Repositioning Treatment Research Articles

Influence of natural hyoid bone position and surgical repositioning on upper airway patency: a computational finite element modeling study.

The hyoid bone's inferior baseline position in obstructive sleep apnea (OSA) has led to surgical hyoid repositioning (SHR) treatment, yet outcomes vary widely. The influence of baseline hyoid position (BHP; phenotype) and SHR on upper airway (UA) function remains unclear. We aimed to investigate their impact on the UA using computational modeling. A validated finite element model of the rabbit UA was advanced and used to simulate changes in BHP and SHR, alone and in combination. The hyoid was displaced in cranial, caudal, anterior, anterior-cranial, and anterior-caudal directions from 1 to 4 mm. Model outcomes included UA collapsibility, measured using closing pressure (Pclose), cross-sectional area (CSA), and soft tissue mechanics (displacement, stress, and strain). Graded BHP increments increased Pclose for all directions and up to 29%-43% at 4 mm (relative to the original BHP). Anterior-based SHR decreased Pclose (approximately -115% at 4 mm) and increased ΔCSA (approximately +35% at 4 mm). Cranial SHR decreased ΔPclose (-29%), minimally affecting CSA. Caudal SHR increased ΔPclose (+27%) and decreased ΔCSA (-7%). Anterior-cranial and anterior-caudal SHR produced the highest stresses and strains. SHR effects on UA outcomes were dependent on BHP, with more caudal BHPs leading to less effective surgeries. In conclusion, BHP (phenotype) and SHR both alter UA outcomes, with effects dependent on hyoid displacement direction and magnitude. BHP influences the effectiveness of SHR in reducing UA collapsibility. These findings provide further insights into the hyoid's role in UA patency and suggest that considering the hyoid's baseline position and surgical repositioning direction/increment may help improve hyoid surgeries for OSA treatment.NEW & NOTEWORTHY Using computational modeling, this study directly shows that any shift from the healthy natural hyoid bone position increases upper airway collapsibility. Surgical hyoid repositioning alters upper airway outcomes in a direction- and magnitude-dependent manner, with its effects influenced by the natural hyoid position. Accounting for both the natural hyoid position and individually prescribed surgical repositioning may enhance upper airway stability and improve outcomes in obstructive sleep apnea (OSA) treatment.

Associations between cognition, anxiety, depression, and residual dizziness in elderly people with BPPV.

To investigate the associations between cognition, anxiety, depression, and residual dizziness after successful repositioning maneuvers in the elderly with benign paroxysmal positional vertigo (BPPV). We enrolled 40 elderly patients with BPPV in our outpatient department. We used the Dizziness Handicap Inventory (DHI), Visual Analog Scale (VAS), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder Questionnaire-7 (GAD-7) to assess the degree of dizziness, anxiety, and depression of participants before repositioning therapy, respectively. At the 1-week follow-up after BPPV treatment, each participant will be reassessed and divided into a group with residual dizziness (RD) and a group without residual dizziness (NRD) based on the follow-up DHI score. The Mini-Mental State Examination (MMSE) evaluated the cognitive function of the participants. The age, gender, duration of BPPV, and involved semicircular canals in the two groups did not show a significant difference. The RD group scored significantly higher on the DHI (p = 0.006), GAD-7 (p < 0.001), and PHQ-9 (p = 0.002) before the repositioning treatment than the NRD group. The two groups had no significant difference in MMSE score (p = 0.381). Anxiety and depression scores before repositioning treatment significantly and positively correlated with follow-up DHI scores (r = 0.678 and 0.522, respectively), but the MMSE score did not significantly relate to it. The univariate linear regression showed that the DHI (p < 0.001), GAD-7 (p < 0.001), and PHQ-9 (p = 0.002) scores before treatment could predict residual dizziness. The multivariate linear regression showed that GAD-7 before treatment was the only significant predictor of residual dizziness (p < 0.001). The level of dizziness, anxiety, and depression before treatment can predict residual dizziness after successful repositioning maneuvers in the elderly with BPPV. Anxiety may be the strongest predictor of residual dizziness after successful repositioning treatment in elderly BPPV patients.

