establish a diagnostic pattern useful in patients admitted due to vertigo, based on the most common clinical characteristics of patients suffered from posterior canal BPPV (PC-BPPV), horizontal canal BPPV with geotropic (HCG-BPPV) and apogeotropic nystagmus (HCA-BPPV). Methods: The analysis covered the results obtained in 105 patients with a positive result of the Dix-Hallpike maneuver or the supine roll test. The patients were divided into 3 groups based on the BPPV type: gr.1:PC-BPPV (60%); gr.2: HCG-BPPV (27%); gr.3: HCA-BPPV (13%). Patients before the diagnostic maneuvers filled the questionnaire concerning their symptoms and previous diseases. Results: Almost all patients had vertigo during turning over in bed and the character of the symptoms was paroxysmal. The answers to questions about the type of head movement evoked vertigo and how long vertigo lasted were differentiating. The percentages of correct diagnosis speculated by the combined answers were 69.6% in PC-BPPV, 61.8% in HCG-BPPV, and 80% in HCA-BPPV. Conclusions: Basing on those observations there is presented the diagnostic schedule which could be useful in dizziness examination. The above results indicate that a properly collected interview with the patient allows for a high percentage of accurate diagnosis.

Can Video Head Impulse Testing Be Used to Estimate the Involved Canal in Benign Paroxysmal Positional Vertigo?

There may be confusion about which canal is involved in patients with benign paroxysmal positional vertigo (BPPV), especially with those that have subtle findings. The study aimed to determine if video head impulse testing may be used in such patients as a diagnostic tool. Symptom scoring and treatment efficiency in BPPV are essential parts of the process. Therefore, inventories like "Dizziness Handicap Inventory" may be useful in this regard. Patients with posterior and lateral canal BPPV were included. Video head impulse testing was performed prior to treatment and 1 week after treatment. Vestibuloocular reflex (VOR) gains were noted and compared to the opposite side. The presence of correction saccades was noted as well. Also, pretreatment and posttreatment Dizziness Handicap Inventory scores were compared. Fifty-seven patients were diagnosed with posterior canal BPPV, and sixteen were with horizontal canal BPPV. In patients with posterior canal BPPV, there was no difference between the involved canal VOR gains and the other canals on the same side (P=.639). The involved horizontal canal did not differ from the opposite horizontal canal. Patients with lateral canal BPPV show more significant improvement after treatment compared to patients with posterior canal BPPV. Video head impulse testing may not be used to estimate the involved canal in BPPV; however, it may be used to evaluate the efficiency of the treatment, especially in the lateral canal.

Do single-session Epley maneuvers treat benign paroxysmal positional vertigo?

Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular condition characterized by short-term vertigo attacks that significantly affect quality of life. Examine how well a single Epley maneuver worked in an outpatient setting for people with posterior canal benign paroxysmal positional vertigo (PC-BPPV) and whether they needed a second Dix-Hallpike maneuver. Prospective. Otorhinolaryngology department of a tertiary care center. Sociodemographic data, body mass index (BMI), and systemic disease history of 75 patients diagnosed with PC-BPPV were recorded, and their relationship with success rates after the modified Epley maneuver was analyzed. Detect cases that could not be repositioned with the diagnostic control Dix-Hallpike test performed 20 minutes after the modified Epley reposition maneuver in the same session in PC-BPPV patients. 75. Of the 75 patients, 31 were male (41.3%), 44 female (58.6%) with a mean (standard deviation) age of 58.6 (15.9) years age, 54.6% had one or more chronic diseases. BMI was 30 mg/kg2 and above in 31 patients (41.3%). The modified Epley maneuver was successful in 77.3%. No significant relationship was found between additional diseases or BMI in the patient group in whom the maneuver was unsuccessful. The success rates of repositioning maneuvers in treating patients diagnosed with PC-BPPV are high. However, more than a single maneuver is required in some resistant patients. Second diagnostic and repositioning maneuvers performed in the same session will reduce multiple hospital admissions. While it is helpful to repeat the maneuver in the patient group where it was unsuccessful, other factors causing the failure should be investigated. Lack of follow-up results of patients after 7-10 days.

Otolithic functions in patients with residual dizziness after successful repositioning manoeuvres for unilateral posterior canal BPPV.

