Recurrence Of Benign Paroxysmal Positional Vertigo Research Articles

Life after benign paroxysmal positional vertigo: one-year analysis of recurrence, headaches, neck pain, falls, and functional vestibular symptoms.

Benign paroxysmal positional vertigo (BPPV) is a vestibular disorder causing recurrent episodes of vertigo. Despite symptom resolution at discharge, events such as relapses, migraines, neck pain, falls, and persistent postural-perceptual dizziness (PPPD) may occur. This study aims to estimate the incidence, timing, and risk factors for these symptoms. This multicenter, prospective, observational study recruited patients with a first episode of BPPV. Patients were treated with canalith repositioning maneuvers and discharged when no nystagmus was observed. Follow-up included in-person and telephone assessments over one year. The incidence and timing of symptoms were calculated, and risk factors were identified through regression models. 201 patients were recruited, and 124 met the inclusion criteria. 70.97% experienced events after discharge, though symptoms were not always severe enough to seek medical care. No useful risk factors were found for predicting BPPV recurrence. Low vitamin D levels increased recurrence risk but did not effectively discriminate patients. Women were more likely to develop headaches. Prior headaches, migraines, or neck pain were the strongest predictors of future occurrences of these conditions. Headaches or neck pain themselves triggered vestibular symptoms, often indistinguishable from BPPV. BPPV was associated with new-onset neck pain. The risk of falls increased with age. Anxiety triggered by BPPV predicted PPPD. Developing symptoms after discharge increased the likelihood of other events. Although BPPV is considered resolved when no nystagmus is observed during provocation tests, it should be understood as a condition accompanied by other symptoms that often persist after discharge in most patients.

Evaluation of Risk Factors Associated with the Occurrence and Recurrence of Benign Paroxysmal Positional Vertigo in Koreans: A Nested Case-Control Study.

Benign paroxysmal positional vertigo (BPPV) is the most prevalent cause of vertigo. This study analyzes the risk factors involved in the occurrence and recurrence of BPPV. A database maintained by the Korean National Health Insurance Service (NHIS) was used to enroll 434,552 patients diagnosed with BPPV from 2011 to 2017. A propensity score was used to match participants with an equal number of control patients without BPPV by age, sex, residential status, and socioeconomic status. Recurrence of BPPV was defined as an occurrence of BPPV more than 90 days after treatment. Logistic regression was used to analyze the occurrence of BPPV, and Cox proportional hazards models were applied to analyze the risk factors for recurrence. BPPV was 2.2 times more common in females, peaking between the ages of 50 and 59 years. The five-year BPPV recurrence rate was 39.8%, with a significant portion recurring within the first year. The incidence of BPPV was statistically significantly associated with several underlying medical conditions, including vitamin D deficiency, thyroid hormone abnormalities, head trauma, and disorders of the inner ear. Advanced age, female gender, rural residence, low socioeconomic status, and the presence of inner-ear diseases were notable risk factors for the recurrence of BPPV. Our study provides significant insight into the risk factors associated with both the occurrence and recurrence of BPPV, which appears to be linked to vitamin D levels, thyroid hormones, and estrogen. Conditions such as inner-ear disorders, head trauma, and otologic surgery were strongly associated with both the occurrence and recurrence of BPPV.

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.

Transcriptomic analysis reveals cross-talk genes between type 2 diabetes and recurrent benign paroxysmal positional vertigo

BackgroundBenign paroxysmal positional vertigo (BPPV) is a common neurological disorder with a high recurrence rate. Type 2 diabetes mellitus (T2DM) is recognized as a risk factor for BPPV recurrence. However, the genomic association between T2DM and BPPV recurrence remains understudied. MethodsDifferential gene expression analysis and weighted gene co-expression network analysis were used to identify shared genes between BPPV recurrence and T2DM. The MCC algorithm was employed to select hub genes from the protein-protein interaction network of the shared genes. The predictive efficacy of hub genes for BPPV recurrence and T2DM was assessed using ROC curve analysis. Genemania database was used to identify downstream targets of hub genes. The immune infiltration landscape of BPPV and T2DM was characterized using the CIBERSORT algorithm. Correlation analysis was performed to explore the relationship between hub genes and immune cells. The expression levels of hub genes in patient blood samples were validated using qPCR. ResultsThirteen shared genes were identified and a protein-protein interaction network was constructed for BPPV recurrence and T2DM. Subsequently, four hub genes were selected, and their expression levels effectively predicted the occurrence of BPPV recurrence and T2DM. These hub genes were highly correlated with immune cell infiltration, indicating a common mechanism underlying recurrent BPPV and T2DM. Finally, the upregulation of hub genes in patients with T2DM comorbid with BPPV recurrence was confirmed in blood samples. These hub genes may serve as predictive biomarkers for assessing the recurrence rate in BPPV patients with comorbid T2DM. ConclusionWe proposed shared gene characteristics between BPPV recurrence and T2DM, revealing an immune-mediated inflammatory regulation as a common pathway and identifying four immune-related biomarkers and potential therapeutic targets for T2DM comorbid with recurrent BPPV.