Elevated red cell distribution width predicts residual dizziness in patients with benign paroxysmal positional vertigo.

ObjectiveThe present study aimed to determine whether residual dizziness (RD) after successful repositioning treatment in benign paroxysmal positional vertigo (BPPV) patients could be predicted by red blood cell distribution width (RDW).Materials and methodsIn this study, a total of 303 BBPV patients hospitalized at the neurology department were investigated. The enrolled patients were divided into two groups after successful repositioning treatment: non-RD group included patients who were completely cured, and RD group included patients with RD. We collected data on all subjects, including general information, blood routine examination, blood biochemical examination, and magnetic resonance imaging tests.ResultsThe mean RDW values of patients in the RD group were significantly higher than that in the non-RD group (13.63 ± 1.8 vs. 12.5 ± 0.8; p < 0.001). In subsequent multivariate analysis, elevated RDW levels were a statistically significant risk factor associated with the occurrence of RD [odds ratio = 2.62, 95% confidence interval (CI) 1.88–3.64, p < 0.001]. The area under the ROC curve was 0.723 in terms of its predictive ability to distinguish patients with RD. A cut-off point of 12.95% of RDW predicted RD with a sensitivity of 75.6% and a specificity of 69.5%. Moreover, the AUC for the ability of the RDW to predict recurrence were 0.692 (95% CI = 0.561–0.831; p < 0.014).ConclusionsElevated RDW level was related to increased risk of RD among BPPV patients, requiring further efforts to clarify the actual underlying pathophysiology.

Effect of the course of posterior semicircular canal benign paroxysmal positional vertigo on residual symptoms after successful canalith repositioning procedure

Objective:To investigate the effect of the course of posterior semicircular canal benign paroxysmal positional vertigo（BPPV） on residual symptoms after successful canalith repositioning procedure（CRP）. Methods:A total of 56 patients with posterior semicircular canal BPPV were selected from July 2020 to March 2021. They were divided into the short course group and the long course group according to the duration of disease from symptom onset to CRP treatment. All patients were treated with mechanical Epley repositioning procedure with rotary chair assistance. After successful repositioning treatment, they were followed up for seven to ten days. All patients were assessed using the vertigo disorder scale （DHI） before and after treatment,the differences of each dimension score and total score of DHI before and after successful CRP were compared between these two groups. Results:① After successful CRP, in patients with mild residual symptoms, the ratio between short course group and long course group were 68.6% and 31.4%, respectively. While in patients with moderate to severe residual symptoms,the ratio between short course group and long course group was 20% and 80%, respectively. The difference was statistically significant（P<0.05）. ②Before CRP, there was no significant difference in Physical dimension（DHI-P, 7 items） and in Function dimension（DHI-F, 9 items） between the two groups（P>0.05）, but there was significant difference in Emotion dimension（DHI-E, 9 items） and in total DHI score between the two groups（P<0.05, respectively）. After treatment, there was no significant difference in DHI-P score between the two groups（P>0.05）, but there were significant differences in DHI-F, DHI-E and DHI total score between the two groups（P<0.05,respectively）. Compared with the scores of DHI-P, DHI-F, DHI-E and DHI total score before and after successful CRP, the significant differences were found between the short course group and long course group（P<0.05,respectively）. ③There was no significant difference in the difference of DHI dimensions and total score between the short course group and the long course group before after reduction（P>0.05,respectively）. Conclusion:The duration of posterior semicircular canal BPPV（P-BPPV） does not affect the short-term efficacy of P-BPPV repositioning treatment, but patients with long course of P-BPPV are more likely to have moderate to severe residual symptoms after successful CRP，mainly in social function and emotional psychology.