To evaluate otolithic functions in patients with residual dizziness after successful canalith repositioning procedures (CRPs) for unilateral posterior canal benign paroxysmal positional vertigo (BPPV), and to investigate possible risk factors. This case-control observational study included healthy controls and patients with residual dizziness after improvement following CRP for BPPV. All participants were subjected to full history taking, otoscopy, audiological basic evaluation, Dix-Hallpike test to search for posterior canal BPPV, residual dizziness screening, and vestibular evoked myogenic potential (VEMP) testing. Between-group differences were assessed and possible factors associated with residual dizziness were identified by univariate analysis. A total of 50 patients with residual dizziness (mean age, 56.53 ± 7.46 years [29 female: 21 male]) and 50 healthy controls (mean age, 58.13 ± 7.57 years [20 female: 30 male]) were included. A significant difference in VEMP latencies was found between the patient and control group (delayed in the patient group), with no significant between-group difference in amplitude in both ears. Aging, female sex, long duration of BPPV, number of CRPs, cervical VEMP and ocular VEMP abnormalities, and winter onset, were significantly associated with the risk of residual dizziness. Residual dizziness is a frequent sequel of BPPV that may relate to otolithic dysfunction. VEMP changes were revealed in the form of delayed latencies.

To compare the recovery rates of modified Epley's against Semont's manoeuvres in patients with posterior canal benign paroxysmal positional vertigo: a randomized clinical trial.

Benign paroxysmal positional vertigo (BPPV) is one of the commonest causes of peripheral vertigo. It is treated with various canalolith repositioning manoeuvres by changing the head positions to allow the otoconial debris to fall back from the affected canal back to the utricle. The present study has compared the rate of recovery of vertigo with modified Epley's manoeuvres as compared to Semont's manoeuvre in patients with posterior canal BPPV. One hundred and seventy patients diagnosed by positive Dix-Hallpike test as posterior canal BPPV were included in this clinical trial. Subjective analysis of vertigo was done using visual analogue scale. 85 patients each were recruited in two arms by simple randomization using lottery method. Modified Epley's manoeuvre was administered to one group and Semont's manoeuvre to the other. They were recalled after 2weeks for clinical assessment with repeat Dix-Hallpike and VAS. Repeat Dix-Hallpike manoeuvres after two weeks revealed that 95.3 and 90.6% patients improved in Modified Epley's and Semont's group, respectively. After the second manoeuvre, the resolution rate was significantly higher in Semont's manoeuvre 100% (8 out of 8 patients), as compared to 25% (1 out of 4 patients) in Modified Epley's manoeuvre. Comparison of the mean values of VAS day 0 and VAS 2 weeks has been found to be statistically significant (p value of < 0.001). Both Epley's and Semont's manoeuvre are equally efficacious in treatment of BPPV. However, use of Semont's manoeuvre required fewer repeat manoeuvres for complete resolution of symptoms in patients. The Semont's manoeuvre is also comparatively easier to perform with less number of position changes, takes less time, and has no requirement of post-manoeuvre mobility restrictions. Hence, it is recommended that Semont's manoeuvre can be routinely used for the management of PC BPPV especially in older population and patients with spinal problems.

Enhancing BPPV Treatment Outcomes: A Comparative Study of the Epley Maneuver with and without the Dizzy-Fix Training Device.

This study evaluates the effectiveness of combining the Epley Maneuver with the Dizzy-Fix Training Device in treating Benign Paroxysmal Positional Vertigo (BPPV), aiming to enhance treatment outcomes and patient satisfaction. In this randomized controlled trial, 50 patients diagnosed with posterior canal BPPV were allocated into two groups: one receiving the traditional Epley Maneuver and the other undergoing the Epley Maneuver supplemented with the Dizzy-Fix Training Device. Key measures included the proportion of symptom-free patients at one month, changes in the Visual Analogue Scale (VAS) and Dizziness Handicap Inventory (DHI) scores, the recurrence rate within one month, and patient satisfaction. The Dizzy-Fix group achieved a significantly higher symptom resolution rate by day 7 (90% vs. 60%) and reported greater patient satisfaction (4.5/5 vs. 3.8/5) compared to the Epley Maneuver alone group. Additionally, this group exhibited a more substantial decrease in DHI scores (from an average of 30 to 5) and a lower recurrence rate (10% vs. 40%) within the first month post-treatment. Incorporating the Dizzy-Fix Training Device with the Epley Maneuver significantly improves the management of BPPV, evidenced by faster symptom resolution, enhanced patient satisfaction, and reduced symptom recurrence. These findings underscore the value of integrating real-time visual feedback technologies in vestibular rehabilitation, promising better patient outcomes, and advancing the quality of care in BPPV treatment.

