A survey of the nature of trauma of post-traumatic benign paroxysmal positional vertigo

Pisani, Valerio; Mazzone, Sara; Mauro, Roberta Di; Giacomini, P; Girolamo, Stefano Di

doi:10.3109/14992027.2014.989454

Cited by 35 publications

(29 citation statements)

References 23 publications

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“…Pisani et al. 29 reviewed 3060 patients with a clinical diagnosis of BPPV, and a clear association with a traumatic event was present in 23.4% of patients. Chang et al.…”

Section: Discussionmentioning

confidence: 99%

Review of the pathology underlying benign paroxysmal positional vertigo

Yetışer

2019

J Int Med Res

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The pathophysiological mechanism underlying benign paroxysmal positional vertigo (BPPV) is related to free-floating debris/otoliths in the semicircular canal (canalolithiasis) or debris/otoliths attached to the cupula (cupulolithiasis). These debris/otoliths are considered to originally accumulate after detachment from the neuroepithelium of the utricular macula secondary to a type of degeneration. An idiopathic form, which is assumed to occur spontaneously, is diagnosed when the causative pathology is obscure. However, an association between various other systemic or inner ear conditions and BPPV has been reported, indicating the existence of secondary BPPV. This study was performed to present the first review of the pathology underlying BPPV following a complete PubMed/Medline search. In total, 1932 articles published from 1975 to 2018 were reviewed. The articles were classified according to 17 potentially causative factors (aging; migraine; Meniere's disease; infection; trauma; idiopathic sudden sensorineural hearing loss; sleeping habits; osteoporosis and vitamin D insufficiency; hyperglycemia and diabetes mellitus; chronic head and neck pain; vestibule or semicircular canal pathology; pigmentation disorders; estrogen deficiency; neurological disorders; autoimmune, inflammatory, or rheumatologic disorders; familial or genetic predisposition; and allergy). A discussion of the underlying cause of BPPV for each factor is presented.

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“…Pisani et al. 29 reviewed 3060 patients with a clinical diagnosis of BPPV, and a clear association with a traumatic event was present in 23.4% of patients. Chang et al.…”

Section: Discussionmentioning

confidence: 99%

Review of the pathology underlying benign paroxysmal positional vertigo

Yetışer

2019

J Int Med Res

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“…The pathophysiology of BPPV remains unclear, and it is suspected that otolith debris detaches from macula of the otolith membrane, and migrates into the endolymphatic lumen of semicircular canals (27) or attaches to the cupula of the semicircular canals (28). The cause of dislodged otoconia in secondary BPPV may be attributed to head trauma (29) or inner ear diseases such as sudden sensorineural hearing loss (30) and Meniere's disease (31). But otolithic degenerative changes related to age (32) and osteoporosis (33) and so on, may be responsible for the occurrence of idiopathic BPPV.…”

Section: Discussionmentioning

confidence: 99%

Cervical Vestibular Evoked Myogenic Potentials in Benign Paroxysmal Positional Vertigo: A Systematic Review and Meta-Analysis

Chen

et al. 2019

Front. Neurol.