Management of recurrent benign paroxysmal positional vertigo.

Benign paroxysmal positional vertigo is the most common episodic vestibular disorder, although it is often quiescent by the time patients visit a specialist clinic, making the diagnosis difficult to confirm. Patients fear the consequences of a relapse and it is not clear what follow up should be provided. This evaluation reviewed the results of an open access pathway that offered priority appointments to patients with a history of positional vertigo. In total, 664 patients were included in the analysis, 52 per cent of whom had unconfirmed benign paroxysmal positional vertigo. Open follow up improved diagnostic rates by approximately 40 per cent. The rate of benign paroxysmal positional vertigo recurrence was 34 per cent in patients with follow up of at least one year, 41 per cent with follow up of one to two years, and 53 per cent with follow up of two years or more. One in five recurrences occurred in a different semi-circular canal. These results suggest that specialist follow up is required for management of recurrent benign paroxysmal positional vertigo.

Clinical Outcomes in Patients With Benign Paroxysmal Positional Vertigo and Vitamin D Deficiency: A Singaporean Perspective.

Benign paroxysmal positional vertigo (BPPV) is the primary vestibular disorder causing peripheral vertigo. Given the role of vitamin D in maintaining otoconia homeostasis, its deficiency may elevate the risk of BPPV. Our study seeks to evaluate the correlation between vitamin D deficiency and clinical outcomes of patients with BPPV in the local Asian population. We performed a retrospective analysis of 149 consecutive adult patients referred to a tertiary center's Otolaryngology dizziness clinic between 2018 and 2021. All of these patients had both BPPV and vitamin D deficiency. The mean serum vitamin D level was 19.4 ± 5.5 ng/mol. Approximately 51.7% (77/149) of patients experienced recurrent episodes of BPPV. Univariate Chi-square analyses demonstrated vitamin D levels (P < 0.001) and history of migraine (P= 0.04) were related to BPPV recurrence. On multivariate analyses, patients with higher serum vitamin D levels were 16.7% less likely to develop recurrent BPPV (odds ratio [OR] 0.83, 95% confidence interval [CI] 0.76-0.90, P< 0.001). However, migraine history was not significantly related to BPPV recurrence (OR 0.38, 95% CI 0.14-1.00, P= 0.050). There was no statistically significant difference in the duration of BPPV episodes based on vitamin D levels (P = 0.327). Patients with vitamin D deficiency are at higher risk of recurrent BPPV. Future research directions that would be beneficial include conducting a randomized controlled trial to evaluate both the effectiveness of vitamin D supplementation and its optimal dosage.

Effect of the early diastolic blood pressure response to the head-up tilt test on the recurrence of benign paroxysmal positional vertigo.

Otolith organ acts complementarily with the autonomic nervous system to maintain blood pressure. However, the effect of blood pressure variability in the autonomic nervous system on otolith organ has not yet been determined. This study aimed to verify the hypothesis that blood pressure variability in the autonomic nervous system affects the recurrence of benign paroxysmal positional vertigo (BPPV), which is the most common disease of the vestibular organs, by using the head-up tilt test (HUTT). This study included 432 patients diagnosed with idiopathic BPPV. The follow-up period for all patients was 12 months. Age, sex, hypertension, diabetes and recurrence were analyzed. The HUTT parameters were divided into a group of patients whose average diastolic blood pressure increased in the upright position compared to supine position during the HUTT (DBP1) and a group of patients whose average diastolic blood pressure decreased in the upright position compared to supine position during the HUTT (DBP2). Model selection, general loglinear analysis, and logit loglinear analysis were performed using a hierarchically progressing loglinear analysis. In summary, the group with increased average diastolic blood pressure (DBP1) showed a higher tendency for BPPV recurrence compared to the group with decreased diastolic blood pressure (DBP2) in the upright position during the HUTT, although the difference was not statistically significant (p = 0.080). However, in males, the DBP1 group demonstrated a significantly higher recurrence rate of BPPV than the DBP2 group during the HUTT (95% CI, -20.021 to -16.200; p < 0.001). It is presumed that poor autonomic nervous system response through vestibulosympathetic reflex maintains elevated diastolic blood pressure in the upright position during the HUTT. This variability is assumed to affect the recurrence of BPPV.