A new roll test to diagnose posterior semicircular canal benign paroxysmal positional vertigo

BackgroundThe Dix-Hallpike (DH) test is a gold standard for diagnosing benign paroxysmal positional vertigo (BPPV). However, lateral semicircular canal BPPV is not rare. We have been performing the new roll test that begins from the sitting position and contains a head-hanging position, in order not to overlook lateral canal BPPV. We noticed that transient vertical/torsional nystagmus sometimes occurs during the new roll test. ObjectiveTo clarify the value of the new roll test in diagnosing posterior canal BPPV and elucidate the position that elicits nystagmus. Materials and methodsThe subjects were 100 consecutive patients (79 were female, 21 were male) with posterior canal BPPV. We classified the patients into four types based on a position that induced nystagmus. ResultsThe patient's position that elicited nystagmus varied. The supine type accounted for 24 %, the lateral type accounted for 62 %, the head-hanging type accounted for 9 %, and the DH type accounted for 5 %. ConclusionThe new roll test is valuable for diagnosing posterior canalolithiasis cases. Most patients reveal vertical/torsional nystagmus in the supine or lateral position. Therefore, performing the new roll test first is efficient at the initial visit.

Anterior Canal BPPV- A Rare Form of Vertical Canaloliathiasis: Series of 11 Cases.

The most common cause of peripheral vertigo is Benign Paroxysmal Positional Vertigo (BPPV) primarily due to involvement of posterior semicircular canal. BPPV due to anterior canal is rare entity. This is a retrospective study, in which data of 628 patients who underwent vertigo test were analyzed. Amongst which 354 were patients of BPPV. It was found that 305 patients had posterior canal BPPV, 18 patients had lateral canal BPPV and 11 patients had anterior canal BPPV. The VNG data of 11 patients with anterior canal BPPV along with their treatment outcomes was analyzed. Of the eleven patients of anterior canal BPPV, ten patients had torsional nystagmus with or without downbeat nystagmus in Deep Head Hanging test. Only one patient had isolated downbeat nystagmus in Supine Head Hanging Test. Patients were treated with modified Yacovino's maneuver. Eight patients had immediate relief with modified Yacovino's repositioning maneuver. One patient had immediate conversion to left posterior canal BPPV and was treated for the same. Two patients presented with delayed conversion to posterior canal BPPV and were treated for the same. Anterior canal BPPV is rare but existent entity. It has a typical torsional and downbeat Nystagmus which is induced by Dix-Hallpike and Deep head hanging test. There is no reversal of nystagmus on getting up. It can be easily corrected by Yacovino's maneuver in the majority of the cases.

Semont maneuver for posterior canal benign paroxysmal positional vertigo: a systematic review of randomized controlled trials.

This review aimed to examine the effects of the Semont maneuver on posterior canal benign paroxysmal positional vertigo (BPPV). PubMed, PEDro, SCOPUS, REHABDATA, EMBASE, and Web of Science were searched comprehensively from inception to January 2024. The Physiotherapy Evidence Database (PEDro) scale was employed to evaluate the quality of the selected studies. In total, 18 randomized controlled trials met the eligibility criteria. A total of 2237 participants with BPPV (mean age = 58.10years) were included in this review. Among them, 37.5% were males, and 58% presented with right-sided BPPV. The included studies ranked from 5 to 9 out of 10 (Median = 7), suggesting good to excellent quality on the PEDro scale. The available literature revealed that the Semont maneuver is effective in improving posterior canal BPPV symptoms. The Semont maneuver is considered a standard option for treating posterior canal BPPV, with a high success rate of around 80%. It is suggested as the primary option for managing posterior canal BPPV in individuals who complain of cervical or lumbar problems, severe cardiac or respiratory conditions. Further studies are strongly needed to understand the long-term effects of the Semont maneuver and to identify the recurrence rate.