The Role of Age on Effectiveness of Active Repositioning Therapy in Positional Skull Deformities

Purpose: Non-synostotic positional deformities are currently diagnosed in nearly half of the newborns, however not any evidence-based guidelines are available for management. The aim of this study is to assess the effect of active repositioning treatment at infants with positional skull deformities.Method: A retrospective data of 158 infants treated with active repositioning as a conservative treatment for at least 2 months were analyzed in this study. Anthropometric 3D scanner measurements of pre-and post-treatment diagonal difference, cranial vault asymmetry index, cranial ratio were evaluated for each patient. Infants were separated to 4 different groups according to their morphologic deformation types as plagiocephaly, brachycephaly, scaphocephaly and combined brachycephaly+plagiocephaly , and 2 groups according to age at onset of treatment.Results: In combined group, pre-treatment mean diagonal difference and cranial vault asymmetry index values decreased from 9.38 mm and 6.9% to 6.94 mm and 4.9% respectively. In plagiocephaly group, mean pre-treatment results changed from 10.32 mm and 7.5% to 7.83 mm and 5.5% respectively after treatment. All these changes were statistically significant. Effectiveness of timing of repositioning treatment on different positional skull deformities was analyzed and outcome was found significantly improved when the active repositioning treatment was started before 4 months of age.Conclusion: Improvement rates of the asymmetry decrease with age due to decreasing skull enlargement rate. Early diagnosis, especially before 4 months of age, more parental education, and close follow-up are important for babies with this condition who may benefit just from repositioning treatment

Analysis of clinical features of secondary benign paroxysmal positional vertigo

Objective:To analyze the clinical features of secondary benign paroxysmal positional vertigo (BPPV) and provide evidence for its precise diagnosis and treatment. Method:There were 942 patients with vertigo related to BPPV, including 204 patients with primary BPPV, 592 patients with vestibular migraine (VM), 83 patients with Meniere's disease (MD), 48 patients with vestibular neuronitis (VN), and 15 patients with sudden sensorineural hearing loss (SSNHL) accompanied by vertigo.There were 127 patients with BPPV secondary to vertigo in MD, VN, VM, and SSNHL. All patients received otolith repositioning treatment by hand or instrument based on detailed medical history. Secondary BPPV patients are treated according to the principle of diagnosis and treatment of primary BPPV. The incidence of secondary BPPV in each related disease was counted, and the difference between primary and secondary BPPV in gender, age, affected semicircular canal, number of reductions, and vertigo control rate was compared. Result:①The incidence of MD, VN, sudden vertigo, and VM secondary BPPV were 36.1% (30/83), 35.4%(17/48), 33.3% (5/15), and 12.7% (75/592). ②In patients with BPPV secondary to MD, the proportion of multi-semicircular canals involved was higher than that of primary BPPV, the difference was statistically significant (P<0.05), and there was no significant difference in the distribution of semicircular canals involved among the remaining diseases. ③The vertigo control rate of BPPV secondary to MD and VM was lower than that of primary BPPV, and the difference was statistically significant (P<0.05). ④The repositioning time of BPPV secondary to VM (2.88±2.32) and MD (2.53±1.14) was higher than that of primary BPPV (2.37±1.77). The difference was statistically significant (P<0.05). There was no significant difference in the repositioning time between other secondary BPPV and primary BPPV. Conclusion:Common causes of secondary BPPV include MD, VN, SSNHL, and VM. Same as primary BPPV, the secondary BPPV was more common in women and the posterior semicircular canal was most affected. BPPV secondary to MD is more susceptible to multi-semicircular canals involvement than primary BPPV. Detailed medical history combined with targeted examination is conducive to the accurate diagnosis of BPPV. Secondary BPPV can also be treated by manipulation or instrument, however, the effect is worse than primary BPPV. Secondary BPPV should be treated according to the treatment principle of primary disease besides otolith repositioning.