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Objective: The objective of our study was to investigate the potential association between the occurrence of benign paroxysmal positional vertigo (BPPV) and saccular dysfunction using cervical vestibular evoked myogenic potentials (cVEMP) testing.Methods: The databases including Pubmed, Embase, and CENTRAL were systemically searched for case-control literatures investigating saccular dysfunction using cVEMP testing in BPPV patients compared with healthy controls. The literatures were published up to 16 April 2019 and were limited to the English language. All statistical processes were carried out using software Review Manager, version 5.3. Subgroup analysis and sensitive analysis were performed simultaneously.Results: Of the 12 case-control studies confirmed for meta-analysis, p13 latency of cVEMP was assessed in 8 studies, n23 latency in 6 studies, amplitude in 5 studies, asymmetry ratio (AR) in 3 studies, proportion of absent response in 9 studies, and abnormal cVEMP in 8 studies. Compared with healthy controls, the p13 mean latency of cVEMP was longer (MD = 0.88, 95% CI = 0.64–1.12, p < 0.00001), the mean amplitude was lower (SMD = −0.60, 95% CI = −0.80 to −0.41, p < 0.00001), and the proportions of absent response (OR = 8.76, 95% CI = 2.28–33.61, p = 0.002), and abnormal cVEMP (OR = 7.47, 95% CI = 4.65–12.01, p < 0.00001) were higher in BPPV patients. But there was no significant difference in the n23 mean latency (MD = 0.37, 95% CI = −0.23–0.98, p = 0.22) and the AR of cVEMP (MD = 3.95, 95% CI = −4.75–12.65, p = 0.37) between BPPV patients and healthy controls. In the sub-group analysis based on age, only the result of the proportion of absent response of cVEMP indicated a significant difference existed (p = 0.002) between the studies with age-matched controls (OR = 2.78, 95% CI = 1.09–7.10, p = 0.03) and the studies without age-matched controls (OR = 53.85, 95% CI = 10.09–287.13, p < 0.00001). In the sub-group analysis of the proportion of abnormal cVEMP according to the diagnostic criteria of abnormal cVEMP, the result indicated no significant difference existed between the four groups (p = 0.61, I2 = 0%). In the sensitivity analysis, we obtained the consistent results after removing each study sequentially.Conclusion: The meta-analysis reveals that saccular dysfunction may be associated with BPPV occurrence, and neural degeneration in the saccular macula may be a potential pathogenesis for BPPV.

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“…According to some studies, the separation takes place due to changes in the structure of the otoconia (e.g., osteoporosis, osteopenia, calcium metabolism disorders, or vitamin D deficiency) [4] . Additionally, head trauma and whiplash injuries can cause otoconial fragmentation without neuroepithelial degeneration [5,6] .…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Cervical Vestibular-Evoked Myogenic Potential Findings in Benign Paroxysmal Positional Vertigo

Karataş

Yüce²,

Cebi³

et al. 2016

Int Adv Otol

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OBJECTIVE:Although there has been a wide consensus on the mechanism of nystagmus and clinical presentation of benign paroxysmal positional vertigo (BPPV), the neuroepithelial pathophysiology of BPPV still remains unclear. In this study, we aimed to clarify the pathophysiology of BPPV by evaluating the cervical vestibular-evoked myogenic potential (cVEMP) findings of patients. MATERIALS and METHODS:Thirty-six BPPV patients and 20 healthy volunteers were included. Bilateral cVEMP tests were performed on all participants. The participants were divided into the following three groups: those with a BPPV-affected ear, those with a BPPV-unaffected ear, and the healthy control group. RESULTS:There were no significant differences regarding the latencies of the first positive (p1) and negative (n1) peaks among the three groups. The mean normalized amplitude asymmetry ratio also did not differ between the BPPV and control groups. However, the normalized amplitudes of the BPPV patients (with both affected and unaffected ears) were significantly lower than those of the healthy control group. CONCLUSION:We detected that the cVEMP data of the affected and unaffected ears of the BPPV patients was similar and that their normalized amplitudes significantly differed from those of the healthy controls. Eventually, we concluded that even if the symptoms of BPPV were unilateral, the findings suggest that the bilateral involvement of the macular neuroepithelium is important in understanding the pathophysiology of BPPV. This finding supports the conclusion that the pathophysiological process starts with neuroepithelial membrane degeneration and continues with otoconia separation.

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A survey of the nature of trauma of post-traumatic benign paroxysmal positional vertigo

Abstract: Post-traumatic BPPV is considered one of the most common known etiologies. An accurate understanding of trauma mechanism, gender prevalence, and therapeutic success rates of each event, could be useful in adequately treating and planning follow-up examinations.

Cited by 35 publications

References 23 publications

Review of the pathology underlying benign paroxysmal positional vertigo

Review of the pathology underlying benign paroxysmal positional vertigo

Cervical Vestibular Evoked Myogenic Potentials in Benign Paroxysmal Positional Vertigo: A Systematic Review and Meta-Analysis

Evaluation of Cervical Vestibular-Evoked Myogenic Potential Findings in Benign Paroxysmal Positional Vertigo

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