Diagnostic value of vestibular evoked myogenic potentials in benign paroxysmal positional vertigo

ObjectivesVestibular evoked myogenic potentials (VEMPs) are useful for studying the disturbances along nerve pathways implicated in the transmission of neurological information from otolithic organs related to vestibular function. This study aims to determine the differences in VEMPs in patients affected with benign paroxysmal positional vertigo (BPPV). MethodsWe recruited 36 patients, 9 diagnosed with recurrent BPPV (rBPPV), 9 with only one episode of vertigo (iBPPV), and 18 as a control group. We performed cervical and ocular VEMPs (cVEMPs and oVEMPs). ResultsWe observed differences in asymmetry ratio, which was 41.82% in cVEMPs in iBPPV and 68.27% in oVEMPs in rBPPV, while no asymmetry was found in control cases. Also, there was a lack of both VEMP responses in 22.2% of cases and an absence of cVEMP in 11.1% in iBPPV; in rBPPV, 11.1 % presented no responses in cVEMPs or oVEMPs, 22.2% showed no oVEMP, and 11.1% showed no cVEMP. These values were normal in the control group. ConclusionThe value of VEMPs in BPPV demonstrates the implication of vestibular damage, mainly utricle damage. For better sensitivity in detecting otolith abnormalities, we should perform oVEMPs and cVEMPs in recurrent BPPV and early stages of BPPV.

Benign paroxysmal positional vertigo: case developed with hyperparathyreoidism and vitamin D deficiency

The most common cause of spinning vertigo is benign paroxysmal positional vertigo (BPPV). Most cases are related to idiopathic BPPV, which pathogenesis is still not fully understood. In this manuscript the clinical case of recurrent benign paroxysmal positional vertigo is depicted. BPPV in this case was occurred primary in menopausal period. A clinical feature of this case is its combination not only with vitamin D deficiency and postmenopausal osteopenia (confirmed according to osteodensitometry), but also with secondary hyperparathyroidism, laboratory confirmed. The literature has accumulated data to link the development and recurrence of BPPV with vitamin D deficiency and osteoporosis, but few comprehensive studies of all crucial indicators of calcium-phosphorus metabolism in these patients have been published. Meanwhile, according to the author, a comprehensive endocrinological study of calcium-phosphorus metabolism in a patient with newly diagnosed BPPV can help optimize therapy for this category of patients.

Anxiety characteristics in benign paroxysmal positional vertigo: first vs. recurrent episodes

PurposeTo assess the difference in state and trait anxiety levels in patients with Benign Paroxysmal Positional Vertigo (BPPV) at the first episode (FE) versus recurrent episodes (RE), before and after vestibular physiotherapy. A secondary objective was to assess the difference in the prevalence of underlying health conditions between FE and RE BPPV patients.MethodsFifty-five patients with BPPV, aged 40–70, were recruited. The diagnosis of BPPV was confirmed based on subjective complaints of vertigo and positive results from the Dix–Hallpike and Supine Roll tests. Twenty-four patients were in their FE, and 31 had RE. All patients completed the State–Trait Anxiety Inventory (STAI) questionnaire three times; before, immediately after, and a week after vestibular physiotherapy treatment.ResultsThe RE group demonstrated higher trait anxiety than the FE group in all testing points: before treatment (median value of 38 versus 29, p-value = 0.02), immediately after treatment (median value of 36 versus 28, p-value < 0.01) and a week later (median value of 38 versus 28, p-value < 0.01). State anxiety decreased immediately after treatment in both groups, but at the second session, it was significantly higher in the RE than in the FE group (median value of 38 versus 28.5, p-value = 0.03). Hypothyroidism was significantly more frequent in the RE group (RE 16%, FE 0%, p-value = 0.04).ConclusionsBased on the current study’s findings, we recommend assessing anxiety levels in patients with recurrent BPPV and consider referring them for appropriate treatment when necessary.

Association between vitamin D deficiency and benign paroxysmal positional vertigo (BPPV) incidence and recurrence: a systematic review and meta-analysis

ObjectivesThe objective of this study is to determine the relationship between serum vitamin D level and the risk of developing benign paroxysmal positional vertigo (BPPV) incidence and recurrence in countries...