Risk factors analysis for recurrence of the idiopathic benign paroxysmal positional vertigo

Objective:To study the risk factors of recurrence in patients with benign paroxysmal positional vertigo(BPPV) after successful repositioning treatment. Method: Two hundred and two cases of confirmed BPPV patients, were followed-up for 10 months after particle repositioning, and the incidence of recurrence was analyzed. The risk factors for recurrence were analyzed by logistic regression. Result: 51 out of 202 confirmed BPPV patients complained of recurrence. There was significant difference of the duration of vertigo before treatment, the times of repositioning and SDS between the two group(P<0.05). While the sex, the age, the incubation period of BPPV, the duration time of BPPV, underlying diseases and the type of canal were not associated with the residual dizziness(P>0.05). Logistic regression analysis showed that the times of repositioning and the SDS were the risk factor for residual dizziness. Conclusion:The effective repositioning and the psychological care are very important to reduce the recurrence of BPPV.

Automated Mechanical Repositioning Treatment for Posterior Canal Benign Paroxysmal Positional Vertigo: A Single-Center Experience and Literature Review

Objective: To evaluate the feasibility and effectiveness of automated mechanical repositioning treatment (AMRT) for posterior canal benign paroxysmal positional vertigo ­(PC-BPPV). Patients and Methods: We reviewed all PC-BPPV patients admitted to our department between January and ­December 2016. The inclusion criteria mainly required conducting a diagnosis for PC-BPPV by using the Dix-Hallpike test, a PC-BPPV history within 1 month, no intake of medications for the last 48 h. Compared with the cases who received classical manual repositioning treatment (CMRT), the proportion of patients who underwent AMRT with a resolution within the 1-week follow-up session after initial treatment and a recurrence during the 6-month follow-up were evaluated. Results: A total of182 patients who underwent AMRT and 152 patients who underwent CMRT were included. Compared with the CMRT group, the AMRT group had a higher rate of complete or partial resolution and positional nystagmus at the 1 week follow-up (92.6 vs. 86.2%; p = 0.004). AMRT with less treatment cycles was more effective than CMRT (1.5 vs. 1.9; p < 0.001). After 6 months of follow-up, the cumulative recurrence rate of the AMRT group was significantly lower than that of the CMRT group (3.0 vs. 8.9%; p = 0.037). Conclusion: AMRT is a feasible and effective procedure for the resolution of PC-BPPV.

The importance of vestibular evoked myogenic potentials for the assessment of the otolith function in the patients presenting with benign paroxysmal positional vertigo

The objective of the present study was to evaluate the otolith function in the patients presenting with idiopathic benign paroxysmal positional vertigo (pBPPV) attributable to the occlusion of the posterior semicircular canal (PSCC) of the inner ear with the use of vestibular evoked myogenic potentials (VEMP). Cervical (cVEMP) and ocular VEMP (oVEMP) were measured in 34 patients with idiopathic pBPPV before and 7 days after the treatment by means of reposition maneuvers. The results of the repeated Dix-Hallpike test performed 7 days after the repositioning maneuver were negative in 27 patients and positive in 7 patients. There was no statistically significant difference in the amplitude of cervical VEMP between the healthy and affected ears either before or after the repositioning treatment. The measurement of oVEMP revealed a reduction of the response amplitude on the affected side. The average values of the plnl on the healthy side were 12.84±1.09 and those on the affected side 4.62±0.69 (p<0,05). The successful repositioning treatment resulted in a significant increase of the oVEMP amplitude on the affected side (p<0,05). In the patients presenting with the persistent symptoms of pBPPV, the repositioning maneuvers did not cause an appreciable increase in the amplitude of oVEMP on the affected side (p<0.05). The results of the present study give evidence that pBPPV of the posterior semicircular canal is associated with the impairment of the function of the receptor structures of the utriculus and the preserved function of the succulus as suggested by the reduction of the oVEMP amplitude and clinically significant asymmetry of ocular VEMP on the affected side with intact cervical VEMP on both sides. The successful treatment of pBPPV of PSCC with the use of the liberatory maneuver results in the increase of the oVEMP amplitude on the affected side increases while the response asymmetry between both sides significantly decreases which indicates the repair of the utriculus otolith function.