Vitamin D Supplementation and Recurrence of Benign Paroxysmal Positional Vertigo.

Positional vertigo manifests as a spinning sensation triggered by changes in head position relative to gravity. Benign paroxysmal positional vertigo (BPPV) is an inner ear disorder characterized by recurrent episodes of positional vertigo. The connection between vitamin D insufficiency/deficiency and the onset and recurrence of BPPV is established. This study aims to assess vitamin D as a recurring factor in BPPV and the efficacy of vitamin D supplementation in preventing its recurrence. A comprehensive literature review on the relationship between vitamin D and BPPV recurrence was conducted, searching PubMed, Embase, Web of Science, and article reference lists for studies published from 2020 to 2023. A total of 79 articles were initially identified through the search, with 12 of them being utilized in the study. Recurrence rates for BPPV varied from 13.7% to 23% for studies with follow-up less than 1 year and 13.3% to 65% for studies with follow-up equal to or exceeding 2 years. Risk factors for BPPV recurrence include advanced age, female sex, hypertension, diabetes mellitus, hyperlipidemia, osteoporosis, and vitamin D deficiency. While earlier studies did not establish a link between low vitamin D levels and initial BPPV occurrence, they did associate recurrent episodes with low vitamin D levels. Recent research indicates that vitamin D supplementation in BPPV patients with deficiency or insufficiency decreases both the numbers of relapsing patients and relapses per patient. To validate these findings across diverse populations, further randomized controlled studies with larger cohorts and extended follow-up durations are essential.

Vitamin D supplementation in preventing the recurrence of benign paroxysmal positional vertigo.

To evaluate the effect of vitamin D supplementation on the recurrence rate of benign paroxysmal positional vertigo (BPPV). A single-center, prospective, double-blind, placebo-controlled, parallel-group randomized controlled trial was conducted between November 2018 and May 2020. After successful treatment with canalith repositioning maneuvers, patients diagnosed with BPPV were randomized to either the vitamin D (n = 20) or placebo (n = 18) group. Only patients with serum vitamin D levels <20 ng mL-1 were included. The vitamin D group received 7000 IU of vitamin D weekly for a year, while the placebo group received a matching placebo drug. The final endpoint was the BPPV recurrence rate and correlation with serum vitamin D levels after 6 and 12 months in both groups. Among 38 patients, 37 were followed up for 6 months and 30 for 12 months. Significantly higher serum vitamin D levels were observed in the vitamin D group compared to the placebo group at both the 6-month and 1-year follow-ups (p < .001 at each timepoint). The recurrence rate was lower in the vitamin D group than in the placebo group after 6 months (p = .008) and 1 year (p = .003). Vitamin D supplementation, in the absence of calcium, may be beneficial for patients prone to recurrent BPPV episodes, particularly when serum vitamin D levels are suboptimal (PRE20181024-001, Clinical Research Information Service, South Korea). 1b.

Diagnostic value of vestibular evoked myogenic potentials in benign paroxysmal positional vertigo

ObjectivesVestibular evoked myogenic potentials (VEMPs) are useful for studying the disturbances along nerve pathways implicated in the transmission of neurological information from otolithic organs related to vestibular function. This study aims to determine the differences in VEMPs in patients affected with benign paroxysmal positional vertigo (BPPV). MethodsWe recruited 36 patients, 9 diagnosed with recurrent BPPV (rBPPV), 9 with only one episode of vertigo (iBPPV), and 18 as a control group. We performed cervical and ocular VEMPs (cVEMPs and oVEMPs). ResultsWe observed differences in asymmetry ratio, which was 41.82% in cVEMPs in iBPPV and 68.27% in oVEMPs in rBPPV, while no asymmetry was found in control cases. Also, there was a lack of both VEMP responses in 22.2% of cases and an absence of cVEMP in 11.1% in iBPPV; in rBPPV, 11.1 % presented no responses in cVEMPs or oVEMPs, 22.2% showed no oVEMP, and 11.1% showed no cVEMP. These values were normal in the control group. ConclusionThe value of VEMPs in BPPV demonstrates the implication of vestibular damage, mainly utricle damage. For better sensitivity in detecting otolith abnormalities, we should perform oVEMPs and cVEMPs in recurrent BPPV and early stages of BPPV.

Development and verification of a nomogram for recurrence risk of Benign Paroxysmal Positional Vertigo in middle-aged and older populations.

Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause of peripheral vertigo, with frequent recurrence, particularly pronounced among middle-aged and elderly populations, significantly affecting patients' quality of life. This study aimed to identify predictive factors for recurrence in middle-aged and older patients with BPPV and to develop a nomogram prediction model based on these predictors. This retrospective study included 582 participants aged ≥45 years who were selected from the electronic medical records system of the First Hospital of Changsha between March 2021 and March 2024. Randomly chosen participants (n = 407, 70%) constituted the training group, whereas the remaining participants (n = 175, 30%) formed the validation group. This study used LASSO binomial regression to select the most predictive variables. A predictor-based nomogram was developed to calculate the risk of BPPV recurrence. The performance of the nomogram was evaluated using the area under the receiver operating characteristic curve (AUC) and calibration curves with 1,000 bootstrap resampling validations. Decision curve analysis (DCA) was conducted to assess the clinical usefulness of the nomogram. According to findings from least absolute shrinkage and selection operator (LASSO) binomial regression and logistic regression screening, older age, higher levels of uric acid (UA) and homocysteine (HCY), diabetes, migraine, anxiety, and insomnia were identified as independent factors associated with an increased recurrence risk of BPPV. A nomogram model for predicting recurrence risk was developed based on these predictors. The nomogram achieved an AUC (C-statistic) of 0.8974 (95% CI: 0.8603-0.9345) in the training group and 0.8829 (95% CI: 0.8253-0.9406) in the validation group. Calibration curves, after 1,000 bootstrap resamples, demonstrated good agreement between the predicted and actual probabilities in the development and validation cohorts. DCA indicated that the nomogram had clinical utility. The nomogram model incorporating age, UA, HCY, diabetes, migraine, anxiety status, and insomnia demonstrated a strong predictive capability for estimating the probability of BPPV recurrence in middle-aged and elderly patients. This tool is valuable for identifying individuals at high risk of BPPV recurrence and can aid physicians in making informed treatment decisions aimed at reducing recurrence rates.

The role of electrocochleography and the caloric test in predicting short-term recurrence of benign paroxysmal positional vertigo.

The study aimed to assess the value of physiological tests for evaluating inner ear function in predicting the short-term recurrence of benign paroxysmal positional vertigo (BPPV). The clinical information of all idiopathic BPPV patients who were treated in our clinic between February 2021 and December 2022 were reviewed. All patients included in the study had completed audiology examinations including pure tone audiometry, electrocochleography (EcochG), auditory brainstem response, and vestibular function examination such as the vestibular caloric test. The relationships between the results of the above tests and short-term recurrent BPPV were analyzed. A total of 96 patients with unilateral idiopathic BPPV were included for analysis. The numbers of non-recurrent patients and recurrent patients were 57 (59.4%) and 39 (40.6%), respectively. Only the results of EcochG and the caloric test showed significant differences between non-recurrent and recurrent patients (both P < 0.05). The results of these two tests were also found to be independently predictive of short-term recurrence (both P < 0.05). The non-recurrence rate for patients with normal results in both tests reached up to 78.3%, which was significantly higher than that for patients with abnormal results in both tests, 28.6% (P < 0.05). Endolymphatic hydrops and canal paresis were independent risk factors for short-term recurrent BPPV. Additional treatments should be considered to reduce the recurrence rate, including dehydration treatment and vestibular rehabilitation.

Migraine management for the otolaryngologist.

To characterize migraine pathophysiology, presentation, and current treatment strategies, specifically in regard to vestibulocochlear manifestations of migraine. Narrative review of available literature. Migraine disorder can be described as a spectrum of otologic manifestations, with vestibular migraine now recognized with fully-fledged diagnostic criteria. Otologic manifestations are theorized to be due, in part, to trigeminal innervation of the inner ear structures and calcitonin gene-related peptide (CGRP) expression within the labyrinth. Patients can experience vertigo, aural fullness, enhanced tinnitus, and hearing loss without the characteristic migraine headache, leading to under recognition of these symptoms as migraine-related. Meniere's disease, mal de débarquement syndrome, persistent postural perceptual dizziness, and recurrent benign paroxysmal positional vertigo have close associations to migraine and may exist on the migraine spectrum. Migraine treatment consists of two goals: halting acute attacks (abortive therapy) and preventing attacks (prophylactic therapy). Abortive medications include triptans, corticosteroids, anti-histamines, and anti-emetics. Pharmacologic prophylaxis in conjunction with lifestyle modifications can decrease frequency and severity of symptoms and include tricyclic antidepressants, calcium channel blockers, anti-epileptic medications, selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, beta-blockers, gepants, and monoclonal antibodies to CGRP. Promising evidence is emerging regarding the ability of migraine medications to positively treat the various otologic symptoms of migraine. Migraine disorder manifesting with primarily cochleovestibular symptoms can be challenging to diagnose and manage for practicing clinicians. Patients with various vestibulopathies that are closely related to migraine may benefit from migraine treatment. Lifestyle choices and prophylactic medications are key to satisfactorily preventing acute migrainous attacks and improve function.

Gene expression analysis in recurrent benign paroxysmal positional vertigo: a preliminary study.

This study aimed to determine the pathophysiology of recurrent benign paroxysmal positional vertigo (BPPV) in young patients using gene expression profiling combined with bioinformatics analysis. Total RNA was extracted from the whole blood of four young patients with recurrent BPPV and four controls. The differentially expressed genes (DEGs) between the groups were screened using a microarray analysis based on the cutoff criteria of |log2 fold change| > 1 and an adjusted p-value of < 0.05. Functional enrichment analysis of DEGs was performed using Gene Ontology analysis, and the protein-protein interaction (PPI) network was constructed using the Search Tool for the Retrieval of the Interacting Genes database. A total of 39 DEGs were detected between the BPPV and control samples, comprising 33 upregulated DEGs and six downregulated DEGs in the BPPV group. Functional enrichment analysis indicated that the upregulated DEGs were significantly enriched in terms related to metabolic processes and the immune system. Two main pathways were extracted from the PPI network: one was associated with oxidative phosphorylation and stress and the other with the adaptive immune system and extracellular matrix degradation. The findings of our bioinformatics analysis indicated that oxidative stress or extracellular matrix degradation due to immune-mediated inflammatory responses may contribute to the development of recurrent BPPV in young patients.

Cerebral Outflow Discrepancies in Recurrent Benign Paroxysmal Positional Vertigo: Focus on Ultrasonographic Examination.

This prospective pilot study aimed to evaluate whether cerebral inflow and outflow abnormalities assessed by ultrasonographic examination could be associated with recurrent benign paroxysmal positional vertigo (BPPV). Twenty-four patients with recurrent BPPV, affected by at least two episodes, and diagnosed according to American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) criteria, evaluated at our University Hospital, between 1 February 2020 and 30 November 2021, have been included. At the ultrasonographic examination, 22 of 24 patients (92%) reported one or more alterations of the extracranial venous circulation, among those considered for the diagnosis of chronic cerebrospinal venous insufficiency (CCSVI), although none of the studied patients were found to have alterations in the arterial circulation. The present study confirms the presence of alterations of the extracranial venous circulation in recurrent BPPV; these anomalies (such as stenosis, blockages or regurgitation of flow, or abnormal valves, as per the CCSVI) could cause a disruption in the venous inner ear drainage, hampering the inner ear microcirculation and then possibly causing recurrent otolith detachment.

EFFECTIVENESS OF EPLEY’S MANEUVER IN POSTERIOR CANAL BENIGN PAROXYSMAL POSITIONAL VERTIGO: A PROSPECTIVE OBSERVATIONAL STUDY

Objectives: The aim of the present study was to determine the effectiveness of Epley’s maneuver in curing posterior canal benign paroxysmal positional vertigo (BPPV). Methods: This was a single-center, hospital-based, prospective observational study involving a total of 51 patients diagnosed with BPPV. The diagnosis of BPPV was confirmed by Dix–Hallpike’s maneuver (DHM). The patients of BPPV were treated using Epley’s maneuver. The patients were followed on the 4th, 10th, 30th, and 180th days after the initial consultation. The response to DHM was recorded on each follow-up visit. Results: Among the enrolled 51 participants, 47 did not have any complaints related to giddiness post treatment. Thus, the effectiveness of Epley’s maneuver in treating posterior semicircular canal BPPV at 6 months was 92.16%. Overall, 5 participants (10.6%) who were cured on the first follow-up visit had a recurrence of BPPV at the 1-month follow-up visit. As the duration of follow-up increased, the quality-of-life score decreased, indicating that patients felt better or relieved from symptoms with time. On the follow-up visits on day 4, day 10, 1 month, and 6 months after Epley’s maneuver, it was 43.1%, 72.5%, 88.2%, and 92.2%, respectively, for those who had a negative response to DHM. Conclusion: Epley’s maneuver is an effective treatment modality for patients diagnosed with posterior semicircular canal BPPV and shows a significant improvement in quality of life for such patients with low recurrence rates.