Causes of the recurrence of benign, paroxysmal positional vertigo

Objective To investigate why benign, paroxysmal positional vertigo (BPPV) recurs. Methods Three hundred persons diagnosed with BPPV who had been treated at Tongji Hospital of Huazhong University of Science and Technology between April 2012 and April 2014 were given a telephone follow-up at least one year after their manual repositioning treatment. The respondents were divided into a healthy group and a recurrence group according to whether they said their vertigo had recurred. The age and gender distributions of the two groups were compared, along with their underlying diseases and living-related factors. Causes of the recurrence were then hypothesized. Results Single factor analysis and binary logistic regression analysis showed that overwork, an age over 45, travelling frequently, long use of computers, sleep disorders, oral intake of calcium tablets, posterior circulation ischemia and hyperlipidemia were all closely related to the BPPV recurrence. Age over 45 showed the strongest correlation. Conclusion Aging is the greatest risk factor for the recurrence of BPPV. Posterior circulation ischemia, hyperlipidemia, overwork, sleep disorders, long use of computers and being on business frequently are also predictors of relapse. Key words: Vertigo; Relapse; Age

Emotional analysis of the residual dizziness in patients with benign paroxysmal positional vertigo after successful repositioning treatment

Emotional analysis of the residual dizziness in patients with benign paroxysmal positional vertigo after successful repositioning treatment

Management of an intruded tooth and adjacent tooth showing external resorption as a late complication of dental injury: three-year follow-up.

Treatment and prognosis of intrusive luxation can vary depending on the age of the patient, type of dentition, stage of root development, and time and severity of the trauma. Some studies have demonstrated that intrusions of up to 3.0 mm have an excellent prognosis, whereas teeth with severe intrusion or teeth that are intruded more than 6.0 mm present an unfavorable prognosis because of the occurrence of inflammatory resorption and pulp necrosis. The aim of this case report is to present an 11-year-old male patient with complete intrusion of the permanent maxillary left lateral incisor, associated with the adjacent central tooth presenting external resorption, treated by immediate surgical repositioning and root canal treatment with a favorable prognosis. After long-term (3-year) clinical and radiographic follow-up, the teeth appeared normal and the patient was pleased with the outcome.

Danhong enhances recovery from residual dizziness after successful repositioning treatment in patients with benign paroxysmal positional vertigo

Although the repositioning maneuvers are usually very effective in patients with BPPV, some patients still complain residual dizziness. Danhong injection (DHI), a traditional Chinese medicine, can effectively dilate blood vessels and improve microcirculation, and has been proven to be effective in improving cervical vertigo and posterior circulation ischemic vertigo. The aim of this study was to evaluate the effects of DHI on residual dizziness after successful repositioning treatment in patients with BPPV. Eighty-six patients with BPPV were randomized into two treatment groups, DHI group and non DHI group. The DHI group received the same repositioning treatment as the non-DHI group, with the addition of DHI therapy. The durations of residual dizziness of DHI group and non-DHI group were compared. In addition, the scores of the dizziness handicap inventory of these two groups were calculated. The durations of residual dizziness of DHI group were shorter than that of non-DHI group. There were no significant differences in the scores of dizziness handicap inventory in the first week between these two groups, and there were much significant differences in the second, the fourth, the sixth and eighth weeks. The results demonstrate that DHI can significantly improve the residual dizziness after successful repositioning treatment in patients with BPPV.

Residual Dizziness after Successful Repositioning Treatment in Patients with Benign Paroxysmal Positional Vertigo

Background and purposeBenign paroxysmal positional vertigo (BPPV) is the most common form of vertigo. Although the repositioning maneuver dramatically improves the vertigo, some patients complain of residual dizziness. We evaluated the incidence and characteristics of persistent dizziness after successful particle repositioning and the clinical factors associated with the residual dizziness.MethodsWe performed a prospective investigation in 49 consecutive patients with confirmed BPPV. The patients were treated with a repositioning maneuver appropriate for the type of BPPV. Success was defined by the resolution of nystagmus and positional vertigo. All patients were followed up until complete resolution of all dizziness, for a maximum of 3 months. We collected data on the characteristics and duration of any residual dizziness and analyzed the clinical factors associated with the residual dizziness.ResultsOf the 49 patients, 11 were men and 38 were women aged 60.4±13.0 years (mean ±SD), and 30 (61%) of them complained of residual dizziness after successful repositioning treatment. There were two types of residual dizziness: continuous lightheadedness and short-lasting unsteadiness occurring during head movement, standing, or walking. The dizziness lasted for 16.4±17.6 days (range=2-80 days, median=10 days). A longer duration of BPPV before treatment was significantly associated with residual dizziness (p=0.04).ConclusionsResidual dizziness after successful repositioning was observed in two-thirds of the patients with BPPV and disappeared within 3 months without specific treatment in all cases. The results indicate that early successful repositioning can reduce the incidence of residual dizziness.

Horizontal canal benign positional vertigo.

The existence of horizontal canal benign positional vertigo (BPV) was predicted from temporal bone studies in 1973, but was not clinically confirmed until later. In this series of 300 patients with BPV, 35 (12%) were identified as having the horizontal canal variant. The essential features are the onset of vertigo when the patient assumes a supine position and bidirectional horizontal nystagmus as the head is turned from side to side. In one third it appeared as a canal "conversion" in patients undergoing repositioning treatment for posterior canal BPV. The mechanism can be canalithiasis or cupulolithiasis. Repositioning treatment is a 360 degrees horizontal head and body rotation that has a high success rate if the symptomatic ear is correctly identified.

Surgical repositioning of an impacted dilacerated incisor in mixed dentition

Treatment options for a dilacerated incisor are either extraction or surgery and orthodontic traction. Because patients with such incisors usually are young, and because of the root angulation of the impacted incisor, treatment usually is lengthy and complicated. Surgical repositioning provides another option for treatment of this unique problem. The author presents the case of a 9-year-old girl with an impacted dilacerated maxillary central incisor to demonstrate the timing, technique and results of the surgical repositioning treatment approach. The advantages of this approach include immediate esthetic improvement, use of a single and simplified surgical procedure, simple and short orthodontic therapy, a normal gingival margin and the possibility of the developing root's adapting to the new position. Surgical repositioning is a simplified treatment for dilacerated incisors. It is especially valuable in cases of difficult-to-treat impaction. Timing of surgical repositioning depends on the incisor's root development and the space available for the transplant.

総義歯治療により下顎頭のリモデリングを認めた症例

In a longitudinal observation case, it was found that morphological changes of the condylar head can be achieved by complete denture treatment.A 60-year-old edentulous female visited our clinic with complaints of spontaneous pain around the left TMJ and limitation of mouth opening (18 mm). MRI and TMJ radiograph showed osteophyte at the left condylar head, and internal derangement with anterior displacement without reduction of the left meniscus were observed.Through subsequent mandibular repositioning treatment of the patient, with the complete dentures applying centric relation as a treatment position, the condylar head shape and osteophyte were restored within 15 months. Clinical findings such as pain and mandibular disturbance disappeared after the initial three months following treatment, and kinesiologically, mandibular movement during open-close and chewing were improved.Therefore, it is suggested that abnormal changes of the condylar head are closely related to occlusion. Furthermore, it can be suggested that effective mandibular repositioning can be achieved by applying complete dentures as centric relation during treatment.

Comparative study of two treatment methods for internal derangement of the temporomandibular joint

Orthopedic mandibular repositioning and flat plane occlusal splint therapy were compared in the treatment of 20 patients with internal TMJ derangement with reduction. The following conclusions can be drawn. Mandibular repositioning treatment produces significant subjective and objective improvement in the dysfunction of patients with internal joint derangements with reduction. Flat plane occlusal splint treatment produces no significant change in the dysfunction level of patients with internal joint derangements with reduction. Mandibular repositioning treatment may eliminate the reciprocal click of internal joint derangement with reduction. To realize improvement in dysfunction of internal joint derangement, it appears that the reciprocal click must be eliminated. Mandibular repositioning treatment produces a significant improvement in muscle pain associated with internal joint derangement.